Diagnostic and Therapeutic Value of Short‐Term Corticosteroid Therapy in Exacerbation of Mustard Gas‐Induced Chronic Bronchitis

Abstract

Chronic bronchitis is the most frequent late respiratory disease among Iranians exposed to mustard gas during the Iraq-Iran war. The aim of this study was to investigate efficacy of oral and intravenous corticosteroid therapy in improving lung function in mustard gas induced chronic bronchitis patients. 65 mustard gas-exposed chronic bronchitis patients, who were not responsive to standard treatments in exacerbation occasions, were randomly divided into two groups: an intravenous group (39 patients) receiving 500 mg intravenous methylprednisolone daily, and an oral group (26 patients) receiving 1 mg/kg oral prednisolone daily. Corticosteroid was tapered over the study period in both groups. Spirometery was performed on admission and on day 8 of therapy for assessment of effectiveness of therapy. There was significant improvement in spirometery indexes of both groups in approximately half of the patients over the study period. Furthermore, there was no difference between the pulse corticosteroid versus oral corticosteroid therapy in these patients. Since short-term corticosteroid therapy has a significant effect on lung function of almost fifty percent of patients with mustard gas-induced chronic bronchitis in exacerbation occasions, we suggest a short-term bolus steroid treatment to triage the patients into responders and non-responders for subsequent treatment.

Serum levels of IL-8 and IL-6 in the long term pulmonary complications induced by sulfur mustard: Sardasht-Iran Cohort Study

“…This point is important with regard to the current treatment protocol of COPD that mainly focuses on anti-inflammatory agents including corticosteroids. Ineffectiveness of corticosteroids in airway reversibility in more than 50% of mustard injured cases [49] can be due to the absence of active inflammation in these patients. Local inflammatory process as detected in sputum and BALF may be different and relatively remain isolated from circulatory changes.…”

Lung and Systemic Inflammation in COPD

“…This is critical because the glucocorticoids which benefit patients with asthma do not work for COPD. Future research will to elucidate new methods of treatment for those patients [101].…”

Inhaled Corticosteroids and Long-Acting β2-Agonists in Treatment of Patients with Chronic Bronchiolitis Following Exposure to Sulfur Mustard

“…Unfortunately, the common feature of BO has generally poor response to treatment (Perrin-Fayolle, 1995); consequently, therapy is based on symptomatic therapy, and the use of corticosteroids is controversial but common (Ezri et al, 1994). In one study the efficacy of high-dose inhaled fluticasone in BO patients following sulfur mustard exposure has been investigated (Ghanei at al., 2005). In contrast, in another study inhaled fluticasone propionate in infants recovering from acute bronchiolitis was ineffective (Wong et al, 2000).…”

“…It has been shown that there are partial responses to short-term bolus steroid treatment in chemical-injured patients (CIPs) (Ghanei et al, 2005); however, the outcome of inhaler maintenance therapy in these patients is not clear. Since due to frequent chemical attacks by the Iraqi ex-regime a large number of adult chronic bronchiolitis cases in Iran are available, we examined the impact of two regimens of combination inhaler therapy to find amount of reversibility in these patients.…”