Early Detection a Major Advantage in Impaired Lung Function Among Sulfur Mustard Survivors

The study is part of ongoing research on the long-term consequences of exposure to chemical warfare agents. It is being published around the anniversary of the March 16, 1988, chemical attack on Halabja in Iraqi Kurdistan, northern Iraq. Approximately 5,000 people died in the attack, and many more were injured. Several survivors now reside in Sweden.

The study,  Respiratory function after 30+ years following sulfur mustard exposure in survivors in Sweden involves two groups: one with 15 individuals exposed to sulfur mustard over 30 years ago and another with 15 individuals unexposed to the gas. Both groups consist of Kurds currently living in Sweden.

Enhanced Assessment of Small Airway Function

Dysfunction in the small airways of sulfur mustard-exposed individuals has not been thoroughly studied using non-traditional, non-invasive lung function tests. The aim of this study was to evaluate the small airway function in sulfur mustard survivors by comparing the results of various non-traditional, non-invasive lung function tests, including alveolar function assessments through impulse oscillometry, inert gas washout (known as "Multiple Breath Washout"), and measurements of carbon monoxide diffusion capacity in the lungs (DLCO).

"Our findings suggest that exposure to sulfur mustard may be linked to long-term impairment of small airway function, which traditional spirometry fails to detect until significant clinical symptoms are evident," says Faraidoun Moradi, licensed pharmacist and general medicine specialist.

Faraidoun Moradi, the study's lead author, recently earned a Ph.D. in occupational and environmental medicine from the Sahlgrenska Academy. His dissertation, Long-term impact of exposure to sulfur mustard on mental health, quality of life, and lung function, complements his research at the Center for Disaster Medicine at the University of Gothenburg.

A First Step Toward Improved Treatment and Monitoring

The results demonstrate that impulse oscillometry and inert gas washout are valuable tools for detecting small airway dysfunction at an early stage in individuals exposed to sulfur mustard. These measurements also provide useful information for monitoring small airway dysfunction and evaluating treatments for patients exposed to sulfur mustard.

"Currently, neither impulse oscillometry nor inert gas washout is a standard method for evaluating small airway function. However, further studies are needed using these methods and on a significantly larger population."

As for lung diffusion capacity (DLCO), the results suggest that sulfur mustard exposure is unlikely to affect gas exchange at the alveolar-capillary interface in the long term.

"Identifying and characterizing the remaining pathology in small airways among sulfur mustard survivors is the first step toward improving treatment and follow-up care," concludes Moradi.

Text: Susanne Lj Westergren