Alveolitis

Alveolitis refers to a lung disease that can occur in two forms:

• Fibrosing alveolitis diffuse - as - a disease of the lung tissue and alveoli of unknown cause that develops slowly,
• Or as extrinsic allergic alveolitis ( hypersensitivity pneumonitis Syn - EAA, hereinafter briefly called alveolitis ), in which there is by the inhalation of organic dusts in an inflammatory change in the pulmonary alveoli. The EAA may be a notifiable occupational disease if the disease is caused by substances that are inhaled in a professional environment.

Distinction between

The term " diffuse fibrosing alveolitis - ' (syn. idiopathic pulmonary fibrosis), which one, if it is acute, also known as Hamman - Hamman - Rich syndrome or referred to, is considered an important cause of interstitial lung fibrosis. Its cause is unknown.

In the " extrinsic allergic alveolitis ", is frequently found in the literature under the term " hypersensitivity pneumonitis " inhaled organic dust particles cause allergic reactions in the lung tissue. Runs it acutely, it is also called Monday fever.

Etiology

The cause of the disease is usually occupational exposure to substances in the air we breathe. This is generally to fungal and bacterial components, but also faeces flour or chemicals, which are inhaled as a dust aerosol or in the workplace. In the so-called farmer's lung are actinomycetes from moldy hay. The so-called " malt and paper workers lung" is caused by inhaling fungal spores from moldy barley or malt. Bird owners may suffer pneumonitis due to dust from bird feces. Also, fish meal, sawdust, dust made ​​of animal skins, but also chemicals such as cooling lubricants are known to cause the alveolitis.

Pathogenesis

On inhalation of the substances described above, it may be an inflammatory response in the lung tissue, before all the alveoli, come. This is a complex immune response, the Type III ( precipitation of IgG antibodies ) and a cellular immune response (type IV).

Clinical picture

There are two progressive forms. In acute alveolitis occurs within hours to coughing, shortness of breath and fever. In the chronic form the symptoms are increasing slowly.

Diagnostics

In addition to the characteristic history and symptoms of the patients are found typical breath sounds in the investigation. A chest X-ray may show signs of inflammation. In particular, a bronchoscopy with washing out of the airways and alveoli ( bronchoalveolar lavage ) shows inflammation in the form of an acute alveolitis. Here, the lymphocytes within the first 48 hours, first an increase in neutrophils, typically later. With the help of a provocation test ( controlled inhalation of suspected antigens) one can determine the cause of the disease in more detail. The detection of precipitating antibodies by laboratory tests is an important indication of the presence of alveolitis. The classic precipitin detection according to Ouchterlony was largely abandoned in favor of better laboratory methods (ELISA and IFA). The main differential diagnosis is the distinction of alveolitis and asthma:

• Asthmatics often have a positive family history. There will be a changing narrowing of the airways (obstruction ). They suffer symptoms immediately ( minutes ) after antigen contact, the lung is overinflated; it can possibly antibodies are detected by IgE type.

• Patients with alveolitis have no affected family members, unless they are also exposed. The disease is localized in the lung tissue, the reaction to the stimulus is delayed (a few hours ), the lung shows condensations and eventually IgG antibody detected.

Course

If the cause is found and can be avoided, the prognosis of acute extrinsic allergic alveolitis is very good. It is usually a full recovery, if necessary after cortisone treatment.

If the disease is not detected, the cause is not found or can not be avoided, can occur that ultimately lead to death in chronic cases pulmonary fibrosis or cor pulmonale.

Therapy

The most important treatment of alveolitis is the avoidance of contact with the triggering factors. If the disease is detected early, the prognosis is favorable. In severe disease, drug treatment with cortisone tablets for several months is often necessary.

Others

Where, according to an occupational disease regulation related to occupational influences out ( as is the case of hypersensitivity pneumonitis often the case), specialists are required to inform the competent professional association. This checks whether within a company, the statutory provisions are complied with and, where appropriate, relevant health and safety measures (such as special hygiene at work or ventilation system ) must be implemented. In some cases, it is advised to engage in a professional exchange with relevant exposure. If an occupational disease is present, the professional association takes over where appropriate, the costs of necessary rehabilitation measures or retraining.