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Revista Portuguesa de Pneumologia

Print version ISSN 0873-2159

Rev Port Pneumol vol.13 no.1 Lisboa Jan. 2007

 

O aparelho respiratório na doença vibroacústica: 25 anos de investigação

Respiratory pathology in vibroacoustic disease: 25 years of research

 

Nuno A A Castelo Branco1

José Reis Ferreira2

Mariana Alves-Pereira3

 

Resumo

Enquadramento: A patologia respiratória induzida pela exposição a ruído de baixa frequência (RBF, ¡Ü500 Hz, incluindo os infra-sons) não constitui novidade dado que, desde 1960, no âmbito dos programas espaciais dos EUA e da União Soviética, diversos autores divulgaram a sua

existência. No contexto da doença vibroacústica (VAD – vibroacoustic disease), uma patologia sistémica causada pela exposição excessiva a RBF, as lesões respiratórias apresentam características próprias. Inicialmente, esta patologia respiratória não foi tida como uma consequência da exposição ao ruído; no entanto, hoje, o RBF é considerado um agente muito importante de doença respiratória. O objectivo deste trabalho é sistematizar e actualizar todos os dados sobre a patologia respiratória observada na VAD.

Métodos: Ao longo dos últimos 25 anos, recolheu-se informação, de modo continuado, de indivíduos e modelos animais expostos a RBF. Todos estes dados são aqui compilados.

Resultados: Em indivíduos expostos a ruído no trabalho, as queixas brônquicas aparecem nos primeiros 4 anos de actividade e, nesta fase, reduzem ou desaparecem quando de férias ou removidos do seu local de trabalho por outros motivos. Com a exposição prolongada, poderão surgir situações mais graves, como derrames pleurais, insuficiência respiratória, fibrose pulmonar e carcinomas do aparelho respiratório. Não existe correlação com hábitos tabágicos. Em modelos animais expostos a RBF, apresentavam-se alterações morfológicas da pleura e perda da capacidade

fagocítica das células mesoteliais (explicando os derrames pleurais observados). Foram observadas lesões de fibrose e neovascularização ao longo de todo o aparelho respiratório dos animais expostos. Também se identificaram lesões pré-malignas, metaplasia e displasia.

Conclusões: O RBF é um agente de doença e tem como alvo preferencial o aparelho respiratório. A patologia respiratória associada à VAD necessita, ainda, de muito estudo para que uma maior compreenção possa ser alcançada e intervenções farmacológicas possam ser pensadas.

Palavras-chave: Ruído de baixa frequência, infra-sons, fibrose, derrame pleural, broncoscopia, cancro do pulmão, sensibilidade ao CO2.

 

Abstract

Background: Respiratory pathology induced by low frequency noise (LFN, <500 Hz, including infrasound) is not a novel subject given that in the 1960’s, within the context of U.S. and U.S.S.R. Space Programs, other authors have already reported its existence. Within the scope of vibroacoustic disease (VAD), a whole-body pathology caused by excessive exposure to LFN, respiratory pathology takes on specific features. Initially, respiratory pathology was not considered a consequence of LFN exposure; but today, LFN can be regarded as a major agent of disease that targets the respiratory system. The goal of this report is to put forth what is known to date on the clinical signs of respiratory pathology seen in VAD patients.

Methods: Data from the past 25 years of research will be taken together and presented.

Results: In persons exposed to LFN on the job, respiratory complaints appear after the first 4 years of professional activity. At this stage, they disappear during vacation periods or when the person is removed form his /her workstation for other reasons. With long-term exposure, more serious situations can arise, such as, atypical pleural effusion, respiratory insufficiency, fibrosis and tumours. There is no correlation with smoking habits. In LFN-exposed animal models, morphological changes of the pleura, and loss of the phagocytic ability of pleural mesothelial cells (explaining the atypical pleural effusions). Fibrotic lesions and neo-vascularization were observed along the entire respiratory tract. Fibrosis lesions and neovascularisation were observed throughout the respiratory tract of the animals seen. Pre-malignant lesions, metaplasia e displasia, were also identified.

Discussion: LFN is an agent of disease and the respiratory tract is one of its preferential targets.

The respiratory pathology associated with VAD needs further in-depth studies in order to achieve a greater understanding, and develop methods of pharmacological intervention.

Key-words: Low frequency noise, infrasound, fibrosis, pleural effusion, bronchoscopy, lung cancer, respiratory drive.

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

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1 Médico Anatomopatologista,presidente do Conselho Científico, Centro da Performance Humana, Alverca

2 Médico Pneumologista, Unidade de Estudo Funcional Respiratório, Hospital da Força Aérea, Lisboa

3 Engenheira Biomédica, ERISA – Universidade Lusófona, vibroacoustic.disease@gmail.com

 

Recebido para publicação/received for publication: 06.02.28

Aceite para publicação/accepted for publication: 06.11.10