title: The role of N-acetylcysteine in the management of acute and chronic pulmonary complications of sulfur mustard: a literature review.
abstract: BACKGROUND
  Sulfur mustard exposure, as the most widely used chemical weapon, can lead to acute and long-term pulmonary complications via various pathways, such as triggering an imbalance between the oxidant and antioxidant system. Currently, there is no validated antidote, chemoprophylaxis and curative modality for pulmonary toxicities secondary to sulfur mustard exposure.
  
  
  OBJECTIVE
  The aim of this literature review is to collect available experimental and clinical data on the efficacy of N-acetylcysteine (NAC), as a prominent antioxidant agent, in the prevention and/or treatment of sulfur mustard-induced acute and chronic pulmonary toxicities.
  
  
  METHODS
  A literature search was performed by the relevant keywords like "N-acetyl cysteine", "Sulfur mustard" and "Lung injury" in databases such as Scopus, Medline, Embase and ISI Web of Knowledge. No time limitation was considered. Nineteen articles were selected for review.
  
  
  RESULTS
  A number of in vitro and experimental studies concluded that oral, intravenous, intraperitoneal and intra-tracheal administration of NAC is effective in the management of sulfur mustard-induced acute lung injury, in a time-dependent manner, via direct scavenging, inhibition of oxidative stress, inflammatory responses and apoptosis. In addition, oral NAC alone (1200 or 1800 mg/day for 4 months) or at a dose 600 mg/day for 6 months in combination with clarithromycin (500 mg/day) have led to improvements of clinical and paraclinical pulmonary parameters of patients with bronchiolitis obliterans due to sulfur mustard, through undetermined mechanisms.
  
  
  CONCLUSIONS
  Despite limitations of relevant experimental and clinical studies, NAC can be considered as a candidate agent for prevention and/or treatment of sulfur mustard-induced acute lung injuries, as well as its long-term pulmonary toxicities, especially bronchiolitis obliterans.
authors: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences , Tehran , Iran .
authors: Majid
authors: M
authors: Shohrati
authors: Iman
authors: I
authors: Karimzadeh
authors: Amin
authors: A
authors: Saburi
authors: Hossein
authors: H
authors: Khalili
authors: Mostafa
authors: M
authors: Ghanei
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage / Q000494:pharmacology*; D000818:Animals; D001989:Bronchiolitis Obliterans / Q000139:chemically induced / Q000188:drug therapy*; D002619:Chemical Warfare Agents / Q000633:toxicity; D004195:Disease Models, Animal; D006801:Humans; D008168:Lung / Q000187:drug effects; D009151:Mustard Gas / Q000633:toxicity*; D018384:Oxidative Stress / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic
chemical_list: D002619:Chemical Warfare Agents; D009151:Mustard Gas; D000111:Acetylcysteine
keywords: Acetylcysteine; early lung injuries; late lung injuries; mustard gas; prophylaxis; treatment