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The evaluation of the damage to biological and relational capacities of the subject is the novel approach of the Italian Insurance Regulation Decree N(o) 38/2000 for compensating occupational asthma (OA). In this study we aimed to apply retrospectively the novel rating system to mild OA. From a data base of 201 diagnosis of OA collected in the 1987-97 decade 85 eligible consecutive cases of mild asthma according to the criteria of NIH/WHO guidelines on asthma were studied. Records on compensation were documented for 41 subjects. The average difference between novel scales and the actual rating individually assessed by Italian National Agency for compensation through criteria used at that time was 45.6 +/- 20%. The average difference between novel scales and rating calculated with guidelines considering the measurement of non-specific bronchial hyperreactivity developed by international experts and American Thoracic Society, endorsed by American Medical Association, was 41.5 +/- 12%. Within the actual rating individually assessed with previous Italian Insurance criteria no significant relationship (r=-0.20, p=0.2) was shown with bronchial responsiveness to methacoline expressed as provocative dose causing a 20% fall in FEV1 (PD20FEV1 microg of mch). A significant (p<0.05) relationship was observed with age at the time of OA diagnosis (r=0.37, p=0.017) and with duration of exposure (r=0.34, p=0.034). This study suggests that scales of the Insurance Regulation Decree N(o) 38/2000 grading mild OA underevaluate biological damage/impairment with reference both to previous practice in Italy and to international criteria guidelines. Among the parameters of evaluation methacoline challenge should be considered an adequate tool in measuring biological damage in OA for medicolegal purpose.

Total cases of fatal asthma in the occupational setting reported in the literature are reviewed and the case of a 39-year-old foundry worker who died at work is described. A diagnosis of occupational asthma induced by diphenylmethane diisocyanate (MDI) had been assessed 5 years in advance through a 0.005-ppm exposure inhalation challenge. Postmortem microscopic examination of the lung showed epithelial desquamation, eosinophilic/neutrophilic infiltration of the mucosa, dilatation of bronchial vessels, edema, hypertrophy and disarray of smooth muscle. Fatal asthma attack in a MDI-sensitized individual, to our knowledge, has not been previously described.

The prophylactic effectiveness of the phthalazinone derivative, azelastine was compared with ketotifen. A total of 111 patients, aged 18-65 years, from 10 centres was entered into this randomized, double-blind study. All patients had reversible asthma. After 1 week on placebo, patients were allocated to either 8 mg/day azelastine once or twice daily, or to 1 mg ketotifen, twice daily, for a further 12 weeks. Azelastine was more effective in improving respiratory function (forced expiratory flow in 1 s and peak expiratory flow rate) when given in the once daily regimen, whereas clinical measures (number of weekly asthma attacks) were most improved by twice daily dosing. There was no significant difference between the effectiveness of azelastine and that of ketotifen. Treatments were equally well tolerated and a low incidence of side-effects was reported. In conclusion, 8 mg/day azelastine, in either a single or twice daily dosage regimen may be regarded as providing effective prophylaxis against bronchial asthma.

The article presents a case study of a 37-year-old man with occupational asthma due to exposure to almond dust shell. The patient was an ex-smoker without a personal or family history of atopy. Several tests were performed. The article discusses that bronchial hyperreactivity was found to be induced by IgE-independent mechanisms.