Involvement of central airways in vibroacoustic disease patients

José Reis Ferreira¹

Miguel B Monteiro²

Fernanda Tavares³

Isabel Serrano⁴

Emanuel Monteiro⁵

Carla P Mendes⁶

Mariana Alves-Pereira⁷

Resumo

Nos últimos vinte cinco anos constatou-se que o aparelho respiratório constitui um alvo do ruído de baixa frequência (RFB <500Hz, incluindo infra-sons). Denomina-se doença vibroacústica (VAD) a patologia sistémica causada pela exposição excessiva a RBF. Em ratos Wistar expostos a RBF, as alterações morfológicas observadas nos tecidos das vias aéreas centrais explicam, parcialmente, os sintomas apresentados pelos doentes com a VAD. Apesar disso, muitas perguntas permanecem por responder. Recentemente, voluntários com a doença vibroacústica submeteram-se a exames broncoscópicos para esclarecer e, se possível, demonstrar possíveis lesões das vias aéreas centrais que estariam associadas com as queixas respiratórias. Treze doentes voluntários, exaustivamente esclarecidos sobre este exame, submeteram-se a broncoscopias, durante as quais se colheram fragmentos para exame histológico e ultra-estrutural. Em todos os indivíduos se observaram lesões de tipo vascular na sub-mucosa próximas das bifurcações das vias aéreas. Estas lesões caracterizavam-se por numerosos pequenos vasos com paredes espessadas, mergulhados em feixes de colagénio e algumas fibras de elastina. Em cinco indivíduos as lesões evidenciavam degenerescência e ruptura do colagénio. Histologicamente, na mucosa normal observaram-se alterações ciliares, hiperplasia da membrana basal e espessamento dos vasos sanguíneos. Em nenhum caso se observaram infiltrados celulares de natureza inflamatória. O estudo da ultra-estrutura revelou numerosos axonemas (de dois a oito) contidos numa membrana ciliar comum, algumas vesículas emanando dos cílios, imagens de apoptose com reforço do citosqueleto celular e das ligações intercelulares. Não se observaram diferenças entre fumadores e não fumadores. Estes dados estão de acordo com o que já fora observado nas vias aéreas centrais de oito doentes com carcinoma pavimento-celular do pulmão e também com as imagens observadas em ratos expostos a RBF. Em broncoscopias efectuadas em doentes sem a doença vibroacústica, não é normal observar-se este tipo de lesões vasculares. Assim, estas lesões vasculares das vias aéreas centrais podem ser específicas da doença vibroacústica.

Palavras-chave: Ruído de baixa frequência, doença vibroacústica, lesões vasculares, displasia, doença auto-imune, doença do colagénio, estrutura ciliar, apoptose, mecano-transdução.

Abstract

Introduction. Vibroacoustic disease (VAD) is the whole-body pathology caused by excessive exposure to LFN. For the past 25 years, it has been know that low frequency noise (LFN, <500 Hz, including infrasound) targets the respiratory system. In LFN-exposed rodents, the morphological changes of respiratory tract tissue partially explained some respiratory symptoms reported by VAD patients. However, many questions remain unanswered. Recently, some volunteer VAD patients underwent bronchoscopy in order to ascertain possible damage that could be associated with their respiratory complaints. Methods. Fourteen fully-informed and volunteer VAD patients were submitted to bronchoscopy, and biopsies were removed for analysis. Results. All patients exhibited small submucosal vascular-like lesions near the spurs, consisting of increased collagen and elastin fibres. Histology disclosed cilliary abnormalities, basal membrane hyperplasia, and thickening of vessel walls. In five patients, collagen bundles appeared degenerative and disrupted. No inflammatory process was ever identified, and no differences were seen between smokers and non-smokers. Discussion. Data is in accordance with what was observed in LFN-exposed animal models and also in 8 VAD patients who developed lung tumours. Collagen disruption and degeneration was also observed in electron microscopy images of the respiratory tract of LFN-exposed rodents. Thickened blood and lymphatic vessel walls have been consistently seen in images of VAD patients and of LFN-exposed rodents. During bronchoscopy performed by other reasons, this sort of structural aspects is not frequently seen. Taken together, it is strongly suggested that these findings could be VAD-specific.

]]> Key-words: Low frequency noise, vibroacoustic disease, vascular lesions, displasia, auto-imune disorders, collagen disease, ciliar structure, apoptosis, mecano-transduction.

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^* Trabalho vencedor ex-aequo (Secção A)

¹ Médico pneumologista/Pulmonologist. Unidade de Estudo Funcional Respiratório, Hospital da Força Aérea, Lisboa

² Médico pneumologista/Pulmonologist. Unidade de Pneumologia, Centro Hospitalar de Cascais

³ Médica anatomopatologista/Anatomo-pathologist. Centro de Patologia Humana, Oeiras

⁴Médica anatomopatologista/Anatomo-pathologist. Centro Hospitalar de Cascais

⁵Técnico de anatomia/Anatomy technician. Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto

⁶Médico pneumologista/Pulmonologist. Unidade de Estudo Funcional Respiratório, Hospital da Força Aérea, Lisboa ]]> ⁷Mestre em engenharia biomédica/M.A.in Biomedical engeneering. Departamento de Ciências e Engenharia do Ambiente, Universidade Nova de Lisboa

⁸Médico anatomopatologista/Anatomo-pathologist. Presidente do Conselho Científico/President of the Scientific Board, Centro da Performance Humana, Alverca

vibroacoustic.disease@gmail.com

Recebido/aceite para publicação/received/accepted for publication: 05.11.12 ]]> 2004 6 23 23 3-20