ASSESSMENT OF MICROCIRCULATION IN PATIENTS WITH PROFESSIONAL BRONCHITIS WITH THE HELP OF ULTRASONOGRAPHY

Purpose: The aim of our investigation was to analyze the characteristics of basal microcirculation and microcirculation reactivity in miners with professional bronchitis using ultrasonography.

Methods and Materials: 30 patients (all males, mean age 52.4 +/- 2.1 years) with professional bronchitis were examined. The time of work in mine and permanent contact with breeze was 23.8 +/- 5.2 years. The level of breeze concentration in all cases was 10 times higher than maximum allowable concentration. 90% of examined individuals were smokers. Subjects were studied in two separate groups: (1) patients with diagnosed professional chronic nonobstructive pulmonary disease (respiratory failure 1 degree), (2) patients with professional chronic obstructive pulmonary disease (respiratory failure 2 degree). All patients underwent high frequency dopplerography (20–25MHz; Minimax Doppler K) of digital nail bed microcirculation. Standard position of the probe was used. Initial velocities and resistive indices were recorded and then cold and thermal tests and reactive hyperemia test were performed. Thermal and cold tests consisted in submersion of upper extremity into the bath with hot (+45C) or cold (+4C) water. Changes in flow were measured in 1, 2, 3 and 5 minutes after hand extraction from the water. Percentage changes in flow during reactive hyperemia were analyzed 30, 60 seconds and 5 minutes after decompression (occlusion time 5 minutes).

Results: In patients of 1-st group initial low amplitude normokinetic type of flow was found. The reactivity in response to thermal and cold tests was significantly decreased. Response to reactive hyperemia test in 60% of patients was positive. In patients of 2-nd group we have found in most of cases normal amplitude stagnant type of flow. Response to thermal and cold tests was paradoxical in 21.4% and 42.8% of cases, respectively. In 71% of patients of this group the response to reactive hyperemia test was inadequate, so modified reactive hyperemia test (D. Celemajer) was applied. The strongly pronounced changes were found in subgroup of patients with pulmonary hypertension and significantly depressed respiratory function; changes included absent increase of flow during reactive hyperemia test. This finding reflects severely depressed endothelial function.

Conclusions: Individuals with professional chronic obstructive pulmonary disease have normal amplitude stagnant type of flow. Patients with such lung pathology are characterized by disturbed microcirculation; mostly pronounced changes can be seen in response to cold test. In patients with pulmonary hypertension reactive hyperemia test reveals severely depressed endothelial function.