M. MARQUET

Despite the progressive closure of large collieries, silicosis will remain a topical issue for many years to, come. However, given the scattering and small size of companies exposing their workers to siliceous dusts, knowledge on this pathology is likely to become dispersed and decline in the long run.

Apart from. the few cases of silicosis that become acute generally because of massive exposure, the labour world will know only about the milder forras of the disease by the time people retire.

The organisation of post-occupational monitoring in the former coal basin of the Nord Pas de Calais a real observatory of pensioners sufféring from silicosis has led to an awareness of the evolutionary potential of this disease which leads sooner or later to complete destruction of the lungs.

The various therapeutic tests such as the administration of aerosols of aluminium salts have not allowed this evolution to be stopped. However we have been able to observe a significant decrease in the number of silicoses, that could have become acute, in former miners removed from. risk exposure at an early stage as soon as the first signs of the disease appeared. Also, the later the first radiological signs appear, the lower the evolution from the milder to the more acute forms of the disease.

For want of a curative therapy, prevention remains the master word. It should be applied at all levels: industrial by reducing dust levels, medical by the earliest exit of persons presenting radiological signs of a pulmonary disease.

The past fifty years have however seen therapeutic progress, particularly regarding the management of respiratory insufficiency and its complications. However, a lung that bas been destroyed does not regenerate and the only solution consists in making best use of what remains.

To be effective this action should be undertaken early with active participation of patients. It firstly requires an improvement in health practices (suppression of tobacco, keeping of a physical activity, combating obesity, etc. ...).

Respiratory reeducation and effort re-training under the guidance of a physiotherapist can delay the appearance of a serious respiratory insufficiency and preserve autonomy to the maximum. They can be started during a cure at a spa but should be continued when back at home.

Even in the most serious cases, requiring long-term oxygenotherapy, autonomy should remain the therapist's first concern. Oxygenotherapy is now facilitated by the use of ambulatory equipment using liquid oxygen.

Lastly, treatment for sufférers of very serious respiratory insufficiency can now be given in the family setting by using ventilation equipment, putting an end to isolation in hospitals.

This appraisal may appear sombre but the management of the problem, currently facilitated by the geographic concentration of the affected population, has allowed effective treatinent protocols to be developed. Let's hope that these bases contribute to, the continuation of equally effective treatinent for the isolated cases who are going to become the majority.