**6. Clinical manifestations**

234 Chronic Obstructive Pulmonary Disease – Current Concepts and Practice

Furthermore, the BODE (body mass index, obstruction, dyspnea, and exercise capacity) index, that is more reliable parameter of COPD morbidity and mortality, was significantly

Additionally increased levels of IL-8 in the bronchoalveolar lavage fluid of patients with sulfur mustard poisoning and late pulmonary complications have been demonstrated (15) Despite these studies, few studies reported that inflammatory mediators probably do not have any major role in the pathogenesis and persistence of pulmonary complications of

Fig. 4. The correlation of FEV1 and IL-6 in mustard lung patients (9)

correlated with the serum IL-6 level (Fig 5) (9).

Fig. 5. The correlation of BODE index and serum IL-6 (9)

sulfur mustard exposure (27).

The most common compliant of mustard lung patients is chronic cough (12).A study showed that a triad of cough, expectoration and dyspnea was found in more than 80% of Iranian veterans 3 years after the exposure (1,28).

On physical examination, crackles, wheezing, and rhonchi depending to the state of the patient, can be seen (12, 29).The attacks of COPD exacerbation with increasing the severity of dyspnea, cough, and discoloration of sputum, is a common clinical presentation (12, 30).

The late pulmonary complications of SM injury may occur in patients who had not developed acute symptoms (12).A study on patients who did not have acute symptoms showed that 38% of these patients had air trapping on high resolution CT (HRCT) of chest (31).

Our previous studies on exercise tolerance of mustard lung patients have shown that the mean exercise capacity of these patients measured by 6 minute walk distance test (6MWD) has been decreased in comparison of normal population (8,9 ).Also the evaluation of quality of life in mustard lung patients showed significant impairment in this assessment by saint George respiratory questionnaire (SGRQ) (8,9,32).Additionally ,in our study the BODE (body mass index, obstruction, dyspnea, and exercise capacity) index had significant correlation with the serum level of inflammatory markers (8,9).
