Treatment for sulfur mustard lung injuries; new therapeutic approaches from acute to chronic phase

Abstract

ObjectiveSulfur mustard (SM) is one of the major potent chemical warfare and attractive weapons for terrorists. It has caused deaths to hundreds of thousands of victims in World War I and more recently during the Iran-Iraq war (1980–1988). It has ability to develop severe acute and chronic damage to the respiratory tract, eyes and skin. Understanding the acute and chronic biologic consequences of SM exposure may be quite essential for developing efficient prophylactic/therapeutic measures. One of the systems majorly affected by SM is the respiratory tract that numerous clinical studies have detailed processes of injury, diagnosis and treatments of lung. The low mortality rate has been contributed to high prevalence of victims and high lifetime morbidity burden. However, there are no curative modalities available in such patients. In this review, we collected and discussed the related articles on the preventive and therapeutic approaches to SM-induced respiratory injury and summarized what is currently known about the management and therapeutic strategies of acute and long-term consequences of SM lung injuries.MethodThis review was done by reviewing all papers found by searching following key words sulfur mustard; lung; chronic; acute; COPD; treatment.ResultsMustard lung has an ongoing pathological process and is active disorder even years after exposure to SM. Different drug classes have been studied, nevertheless there are no curative modalities for mustard lung.ConclusionComplementary studies on one hand regarding pharmacokinetic of drugs and molecular investigations are mandatory to obtain more effective treatments.

Carvacrol ameliorates haematological parameters, oxidant/antioxidant biomarkers and pulmonary function tests in patients with sulphur mustard‐induced lung disorders: A randomized double‐blind clinical trial

“…Lung injury is an ongoing pathological and active disorder even years after exposure to SM. Different drug classes have been studied; nevertheless, there are no curative modalities for mustard lung . Recent studies have shown that bronchiolitis obliterans (BO) is the major cause of respiratory complications following SM exposure.…”

Sulfur mustard resistant keratinocytes obtained elevated glutathione levels and other changes in the antioxidative defense mechanism

“…Proven pathologies are oxidative stress, apoptosis and inflammation. SM-induced oxidative stress results in depletion of low molecular mass antioxidants such as glutathione (GSH) and increase of reactive oxygen species (ROS) (Gould et al, 2009; Laskin et al, 2010; Poursaleh et al, 2012). …”

Intratracheal heparin improves plastic bronchitis due to sulfur mustard analog

“…Sulfur mustard (bis (2‐chloroethyl) sulfide) is an alkylating vesicant used as a chemical warfare agent, reportedly causing more than 80% of all documented chemical warfare gas casualties in the last century . Sulfur mustard (SM) remains a threat, despite last being used in the Iran‐Iraq War (1979–1988), because it is stockpiled in multiple countries around the world, including the United States, the former Soviet republic, North Korea, Syria, and potentially others.…”

“…Sulfur mustard (SM) remains a threat, despite last being used in the Iran‐Iraq War (1979–1988), because it is stockpiled in multiple countries around the world, including the United States, the former Soviet republic, North Korea, Syria, and potentially others. SM has acute and chronic harmful effects on the eyes, skin, bone marrow, and respiratory tract . The most acutely threatening injury is damage to the respiratory tract.…”