Ajmer is nestled in Aravali hills with plenty of stone crushers and pulverising factories using few safeguards to prevent dust exposure resulting in unusally high incidence of accelerated silicosis. This study was conducted to find the role of steroid pulse therapy in preventing the progression of disease once it has been clinicoradiologically evident.
42 confirmed cases of silicosis were evaluated. Routine investigations were carried out. Tuberculosis and pyogenic infections were ruled out. Comorbid conditions having contraindications for steroids (diabetes mellitus, hypertesnsion, peptic ulcer) were excluded. Respiratory status were asessed by PEFR, FEV1, FVC, FEV1/FVC & % Saturation of O2 (SaO2) which were found to be below normal limits. pts. put on pulse steroid therapy (dexamethasone 100 mg i.v. infusion in 5% GDW 500 c.c. over 3 hours, Day I to III) with close monitoring of fluid & electrolytes. Therapy was repeated every 28th day upto maximum of three cycles
26 males and 16 females were put on pulse therapy, 27 patients had remarkable benefit & improvement in PFT & SaO2 (average increase of 8-10%). 6 month f/u of 38 patients revealed that 56% patients had sustained improvement in PFT, SaO2 & clinical status. 24.6% patients had same status but 19.4% showed marked deterioration and died.
Dexamethasone pulse therapy showed marked improvement but stationary x-ray findings, but this improvement waned just after 2-3 months of last pulse.CLINICAL IMPLICATION: Dexamethasone pulse therapy helps in improving hypoxemia in actue condition and PFT for a period ranging from 2 to 6 months. However mechanism is not clear, results are unsustainable so large clinical trials are warranted.
R.C. Gupta, None.