Alveolitis

This article explains lung disease; for the term used in dentistry, see alveolitis sicca .

Classification according to ICD-10
J67	Allergic alveolitis from organic dust
ICD-10 online (WHO version 2019)

Alveolitis ( Latin alveolus and the suffix -itis ) is a lung disease that can come in two forms:

• as diffuse-fibrosing alveolitis - a disease of the lung tissue and alveoli of unknown cause that slowly develops
• or as exogenous allergic alveolitis (EAA, syn. hypersensitivity pneumonitis, hereinafter referred to as alveolitis), in which inhalation of organic dust leads to an inflammatory change in the alveoli. The EAA can be a reportable occupational disease if the disease is triggered by substances that are inhaled in the professional environment (BK No. 4201).

Definition of terms

The term "diffuse-fibrosing alveolitis" (syn. Idiopathic pulmonary fibrosis) , which, when it is acute, is also known as Hamman or Hamman-Rich syndrome, is an important cause of interstitial pulmonary fibrosis . Its cause is unknown.

In the case of "exogenous allergic alveolitis", which is often also found under the term "hypersensitivity pneumonitis" in the literature, inhaled organic dust particles lead to allergic reactions in the lung tissue. If it is acute, it is also known as Monday fever .

etiology

The cause of the disease is mostly occupational exposure to substances in the breath. These are usually fungal and bacterial components, but also excrement, flour or chemicals that are inhaled as dust or aerosols at the workplace. In the so-called farmer's lung , it is actinomycetes made from moldy hay. The so-called “malt and paperworker's lung” is caused by inhaling fungal spores from moldy barley or malt . Bird owners can suffer from alveolitis from dust from bird excrement. Fish meal, sawdust, dust from fur, but also chemicals such as cooling lubricants are known to cause alveolitis. Another rare cause is fungi that grow in improperly cleaned wind instruments .

Pathogenesis

Inhaling the substances described above can lead to an inflammatory reaction in the lung tissue, especially the alveoli. This is a complex immune response of type III (precipitation of IgG antibodies) and a cellular immune response (type IV).

Clinical picture

There are two forms of progression. In acute alveolitis, coughing, shortness of breath and fever occur within hours. In the chronic form, the symptoms slowly increase.

Diagnosis

In addition to the characteristic history and symptoms of the patient, typical breathing sounds can be found during the examination . An x-ray of the lungs may show signs of inflammation. In particular, a bronchoscopy with irrigation of the airways and alveoli ( bronchoalveolar lavage ) shows inflammation in the form of acute alveolitis. An increase in neutrophil granulocytes and later in lymphocytes is typical within the first 48 hours. With the help of a provocation test (controlled inhalation of the suspected antigens) the cause of the disease can be determined more precisely. The detection of precipitating antibodies by laboratory tests is an important indicator for the presence of alveolitis. The classic Ouchterlony detection of precipitin has largely been abandoned in favor of better laboratory methods (ELISA and IFT). The most important differential diagnosis is the distinction between alveolitis and bronchial asthma :

• Asthmatics often have a positive family history. There is an alternating narrowing of the airways (obstruction). You suffer discomfort immediately (a few minutes) after contact with the antigen, the lungs are inflated; it may be possible to detect antibodies of the 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 compressions and it will possibly IgG - antibodies detected.

course

If the cause is found and can be avoided, the prognosis for acute exogenous allergic alveolitis is very good. As a rule, there is a complete recovery, possibly after cortisone treatment.

If the disease is not recognized, the cause is not found or cannot be avoided, pulmonary fibrosis or cor pulmonale can occur in the chronic course , which ultimately lead to death.

therapy

The most important treatment for alveolitis is to avoid contact with the causative factors. If the disease is recognized in good time, the prognosis is favorable. Serious illnesses often require drug treatment with cortisone tablets for several months.

Others

If, according to the Occupational Diseases Ordinance, a connection with occupational influences emerges (as is often the case with exogenous allergic alveolitis ), specialists are obliged to inform the responsible trade association . This checks whether the statutory regulations are observed within a company and whether appropriate occupational safety measures (such as special hygiene at the workplace or ventilation system ) must be implemented. In some cases, a change of occupation is urgently recommended if the exposure is appropriate . If there is an occupational disease, the employers' liability insurance association will cover the costs for necessary rehabilitation measures or retraining .

See also

• Idiopathic pulmonary hemosiderosis
• Alveolar proteinosis

swell

• Gerd Herold : Internal Medicine. Self-published, Cologne 1992 ff.
• Pschyrembel: Clinical Dictionary. de Gruyter, Berlin 1990 ff.

Individual evidence

1. ↑ M. Buchta et al. a .: The hammer exam: revision course for the 2nd section of the medical examination. Urban & FischerVerlag, 2006, ISBN 3-437-43800-X , p. 1044, online here
2. ↑ H.-W. Baenkler: Internal Medicine. Georg Thieme Verlag, 2001, ISBN 3-13-128751-9 , p. 482, online here
3. ↑ Peter Reuter: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 , p. 82.
4. ↑ http://www.euk-info.de/fileadmin/PDF_Archiv/Regelwerk_Archiv/GUV-I/GUV-I_0762.pdf Germ contamination of water-mixed cooling lubricants
5. ↑ J. King, M. Richardson, et al. a .: bagpipe lung; a new type of interstitial lung disease? In: Thorax. [Electronic publication before going to press] August 2016, doi: 10.1136 / thoraxjnl-2016-208751 , PMID 27552781 . Summary (German): Death came out of the bagpipes ; German medical newspaper
6. ↑ Lungs and work - work-related lung diseases at mdgp.de

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