Effectiveness and Health Investigation of N-Acetyl Cysteine Tablets and Comparing it with Foreign Samples in Controlling Pulmonary Symptoms Caused by Sulfur Mustard in Chemical Veterans of Qazvin Province

Document Type : Original Research

Authors

1 Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran

2 Chemical Injuries Research Center, Systems Biology and Poisonings Institute Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Department of Cardiology, Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran

5 Clinical Research Development Unit, Kowsar Hospital, Qazvin University of Medical Sciences, Qazvin, Iran

Abstract

Background and Aim: Sulfur mustard (Mustard gas) is the most famed chemical warfare agent that caused chronic lung damage. Oxidative stress is known as a major cause of mustard lung pathogenesis. This study aimed to introduce antioxidant tablets of Iranian N-acetyl-cysteine (NAC) as an effective treatment for chronic lung damage caused by mustard gas.
Methods: This study was performed as a double-blind randomized clinical trial. In the current study, 85 patients with chronic sulfur mustard lung injury from chemical warfare veterans of Qazvin province for 4 months from 2016 to 2017, randomly took one of the Iranian NAC (Oslyt®) or foreign NAC (Fluimucil®) tablets a dose of 1200 mg per day. The symptoms via breathlessness-cough and sputum scale (BCSS), modified medical research council (MMRC), COPD assessment test (CAT), rhinitis control assessment test (RCAT), and reflux symptom index (RSI) questionnaires and spirometric indices and side effects drugs were compared in groups.
Results: According to the results and comparing the P-value obtained for clinical symptoms obtained through the mentioned questionnaires, it seems that in both groups of Oslyt (with 41 patients) and Fluimucil (with 44 patients), remarkably improved BCSS, MMRC, CAT, and RSI (except for RCAT) overall scores. There was no significant difference between Oslyt and Fluimucil in terms of the frequency of side effects.
Conclusion: Both Iranian and foreign antioxidant drugs NAC improve the majority of clinical signs of the mustard lung. This is the first time that anti-reflux effects have been observed for antioxidants such as NAC. The Oslyt dose of 1200 mg per day is adequate for effectiveness and antioxidant effects.

