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

Abstract

We examined the role of two regimens of combination inhaler therapy on amount of reversibility of chronic lung complications in mustard gas exposed patients. In a phase III, prospective, randomized clinical trial, 105 participants received either combination form of fluticasone propionate and salmetrol, 500/100 microg daily (group 1; n = 52) or beclomethasone, 1000 microg daily, and salbutamol inhaler, 800 microg daily (group 2; n = 53) for 12 wk. Pulmonary function test (PFT) indices and respiratory symptoms (including dyspnea, night awakening due to dyspnea and cough) were assessed at baseline and in each visit. Thirty-six patients in group 1 and 30 patients in group 2 completed study course. Both medication regimes increased pretreatment forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC%, and peak expiratory force (PEF) by the end of 12 wk. It seems that these improvements are more constant in group 1 than in group 2. Reversibility, that is, 10% increase of FEV1 in the second month was seen for 27% of patients in the group 1 and for 7% in the group 2. VAS scores have decreased in two groups during treatment period (p = .003) and after follow-up period it remained sustained in group 1 alone. Inhaled corticosteroids and long-acting beta 2-agonists are effective in treatment of patients with chronic bronchiolitis following exposure to sulfur mustard. However, a medium dose of fluticasone/salmeterol has the same effect on the airways reversibility, rather than a very high dose of beclomethasone with only the short-acting beta-agonist.

Long-term pulmonary complications of chemical warfare agent exposure in Iraqi Kurdish civilians

“…This might have been caused by a lack of medical care in the intervening period-in Kurdistan there was limited access to organized medical care, including inhaled and oral medications that might have influenced disease progression (Ghanei et al, 2007b;Shohrati et al, 2008). Secondly, knowledge of, and access to, first aid to limit acute exposure was limited among civilians in this region.…”

Sulfur mustard-induced pulmonary injury: Therapeutic approaches to mitigating toxicity

“…SM induces early asthma-like symptoms in animals; symptoms and mortality are reduced by intratracheal administration of salbutamol, a β2 agonist [47]. Similarly, human subjects with chronic bronchiolitis and reactive airway disease as a consequence of SM exposure are responsive, or even hyperresponsive, to inhaled bronchodilators [80, 81]. A recent report has suggested that the use of helium-oxygen mixtures with non-invasive ventilation decreases airway resistance and work of breathing in subjects with chronic dyspnea following sulfur mustard exposure [82].…”

Flavonoid Treatment for Mustard Agents' Toxicity

“…Doxycycline may be a promising therapeutic agent for SM (Guignabert et al, 2005). For the lung lesions and systemic toxicity of SM, paracetamol-ibuprofen combination for controlling pain and fever, beclomethasone inhaler as an anti-inflammatory corticosteroid, codeine phosphate or sulphate as a cough suppressant, doxycycline as an antibacterial agent, and N-acetyl cysteine, as a mucolytic and glutathione sparing drug are recommended (Lindsay et al, 2008, Bobb et al, 2005Ghanei et al, 2007, Vijayaraghavan et al, 2011. If haemoconcentration and shock are present either whole blood transfusion or transfusion of plasma expanders should be considered.…”