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

Abstract

The Iraqi government used a range of chemical weapons, including blistering and nerve agents, against Iraqi Kurdish civilians in the 1980s. Few data exist about the long-term respiratory consequences of this exposure. In this study, Kurdish subjects with a history of exposure to chemical weapons were invited to attend a clinical assessment, including a review of their history, physical examination, and a high-resolution computed tomography (CT) of the thorax. Blistering at the time of exposure was used to define significant exposure to mustard gas. Results were compared between two groups of blistering and nonblistering. Four hundred seventy-nine subjects were studied; 45.7% male and 54.3% female. The mean age and standard deviation (mean +/- SD) of the cases was 43.1 +/- 13.7. Spirometry was abnormal in 15.2% of subjects and air trapping was present on CT scan in 46.6% and did not differ between patients with (n = 278) or without a history of blistering. Respiratory symptoms, including dyspnea, cough, and sputum production, were more common in subjects with a history of blistering (all p < .005) and blistering was also associated with a lower forced expiratory volume in one second (FEV(1)) (p < .0001). Severe complications were most common in subjects from Halabja who also made up the majority of participants. These results show that objective abnormalities are common in people with symptoms attributed to prior exposure to chemical agent. Blistering at the time of exposure was associated with more respiratory symptoms and worse lung function, but not with CT appearances. The high proportion of severe cases in comparison to reports from Iran may reflect the historical absence of effective early treatment, including strategies to reduce prolonged early exposure in this population.

Long Term Ocular Effects of Mustard Gas Poisoning: A Cross-Sectional Study in Iraqi Kurdish Civilians

“…Most common problems in all injured Iranian survivors exposed to SMin the Iran-Iraq war have been reported in previous studies [1,4]. Similar to those symptoms we observed, Ghanei et al reported a high incidence of respiratory symptoms in chemical weapon-exposed populations in Iraqi Kurdistan [9]. The use of blistering agents by the Iraqi army still is not known, but a history of blistering at the time of exposure was related, followed by delayed destructive lesions in the ocular surface and cornea, which led to progressive visual deterioration and ocular irritation.…”

“…Therefore, the most interesting finding was that when an ocular damaging process happened, it developed more quickly in the Iraqi Kurdish population than in Iranian subjects. A possible explanation for this might be that Iranian physicians were familiar with SM effects, in addition to the early application of countermeasures such as removing contaminated clothing, washing exposed tissues, and applying neutralizing agents could have been expected to reduce complications and encourage a rapid recovery in Iranian subjects [9,15]. However, there were other factors that could modulate exposure severity, such as the increased dose of chemical agents, different environmental conditions and distance from the attack location in the Iraqi Kurdish population.…”

Characterization of Distinct Macrophage Subpopulations during Nitrogen Mustard–Induced Lung Injury and Fibrosis

“…Pulmonary exposure to these vesicants results in extensive tissue damage and persistent bronchiolitis, which progresses to fibrosis (3,4). Mortality and long-term morbidity following exposure to mustards are a consequence of alkylation and crosslinking of critical nucleophilic sites in target tissues including DNA and proteins.…”

Effects of Mustard Gas on Veterans: A Review

“…Life style, psychiatric parameters, and socioeconomic status are some factors affected by these clinical complications. Many previously performed studies have evaluated the lung complications of these patients (33,36,37), and showed that the frequency of lung complications in mus-tard gas-intoxicated patients was about 100%.…”