title: Effect of therapeutic arsenic exposure on pulmonary function.
abstract: OBJECTIVE
  Arsenic-contaminated drinking water has been associated with respiratory diseases and lung function impairment. Oral arsenic trioxide (ATO) is a standard treatment for acute promyelocytic leukaemia. This study aimed to explore the effect of therapeutic exposure to arsenic on lung function.
  
  
  METHODS
  This was a case-control cross-sectional study on patients with haematological malignancies with or without exposure to ATO. Full lung function tests and serum Clara cell protein 16 (CC16) were measured.
  
  
  RESULTS
  There were 57 cases (arsenic exposed) and 57 matched controls (arsenic non-exposed) recruited. Among cases, the median duration of ATO exposure was 519 (194-1259) days. The mean FEV(1)/FVC ratio, FEV(1) (% predicted), and RV/TLC (%), as well as % subjects with FEV(1)/FVC below lower limits of normal (LLN), were similar in the two groups with or without arsenic exposure. However the mean TLC (% predicted) and DLCO/VA were significantly higher in arsenic-exposed versus non-exposed group (p = 0.01 and p = 0.008 respectively). There were mildly reduced FEV(1)/FVC ratio and FEF(25-75) (% predicted), largely within normal limits, among high level arsenic exposure compared with non-exposure (p = 0.01 and p = 0.05 respectively). Serum CC16 was comparable among both arsenic exposed and non-exposed groups.
  
  
  CONCLUSIONS
  Therapeutic use of oral ATO for a median of around 1.5 years was not associated with clinically significant lung function impairment.
authors.affiliation: Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region. jhocm@hku.hk
authors.forename: James Chung-Man
authors.initials: JC
authors.lastname: Ho
authors.forename: Wing-Yan
authors.initials: WY
authors.lastname: Au
authors.forename: Li
authors.initials: L
authors.lastname: Han
authors.forename: Yok-Lam
authors.initials: YL
authors.lastname: Kwong
authors.forename: Mary Sau-Man
authors.initials: MS
authors.lastname: Ip
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000009:adverse effects*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000503:physiopathology; D008171:Lung Diseases / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000009:adverse effects*; D014598:Uteroglobin / Q000378:metabolism; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; C556389:SCGB1A1 protein, human; D014598:Uteroglobin; D000077237:Arsenic Trioxide
keywords: APL; ATO; Arsenic trioxide; CC16; Clara cell protein; Clara cell protein 16; DLCO; DLCO/VA; FEF(25–75); FEV(1); FVC; IQR; Leukaemia; Lung function; RV; SD; TLC; acute promyelocytic leukaemia; arsenic trioxide; diffusing capacity corrected for haemoglobin; forced expiratory flow between 25% and 75% of FVC; forced expiratory volume in one second; forced vital capacity; interquartile range; residual volume; standard deviation; total lung capacity; transfer factor