Asbestos-related diseases: a five years clinical experience

Occupational and environmental asbestos exposure continues to represent a public health problem, despite increasingly restrictive laws adopted by most industrialized countries. We present 59 subjects with past asbestos exposure (42 males, 17 females; mean age: 62 years), who came to our observation from November 2000 to September 2005, as outpatients (36) or day-hospital cases (23). They underwent occupational health visit (with accurate occupational and environmental anamnesis) and laboratory/instrumental diagnostic procedures (as indicated in the single cases), including: blood/urine testing, ECG, chest radiography with ILO classification, computed tomography (conventional or high resolution), spirometry, six minutes walking test, hemogasanalysis, bronchoalveolar lavage (with search for asbestos bodies or fibers), histopathology, and immunohistochemistry (in mesothelioma cases). Fortyfive subjects had been exposed to asbestos occupationally, and 6 in the general environment. In 8 cases the exposure had been combined (occupational and environmental). The occupational exposures had occurred in the following productive activities: building, shipyards, hydraulics, electrotechnics, metal industry, textile industry, agriculture. At least one asbestos-related pathological condition was diagnosed in 32 patients: 17 cases of pleural plaques, 8 of asbestosis (with pleural plaques in 6 patients), 6 of pleural mesothelioma, 1 of peritoneal mesothelioma. The occupational cases were reported to the Judicial Authority (as established by the Italian Penal Code), and referred to the Italian Workers’ Compensation Authority (INAIL). Our case record indicate that, although asbestos is banned in Italy since 1992, asbestos-related diseases continue to be commonly observed in the clinical practice. Worrisome is the individuation of 7 cases of mesothelioma (one of them peritoneal). This finding agrees with epidemiological projections suggesting that the mortality from pleural mesothelioma in Western Europe each year will almost double until around 2018. Thus, sanitary and epidemiologic surveillance of people ex-exposed to asbestos should continue, to identify and treat the long latency cases, and to evaluate the effects of low doses exposures.