[Long-term therapeutic effects of whole lung lavage in the management of silicosis].

OBJECTIVE

To investigate the long-term therapeutic effect of whole lung lavage (WLL) in the treatment of silicosis.

METHODS

A total of 70 patients with silicosis were randomly and equally divided into WLL group and control group based on chest X-ray, silicosis staging, age, and working age of dust exposure. Comparative analysis was performed to evaluate the long-term therapeutic effect of WLL. Moreover, 157 patients with silicosis treated by WLL were subject to long-term follow-up.

RESULTS

Two years after treatment, the cough, expectoration, and asthma improvement rates of the WLL group were 62.5% , 75.0% , and 81.8%, respectively, significantly higher than those (24.0%, 23.8%, and 26.3%) of the control group (P < 0.05). Four years after treatment, the asthma improvement rate (59.1%) of the WLL group was significantly higher than that (21.1%) of the control group (P < 0.05). The WLL group showed slight decrease in forced vital capacity (FVC) and forced expiratory volume in one second (FEV(1)) after treatment (P > 0.05), while the control group showed significant decrease in FVC and FEV1 after treatment (P < 0.05 or P < 0.01). Two and four years after treatment, the WLL group had higher no change rate and lower progression rate and significant progression rate than the control group in terms of chest X-ray (P > 0.05). 22 cases of accelerated silicosis in the WLL group had significantly higher no change rate than the control group with respect to chest X-ray (75.0% vs. 30.0%; 58.3% vs. 20.0%). The WLL group had lower progression rate (2 years of treatment) and significant progression rate (4 years after treatment) than the control group (16.7% vs. 50.0%, P < 0.05; 8.3% vs. 30.0%, P < 0.05). Follow-up of 59 cases treated by WLL showed that the cough and asthma improvement rates were 74.4% and 76.3% 2 ∼ 3 years after treatment and remained 55.0% ∼ 57.1% 4 ∼ 5 years and 6 ∼ 7 years after treatment. Follow-up of 85 cases treated by WLL showed that FVC remained unchanged or slightly decreased 2 ∼ 3 years after treatment and decreased 4 ∼ 5 years and 6 ∼ 7 years after treatment and that the lower silicosis stage was, the less FVC decreased. Follow-up of 108 cases treated by WLL showed that the lower silicosis stage was, the higher no change rate was, according to the chest X-ray findings 2 ∼ 3, 4 ∼ 5, and 6 ∼ 7 years after treatment and that there were significant differences in no change rate between stages II and III silicosis groups and stages 0+ and I silicosis groups (P < 0.01).

CONCLUSIONS

WLL is an effective therapy for silicosis, especially for early silicosis and accelerated silicosis. However, WLL should be used cautiously in the treatment of advanced silicosis.