Keywords

References

1. White CW, Rancourt RC, Veress LA. Sulfur mustard inhalation: mechanisms of injury, alteration of coagulation, and fibrinolytic therapy. Annals of the New York Academy of Sciences. 2016;1378(1):87. doi: 10.1111/nyas.13130. 2. Ghabili K, Agutter PS, Ghanei M, Ansarin K, Shoja MM. Mustard gas toxicity: the acute and chronic pathological effects. Journal of applied toxicology. 2010;30(7):627-43. doi: 10.1002/jat.1581. 3. Nourani MR, Mahmoodzadeh Hosseini H, Azimzadeh Jamalkandi S, Imani Fooladi AA. Cellular and molecular mechanisms of acute exposure to sulfur mustard: a systematic review. J Recept Signal Transduct Res. 2017;37(2):200-16. doi: 10.1080/10799893.2016.1212374. 4. Ghanei M, Harandi AA. Long term consequences from exposure to sulfur mustard: a review. Inhalation toxicology. 2007;19(5):451-6. doi: 10.1080/08958370601174990. 5. Shohrati M, Karimzadeh I, Saburi A, Khalili H, Ghanei M. The role of N-acetylcysteine in the management of acute and chronic pulmonary complications of sulfur mustard: a literature review. Inhalation toxicology. 2014;26(9):507-23. doi: 10.3109/08958378.2014.920439. 6. Kehe K, Raithel K, Kreppel H, Jochum M, Worek F, Thiermann H. Inhibition of poly (ADP-ribose) polymerase (PARP) influences the mode of sulfur mustard (SM)-induced cell death in HaCaT cells. Archives of toxicology. 2008;82(7):461-70. doi: 10.1007/s00204-007-0265-7. 7. Panahi Y, Gholami N, Ghojazadeh M, Moslemi F, Naghavi-Behzad M, Azami-Aghdash S, et al. complications and carcinogenic effects of mustard gas-a systematic review and meta-analysis in Iran. Asian Pacific Journal of Cancer Prevention. 2015;16(17):7567-73. doi: 10.7314/apjcp.2015.16.17.7567. 8. Rahman I, MacNee W. Antioxidant pharmacological therapies for COPD. Current opinion in pharmacology. 2012;12(3):256-65. doi: 10.1016/j.coph.2012.01.015. 9. Santus P, Corsico A, Solidoro P, Braido F, Di Marco F, Scichilone N. Oxidative stress and respiratory system: pharmacological and clinical reappraisal of N-acetylcysteine. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2014;11(6):705-17. doi: 10.3109/15412555.2014.898040. 10. Matera MG, Calzetta L, Cazzola M. Oxidation pathway and exacerbations in COPD: the role of NAC. Expert review of respiratory medicine. 2016;10(1):89-97. doi: 10.1586/17476348.2016.1121105. 11. Sanguinetti CM. N-acetylcysteine in COPD: why, how, and when? Multidisciplinary respiratory medicine. 2015;11(1):1-11. doi: 10.1186/s40248-016-0039-2. 12. Shen Y, Cai W, Lei S, Zhang Z. Effect of high/low dose N-acetylcysteine on chronic obstructive pulmonary disease: a systematic review and meta-analysis. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2014;11(3):351-8. doi: 10.3109/15412555.2013.858315. 13. Tse HN, Tseng CZS. Update on the pathological processes, molecular biology, and clinical utility of N-acetylcysteine in chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2014;9:825. doi: 10.2147/COPD.S51057. 14. Ghanei M, Shohrati M, Jafari M, Ghaderi S, Alaeddini F, Aslani J. N‐acetylcysteine improves the clinical conditions of mustard gas‐exposed patients with normal pulmonary function test. Basic & clinical pharmacology & toxicology. 2008;103(5):428-32. doi: 10.1111/j.1742-7843.2008.00318.x. 15. Shohrati M, Aslani J, Eshraghi M, Alaedini F, Ghanei M. Therapeutics effect of N-acetyl cysteine on mustard gas exposed patients: evaluating clinical aspect in patients with impaired pulmonary function test. Respiratory medicine. 2008;102(3):443-8. doi: 10.1016/j.rmed.2007.10.004. 16. Ghanei M, Abolmaali K, Aslani J. Efficacy of concomitant administration of clarithromycin and acetylcysteine in bronchiolitis obliterans in seventeen sulfur mustard—exposed patients: An open-label study. Current therapeutic research. 2004;65(6):495-504. doi: 10.1016/j.curtheres.2004.12.001. 17. Dabirmoghaddam P, Amali A, Motiee Langroudi M, Samavati Fard MR, Hejazi M, Sharifian Razavi M. The effect of N-acetyl cysteine on laryngopharyngeal reflux. Acta Med Iran. 2013;51(11):757-64. 18. Kauppi J, Räsänen J, Sihvo E, Nieminen U, Arkkila P, Ahotupa M, et al. Increased oxidative stress in the proximal stomach of patients with Barrett’s esophagus and adenocarcinoma of the esophagus and Esophagogastric junction. Translational oncology. 2016;9(4):336-9. doi: 10.1016/j.tranon.2016.06.004. 19. Soyer T, Soyer OU, Birben E, Kısa U, Kalaycı O, Cakmak M. Pepsin levels and oxidative stress markers in exhaled breath condensate of patients with gastroesophageal reflux disease. J Pediatr Surg. 2013;48(11):2247-50. doi: 10.1016/j.jpedsurg.2013.02.100. 20. Giri AK, Rawat JK, Singh M, Gautam S, Kaithwas G. Effect of lycopene against gastroesophageal reflux disease in experimental animals. BMC Complement Altern Med. 2015;15:110. doi: 10.1186/s12906-015-0631-6. 21. Brzozowska I, Strzalka M, Drozdowicz D, Konturek SJ, Brzozowski T. Mechanisms of esophageal protection, gastroprotection and ulcer healing by melatonin. implications for the therapeutic use of melatonin in gastroesophageal reflux disease (GERD) and peptic ulcer disease. Curr Pharm Des. 2014;20(30):4807-15. doi: 10.2174/1381612819666131119110258. 22. Leidy NK, Rennard SI, Schmier J, Jones MK, Goldman M. The breathlessness, cough, and sputum scale: the development of empirically based guidelines for interpretation. Chest. 2003;124(6):2182-91. doi: 10.1378/chest.124.6.2182. 23. Cazzola M, Calzetta L, Page C, Jardim J, Chuchalin AG, Rogliani P, et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-61. doi: 10.1183/16000617.00002215.
Journal of Military Medicine
Volume 24, Issue 9 - Serial Number 118
January and February 2023
Pages 1619-1629

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