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 mu g daily (group 1; n = 52) or beclomethasone, 1000 mu g daily, and salbutamol inhaler, 800 mu g 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.