title: Efficacy of Tiotropium Bromide and Rehabilitation Treatment on Pulmonary Function of Patients With Sulfur Mustard Lung Injury.
abstract: BACKGROUND
  Chronic pulmonary complication is the most common delayed toxic effect of sulfur mustard (SM) and it has no treatment so far.
  
  
  OBJECTIVE
  To evaluate short-term therapeutic effects of inhaled tiotropium bromide and pulmonary rehabilitation on pulmonary function of patients with SM induced lung injury.
  
  
  METHODS
  In a randomized clinical trial, using convenient sampling method, 54 patients with chronic lung disease due to SM exposure were recruited in Baqiyatallah General Hospital, Tehran, Iran for a period of 2-month study. They were randomly divided into 3 groups of 18 participants each. Group 1 received routine drugs (Serevent, Flixotide), pulmonary rehabilitation 30 minutes/2 times a week, and tiotropium bromide 18 µg/day. Group 2 was treated with routine drugs and pulmonary rehabilitation and group 3 was only on the routine drugs. cardiopulmonary exercise test (CPET), plethysmographic measurements, and respiratory symptoms evaluation were performed before and after medical intervention.
  
  
  RESULTS
  In group 1, compared to group 3, significant differences were found with regard to symptoms of cough ([difference between the first and last visit in group 1: Diff 1] = -1.6, Diff 3 = -0.3, P = 0.01) and nocturnal dyspnea (Diff 1 = -1.9, Diff 3 = 0.0, P = 0.01), likewise, compared to group 2, significant differences were found with regard to lung function parameters of forced vital capacity (Diff 1 = 3.0, Diff 2 = -3.5, P = 0.03), forced expiratory volume in one second (Diff 1 = 3.9, Diff 2 = -5.6, P = 0.009), maximal mid-expiratory flow rate 25% - 75% (Diff 1 = 1.5, Diff 2 = -3.2, P = 0.007) and peak expiratory flow (Diff 1 = -2.06, Diff 2 = -4.3, P = 0.04). Total lung capacity (Diff 2 = 9.28, Diff 3 = -12.07, P = 0.02) and residual volume (Diff2 = 32.1, Diff3 = -27.6, P = 0.04) were increased in group 2 compared to group 3. There were no significant differences with regard to CPET results among all groups (P > 0.05).
  
  
  CONCLUSIONS
  Inhalation of tiotropium bromide in combination with pulmonary rehabilitation could improve some plethysmographic lung volumes and clinical outcomes in patients with chronic pulmonary disease due to SM. Short-term prescription of pulmonary rehabilitation has no effect on CPET of patients.
authors.affiliation: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Shohrati
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy, Islamic Azad University, Tehran, IR Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Jalili
authors.affiliation: Department of Pharmacology, Faculty of Pharmacy, Islamic Azad University, Tehran, IR Iran.
authors.forename: Homa
authors.initials: H
authors.lastname: Afshar
authors.affiliation: Department of Pediatrics, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Bita
authors.initials: B
authors.lastname: Najafian
authors.affiliation: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Qazvini
authors.affiliation: Department of Pharmacology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors.forename: Meysam
authors.initials: M
authors.lastname: Zaeri
authors.affiliation: Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Amini Harandi
authors.affiliation: Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ghanei
keywords: Bronchiolitis Obliterans; Exercise Test; Plethysmography; Rehabilitation; Sulfur Mustard; Tiotropium