[Cobalt-induced asthma in workers exposed to hard metal dust]. / Kobalt asthma keményfém porkohászati üzemben.

A case of 39 years old woman with asthma bronchiale associated with cobalt exposure is reported. Specific bronchial provocation tests in these patients supported the diagnosis of hard-metal-induced asthma and implicated cobalt as the agent responsible. The relevant literature data are reviewed.

[On the bronchodilatory effect of reproterol (author's transl)]. / Uber die bronchodilatatorische Wirkung von Reproterol

The results of an intra-individual double-blind study between placebo, orciprenaline and 7-(3-[2-(3,5-dihydroxyphenyl)-2-hydroxy-ethylamino]-propyl)-theophylline (reproterol, Bronchospasmin) were compared in 16 patients with chronic obstructive bronchitis by means of the findings of objective measurements as well as patients' comments. It was shown that the new monosubstance reproterol, a phenylethyl-aminoalkyl-xanthine, is a very potent bronchodilator whose effect persists for at least 6 h. This bronchlysis could be proven on the basis of total and specific airways resistance as having a significantly superior and longer-lasting effect when compared with placebo. Also, when compared with orciprenaline the total broncholytic effect (areas of Raw and SRaw for effect covering time) was significantly better. No essential cardiovascular or subjective side-effects were caused by any of the three preparations inhaled in from of an aerosol equipped with metering valve. Because of its assured broncholytic efficacy and good tolerance, as well as its different forms of application (ampoules, tablets, aerosol, inhalation-solution), reproterol is a recommendable alternative in recent beta2-adrenergic achievements.

[Studies on the onset of effect of reproterol following inhalation from a metered aerosol (author's transl)]. / Untersuchungen zum Wirkungseintritt nach Inhalation von Reproterol aus einem Dosier-Aerosol

According to a uniform trial procedure, the broncholytic efficacy of the new beta2-adrenergic 7-(3-[2-(3,5-dihydroxyphenyl)-2-hydroxy-ethylamino]-propyl)-theophylline (reproterol, Bronchospasmin) was tested in a total of 21 patients afflicted with airways obstruction in two lungfunction laboratories. The IGV, Ras and SGaw were calculated by bodyplethysmography before and 1,3 and 5 min following of 2 puffs from an aerosol container. Excellent and highly significantly bronchodilation was shown already 1 min post inhalation, which further increased during testing time and with which results of subjective criteria for dyspnoeic changes correspond. The preparation may therefore be recommended for therapy of dyspnoeic attacks in an aerosol form equipped with metering valves.

Changes in clinical status and lung functions of patients with chronic respiratory diseases over 10 years.

After a period of 10 years the authors reexamined the respiratory health status of 381 dust-exposed males. Of the lung function values examined Raw, RV/TLC%, VC, TGV and PaO2 were found to be of significant prognostic importance. Among the radiological changes characteristic of silicosis the most serious B-C category, among the respiratory complaints dyspnoea accompanied by regular cough and expectoration, and among the physical changes extended rhonchi and rales accompanied by an emphysematous thorax are to be considered as most essential with respect to prognosis. Smoking habits significantly affected the total death rate, but did not prove to be significant with regard to respiratory death. In the development of bronchial obstruction recurrent febrile respiratory diseases proved to be more important than smoking habits and mild bronchitic complaints.

Role of occupational asbestos exposure in Hungarian lung cancer patients.

OBJECTIVE: What is the frequency of occupational asbestos exposure among patients suffering from malignant respiratory tumours and how many of these tumours are associated with asbestos in Hungary? METHODS: An internationally established questionnaire with 29 questions, covering the most characteristic activities of asbestos exposure at the workplace was completed for 300 patients with respiratory malignancies, i.e. 297 patients with lung cancer and three with mesothelioma of the pleura. From the questionnaire, the smoking habits were estimated and cumulative asbestos exposure was assessed in fibre-years. Additionally, lung X-rays were classified and the national data on the incidence of malignant pleura mesothelioma were analysed. RESULTS: A cumulative asbestos exposure of 25 fibre-years or more was detected in 11 patients with lung cancer (4%) and in each of the three patients with pleural mesothelioma (100%). In a further 72 patients (24%), cumulative occupational asbestos exposure was assessed as below 25 fibre-years (between 0.01 and 23.9 fibre-years). In this group, car and truck mechanics, and installation and construction workers using asbestos-cement were registered. Among patients with an asbestos exposure of 25 fibre-years or more, six asbestos-cement production workers were observed, among them the three mesothelioma cases. A weak but significant association between positive X-ray findings and exposure estimates could be demonstrated. Additionally, results of the lung tissue fibre counts by scanning transmission electron microscopy were available for 25 of the lung cancer patients. A good correlation was observed between the asbestos fibre counts and the assessment of cumulative asbestos exposure. In Hungary, 84 cases of pleural mesothelioma were registered in 1997 and 73 in 1998. These numbers correspond to an annual incidence of about one new case per 100,000 inhabitants older than 15 years. CONCLUSIONS: The annual incidence of lung cancer in Hungary is about 6,000. Since in our series of lung cancer patients about 4% were observed, which could be accepted as representing occupational disease because of a cumulative exposure to 25 fibre-years or more, the annual asbestos related lung tumour incidences may be estimated to be approximately 150 or more. The proportion of nearly two estimated cases of lung cancer per case of pleural mesothelioma corresponds to international experience. Up to now, lung cancer cases only exceptionally have been registered as occupational diseases, i.e. they were seriously under-diagnosed in Hungary. For improving this situation, diagnostic assistance by a self-interview with a questionnaire covering the working history for all newly diagnosed lung cancer patients would be helpful.