**3. Sulfur mustard**

SM or [bis-(2-chloroethyl) sulfate] (Fig.1) is also known as" Yperite" (Ypres was the name of the place which it was first used), "Lost" (the initials of two German chemists), and "yellow

COPD Due to Sulfur Mustard (Mustard Lung) 233

injury .Our recent studies (8,9) on 50 stable mustard lung patients with all stages according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification (Fig.2) (22),showed that despite the exclusion of smoking, cardiovascular diseases, infections, and other important inflammatory conditions, serum level of highly sensitive c reactive protein (hs-CRP) and interleukin 6 (IL-6), as inflammatory markers, are elevated in mustard lung patients in comparison of normal controls and are directly related to severity of COPD according to spirometry findings (Fig.3,4)(8,9). It is clearly documented that IL-6 has an important part in reduced forced expiratory volume in one second (FEV1), impaired functional capacity, and worsening the underlying inflammatory condition by release of acute phase proteins (23,24).Also the previous studies in COPD patients have shown that

the serum hs-CRP is related to severity of airflow obstruction (25,26).

Fig. 2. The frequency of GOLD stages in mustard lung patients (9)

Fig. 3. The correlation of FEV1 and hs-CRP in mustard lung patients (8)

cross" (it was a symbol means "skin damaging agent" during world war I) (11,12) .It is a colorless to yellowish- brown oily liquid at room temperature that converts to a gas with weapon system delivery (3,11).It has the odor of mustard, garlic, or onion (3 ).

Fig. 1. Molecular structure of sulfur mustard

SM is absorbed by different ways: inhalation, through the skin, eyes, and gasterointestinal tract due to consumption of contaminated food (3 ).In large amount exposure, it can cause damages in rapid proliferating tissues particularly bone marrow (3 ).SM can cause different biochemical reactions and alterations in DNA structure ( 1).
