Long Term Follow-Up of Sulfur Mustard Related Bronchiolitis Obliterans Treatment

  • Hamidreza Abtahi Department of Pulmonary and Critical Care, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND department of Pulmonary and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Soheil Peiman Department of Pulmonary and Critical Care, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.AND Department of Internal Medicine, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Morteza Foroumandi Department of Internal Medicine, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Enayat Safavi Department of Pulmonary and Critical Care, Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pulmonary and Critical Care, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Bioterrorism, Bronchiolitis, Sulfur mustard, Macrolide, Treatment

Abstract

Bronchiolitis obliterans (BO) is the most remarkable pulmonary sequels of war-related sulfur mustard inhalation. There is little if any data about long-term efficacy of associated BO treatment. Five years spirometric records of three groups of patients with obstructive pulmonary diseases (asthma, COPD, BO) and documented sulfur mustard inhalation were evaluated. The BO patients were treated with inhaled Seretide 125-250/25 (2 puffs BID), azithromycin (250 mg, three times/week) and N-acetylcysteine (1200-1800/day). Asthma and COPD patients were treated according to existing guidelines. Seventy-three (38 asthma, 16 COPD and 19 BO) patients completed the 5 years follow-up. Basal and final FEV1 in BO patients (2.69±0.81 and 2.39±0.65 respectively) were not significantly different from COPD patients (2.46±0.56 and 1.96±0.76 respectively). There was also no significant difference between the yearly FEV1 decline in BO patients compared to COPD patients (60±84 cc vs. 99±79 cc respectively, P=0.163). The non-significant difference of FEV1 decline in BO compared to COPD patients suggests the effectiveness of azithromycin, inhaled steroid and N-acetyl cysteine in BO patients. Considering safety and possible effectiveness, this treatment is recommended until more data is available from controlled clinical studies.

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Published
2016-10-31
How to Cite
1.
Abtahi H, Peiman S, Foroumandi M, Safavi E. Long Term Follow-Up of Sulfur Mustard Related Bronchiolitis Obliterans Treatment. Acta Med Iran. 54(9):605-609.
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Articles