**9. References**


Unfortunately, there are no cure for mustard lung disease (11 ).Bronchodilators, inhaled steroids, long- term oxygen therapy, and pulmonary rehabilitation are different therapeutical strategies which are used in these patients (11 ).The combination of long – acting beta agonists (LABAs) and inhaled steroids has been shown to be effective (11,38,39 ). In mustard lung patients, systemic steroid is only recommended during exacerbations (11).The prolonged use of systemic steroids should be avoided because of severe

As we mentioned earlier, the oxidative – antioxidative imbalance may be an underlying mechanism in mustard lung patients. So the potent antioxidant agents are tried for this purpose. N-Acetylcysteine is an antioixidat and mucolytic drug that in double- blind clinical trial, improved dyspnea, cough, and sputum after 4 months of treatment (11,40).

SM can cause serious late pulmonary complications. A unique form of COPD, known as mustard lung, is frequently encountered in patients .Systemic inflammation may be involved in pathogenesis of mustard lung. Unfortunately there is no cure for these patients.

[1] Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard

[2] Ghanei M, Amiri S, Akbari H, et al. Correlation of sulfur mustard exposure and tobacco

[3] Balali-Mood M, Hefazi M, Mahmoudi M, et al. Long-term complications of sulfur

[4] Khateri S, Ghanei M, Keshavarz S, Soroush M, Hainez D. Incidence of lung, eye, and

[5] Jafari M, Ghanei M. Evaluation of plasma, erythrocytes, and bronchoalveolar lavage

[6] Wigenstam E, Rocksén D, Ekstrand-Hammarstr◌ِ m B, Bucht A. Treatment with

[7] Ghanei M, Amiri S, Akbari H, et al. Correlation of sulfur mustard exposure and tobacco

[8] Attaran D, Lari SM, Khajehdaluee M, et al. Highly sensitive C-reactive protein levels in

use with expression (immunoreactivity) of p53 protein in bronchial epithelium of

mustard poisoning in severely intoxicated Iranian veterans. *Fundam Clin Pharmacol*.

skin lesions as late complications in 34,000 Iranians with wartime exposure to

fluid antioxidant defense system in sulfur mustard-injured patients*. Clin Toxicol* 

dexamethasone or liposome-encapsuled vitamin E provides beneficial effects after

use with expression (immunoreactivity) of p53 protein in bronchial epithelium of

Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases.*Hum Exp Toxicol*. 2009; 28:739 –745.

in Iranian veterans.Basic Clin Pharmacol Toxicol 2006; 99: 273–282.

Iranian "mustard lung" patients. *Mil Med*. 2007;172:70–74.

mustard agent. *J Occup Environ Med*. 2003;45:1136–1143.

chemical-induced lung injury. *Inhal Toxicol*. 2009;21:958–964.

Iranian ''mustard lung'' patients. Mil Med 2007; 172: 70–74.

**Treatment** 

complication (39).

**8. Conclusion** 

**9. References** 

2005;19:713–721.

*(Phila)*. 2010;48:184–192.


**12** 

*Spain* 

**Chronic Obstructive Pulmonary** 

The progressive increase in the average age of the population leads to chronic diseases that are increasingly important. Chronic conditions are large in number, the prevalence of each one is high and so does the annual cost of their care. Moreover, clinicians alert about the impact of one disease on the development and severity of others. Among chronic morbidities the most prevalent are cardiovascular disease (CV), cancer, diabetes *mellitus* (DM) and chronic obstructive pulmonary disease (COPD) (Chillón et al., 2009). Noticeably, a 25% of patients older than 65 years have two chronic conditions and this figure rises to 40%

The following text focuses on two of these pathologies: COPD and DM. Our group provided data on COPD pathophysiology, particularly about hypoxia and related oxidative stress, the effect of nutritional status, physical exercise and sleep disorders (Álvarez-Sala R, 2010; García-Río et al., 2009, 2011; Braghiroli & Álvarez-Sala, 2010; Alcolea et al., 2007). In addition, the sleep apnea hypopnea syndrome (SAHS), its association with metabolic syndrome (MS) constituents and the sum of SAHS plus COPD in the so called "overlap syndrome" were studied (Santiago-Recuerda et al., 2007; De Miguel et al., 2002). We made a search in PubMed including articles published during the last ten years about COPD and DM, in order to review how one disease influences the onset, evolution, treatment and

**2. Chronic obstructive pulmonar disease and diabetes** *mellitus* **definitions,** 

COPD is defined as a preventable and treatable entity caused by toxic gases, mainly tobacco. Its main feature is poorly reversible obstruction of airflow that is progressive and is associated with a systemic inflammatory response (Álvarez-Sala, 2010). This proinflammatory state may lead to extrapulmonary manifestations (Global initiative for obstructive lung disease [GOLD], 2008) in the majority of patients have a negative effect on the overall prognosis of the disease (Peces Barba et al., 2008). Its prevalence sharply

**1. Introduction** 

prognosis of the other one.

**epidemiology and comorbidities** 

in population over 75 years old (Chatila et al., 2008).

**Disease and Diabetes** *Mellitus*

Elisabet Martinez-Ceron1, Beatriz Barquiel2, Luis Felipe Pallardo2 and Rodolfo Alvarez-Sala1

> *1Department of Neumology 2Department of Endocrinology,*

*Hospital Universitario La Paz, Madrid* 

