N‐Acetylcysteine Improves the Clinical Conditions of Mustard Gas‐Exposed Patients with Normal Pulmonary Function Test

Abstract

Administration of N-acetylcysteine may be effective in diseases caused by oxidative-antioxidative imbalance. We aimed to determine the effect administration for 4 months of N-acetylcysteine (1200 mg daily) on sulfur mustard-induced bronchiolitis obliterans in patients with normal pulmonary function test. In a double-blind clinical trial, 144 patients with bronchiolitis obliterans due to sulfur mustard and bronchiolitis obliterans syndrome class 0, randomly entered to group 1 (n = 72, N-acetylcysteine) and group 2 (n = 72, placebo). The changes in dyspnoea, wake-up dyspnoea, cough and sputum were measured after 4 months using a 'delta value' (i.e. symptom score after 4 months -symptom score before the trial). Spirometric findings were measured at the beginning of the trial, 2 months later and 4 months later. Dyspnoea (delta value: -0.78 (0.61), P < 0.001), wake-up dyspnoea (delta value: -0.57 (0.64), P < 0.001), and cough (delta value: -0.86 (0.63), P < 0.001) improved after 4 months of N-acetylcysteine administration compared to the control group. N-acetylcysteine reduced sputum from 76.9% (n = 40) of cases before the trial to 9.6% (n = 5) of cases after the trial. Spirometric components were significantly improved in N-acetylcysteine group compared to the placebo group: FEV1 (P < 0.0001), FVC (P = 0.014) and FEV1/FVC (P = 0.003). A 4-month trial with 1200 mg oral N-acetylcysteine per day can be used for treating bronchitis, but is also effective in treating bronchiolitis. It also prevents sulfur mustard-induced oxidative stress, and can be used in the treatment of sulfur mustard-induced pulmonary disease.

Sulfur Mustard Exposure and Cardiovascular Effects: A Review

“…Moreover, mediations that enhance the antioxidant supply, such as N-acetylcysteine and Curcumin, can be effective in both improving cardiovascular system health (47,48) and treating the late complications of SM (49,50). How-…”

COPD Due to Sulfur Mustard (Mustard Lung)

“…The exact mechanism of late pulmonary complication of SM exposure are not fully defined (14).Although the pathogenesis of COPD has completely determined and is mainly dependent on chronic inflammation and oxidative stress following activation of airway inflammatory cells, but there are few studies about the inflammatory basis of mustard lung (8,9,15).The pathological studies have shown that mustard lung is a neutrophilic / lymphocytic disorder (16,17).Also bronchiolar disease with varying degrees of inflammation as the main pathological finding, was demonstrated in a recent pathologic study in patients with sulfur mustard injury (18 ). According to the previous pathological studies, it seems that activation of inflammatory cells and generation of reactive oxygen species resulting in oxidative stress be involved (16,17).…”

“…According to the previous pathological studies, it seems that activation of inflammatory cells and generation of reactive oxygen species resulting in oxidative stress be involved (16,17). It has been shown that decreased glutathione and increased serum malondialdehyde levels in mustard lung patients can be an indicator of oxidative-antioxidative system imbalance (16).…”

The Role of Oxidative Stress in Severity of Obstructive Pulmonary Complications in Sputum of Sulfur Mustard-Injured Patients

“…Neutrophils can accelerate the overproduction of ROS by NADPH oxidase, myeloperoxidase and xanthine oxidase activation [7,9]. In addition, they secret proteases, which in turn manufacture ROS [4]. Formation of ROS leads to oxidative stress and macromolecular damage, which triggers intricate signaling pathways and modulate gene expression, causing a series of SM-associated toxic responses [10].…”

“…The long-term complications of SM exposure are much serious than acute effects [1][2][3]. About 100,000 Iranians were exposed to chemical warfare agents, and 40,000 people suffer from pulmonary diseases such as asthma, chronic bronchiectasis and pulmonary fibrosis [3,4]. Bronchiolitis obliterans (BO) is the main long-term respiratory pathology in chemical victims of SM, which is a complex inflammatory disease with both airway and parenchymal lung injury [1,5].…”