Progressive delayed respiratory complications of sulfur mustard poisoning in 43 Iranian veterans, three decades after exposure

Abstract

The most common delayed complication of sulfur mustard (SM) poisoning has been observed in the respiratory tracts. It was thus aimed to investigate the delayed respiratory complications in SM-exposed patients around 25 years before the study. Forty-three veterans with more than 25% disability of due to SM poisoning were investigated. Clinical examinations as well as pulmonary function test (PFT) were performed. High-resolution computed tomography (HRCT) of the lungs was done as clinically indicated. Triad of chronic cough, dyspnea, and expectoration were the most common symptoms that were recorded in 88.2%, 88.2%, and 64.7% of the patients, respectively. PFT abnormalities were detected in 44.18% of the patients. Restrictive pattern was the most common (41.86%), while pure obstructive pattern did not detect at all. Mixed pattern was significantly correlated with higher disability percentages among the veterans ( p < 0.001). Significant reverse correlation between the disability percentages and forced expiratory volume in 1 s/forced vital capacity ratio was obtained ( p = 0.010, r = -0.389). Air trapping was the most common abnormality in HRCTs (50%). Bronchiectasis (25%), pulmonary fibrosis (25%), and ground-glass attenuation (16.66%) were other common HRCT findings. Comparing with the previous studies on these patients, more restrictive and mixed pattern were observed. Moreover, bronchiolitis, bronchiectasis, and lung fibrosis were the main pathological findings in these patients.

Innate Immune System Status of Sulphur Mustard‐Poisoned Iranian Veterans Three Decades after Exposure

“…Their findings indicated complications in the respiratory tract with a restrictive pattern in most cases. HRCTs revealed air trapping as common abnormality in half of the cases and bronchiectasis, pulmonary fibrosis and ground‐glass attenuation as other disorders with low frequencies . In a review by Darchini and Balali‐Mood (2018), the most subjective findings were chronic cough with expectoration and dyspnoea.…”

“…Late toxic effects of SM on different organs have been largely reported in the exposed individuals. There are also many papers illustrating prolonged hazardous effects of SM on the Iranian veterans who were exposed during the 1980s' Iran–Iraq war . For instance, Darchini et al .…”

“…Late toxic effects of SM on different organs have been largely reported in the exposed individuals. There are also many papers illustrating prolonged hazardous effects of SM on the Iranian veterans who were exposed during the 1980s' Iran-Iraq war [5,[14][15][16][17][18][19]. For instance, Darchini et al (2018) studied delayed respiratory complications from SM exposure nearly 25 years after incidence causing disability and determined physical examination, pulmonary function tests and high resolution computed tomography (HRCT).…”

Occupational Exposures and Environmental Health Hazards of Military Personnel

“…High frequency variations found in these studies were due to differences in sample size (43 to 34,000 subjects analyzed), but nevertheless, the major pathological events were the same. Since respiratory complications were the main cause of SM-related disability among exposed veterans [ 22 ], several studies were focused on the respiratory apparatus. The most frequent long-term respiratory complications detected in the upper tract were dysphonia (79.1% of subjects), post-nasal discharge (41.9%), lower larynx position (30.2%), limitation of vocal cords (25.6%), and inflammation of larynx mucosa (14.8%), while in the lower tract, chronic obstructive pulmonary disease (COPD) (35–84%), bronchiectasis (32.5–44.1%), asthma (25%), large-airway narrowing (15%), pulmonary fibrosis (7.5–7.7%), and simple chronic bronchitis (5%) were the most frequent [ 23 , 24 ].…”

“…The most frequent long-term respiratory complications detected in the upper tract were dysphonia (79.1% of subjects), post-nasal discharge (41.9%), lower larynx position (30.2%), limitation of vocal cords (25.6%), and inflammation of larynx mucosa (14.8%), while in the lower tract, chronic obstructive pulmonary disease (COPD) (35–84%), bronchiectasis (32.5–44.1%), asthma (25%), large-airway narrowing (15%), pulmonary fibrosis (7.5–7.7%), and simple chronic bronchitis (5%) were the most frequent [ 23 , 24 ]. After about 25 years from the exposure, bronchiectasis (25%), pulmonary fibrosis (25%), and ground-glass attenuation (16.66%) were diagnosed in 43 Iranian veterans, causing pulmonary function test abnormalities in 44.18% of the subjects investigated [ 22 ]. In the descriptive study, 128 SM-exposed veterans with severe eye injury were compared with 31 healthy controls.…”