[Asbestos-related diseases in former asbestos-cement workers in Senigallia]. / Le patologie asbesto-correlate degli ex addetti alla produzione di manufatti in cemento amianto a Senigallia.

BACKGROUND: A factory that produced asbestos-cement products, using chrysotile, amosite and crocidolite in very low percentages, cement and water, operated in Senigallia from 1948 to 1984. Workers and residents still living in Senigallia are 238. OBJECTIVES: The need for an organic response to requests by former workers for protection of health and recognition of occupational diseases induced the Prevention and Safety at the Workplace Service in Senigallia/Area Vasta 2 to implement a programme of health surveillance. METHODS: In 2010 a health surveillance programme was initiated that involved 158 subjects, 58 women and 100 men. The average age of men was 75 years and 70 for women. The time elapsed between first exposure and participation in the programme was on average 50 years (SD 7.49). The average number of years of exposure to asbestos fibres was 17 (SD 10.36). The programme included counselling activities, especially as regards cessation of smoking, and first and second level health checks. RESULTS: The health surveillance programme enabled us to diagnose pleural plaques and pleural thickening in 81% of the subjects and various degrees of interstitial abnormalities in 49.4%. The high percentage of asbestos-related diseases was connected mainly with the long latency of the population under study and the higher diagnostic sensitivity of low dose chest CT scan applied to these diseases. CONCLUSIONS: In our experience, in order to optimize the benefits of a health surveillance programme of former workers exposed to asbestos, it will be advisable to define parameters of access to the programme for individual subjects in relation to life expectancy, clinical conditions, time elapsed since first exposure, time of cessation of exposure. Such parameters, together with any risk factors, will influence the diagnostic process.

Dose-response relationship: fenoterol, ipratropium bromide and their combination.

The beta agonist fenoterol, the antimuscarinic ipratropium bromide and their combination were compared in 10 patients with stable reversible airway obstruction. A single-blind cross-over design was used in order to obtain cumulative dose-response curves. The dose inhaled by an IPPB apparatus on different days were: fenoterol, from 12.5 to 1.600 cumulate micrograms; ipratropium bromide, from 5 to 640 cumulate micrograms; combination (5:2), from 17.5 to 1.120 cumulate micrograms. The bronchodilator effect was measured as changes of FEV1 and of SGaw. Data were processed in order to identify the median effective dose (ED50) and the percentage change at ED50 (RED50). The mean ED50 in micrograms (+/- SD) resulted in: Fenoterol, ED50 (FEV1) = 132 (+/- 46); ED50 (SGaw) = 172 (+/- 62); Ipratropium bromide, ED50 (FEV1) = 14 (+/- 7); ED50 (SGaw) = 23 (+/- 11); Combination, ED50 (FEV1) = 109 (+/- 26); ED50 (SGaw) = 121 (+/- 53). The mean RED50% (+/- SD) resulted in: Fenoterol, RED50 (FEV1) = 30 (+/- 16); RED50 (SGaw) = 106 (+/- 78); Ipratropium bromide, RED50 (FEV1) = 21 (+/- 10); RED50 (SGaw) = 82 (+/- 66); Combination, RED50 (FEV1) = 35 (+/- 11) RED50 (SGaw) = 135 (+/- 81). The ED50 (FEV1) of the combination was significantly lower (p less than 0.05) than that of fenoterol. This increased potency of the combination supports evidence for an overadditive interaction between fenoterol and ipratropium bromide. Moreover, the efficacy of fenoterol (RED50) is enhanced by combining the two drugs.