Inhaled Corticosteroids and Long-Acting β2-Agonists in Treatment of Patients with Chronic Bronchiolitis Following Exposure to Sulfur Mustard

Abstract

We examined the role of two regimens of combination inhaler therapy on amount of reversibility of chronic lung complications in mustard gas exposed patients. In a phase III, prospective, randomized clinical trial, 105 participants received either combination form of fluticasone propionate and salmetrol, 500/100 microg daily (group 1; n = 52) or beclomethasone, 1000 microg daily, and salbutamol inhaler, 800 microg daily (group 2; n = 53) for 12 wk. Pulmonary function test (PFT) indices and respiratory symptoms (including dyspnea, night awakening due to dyspnea and cough) were assessed at baseline and in each visit. Thirty-six patients in group 1 and 30 patients in group 2 completed study course. Both medication regimes increased pretreatment forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC%, and peak expiratory force (PEF) by the end of 12 wk. It seems that these improvements are more constant in group 1 than in group 2. Reversibility, that is, 10% increase of FEV1 in the second month was seen for 27% of patients in the group 1 and for 7% in the group 2. VAS scores have decreased in two groups during treatment period (p = .003) and after follow-up period it remained sustained in group 1 alone. Inhaled corticosteroids and long-acting beta 2-agonists are effective in treatment of patients with chronic bronchiolitis following exposure to sulfur mustard. However, a medium dose of fluticasone/salmeterol has the same effect on the airways reversibility, rather than a very high dose of beclomethasone with only the short-acting beta-agonist.