JMERC
Owner
Janbazan Medical and Engineering Research Center (JMERC) is the owner of IJWPH.
0.5
Cite Score
SJR: 0.129 / SNIP: 0.140
Volume 17, Issue 3 (2025)
Iran J War Public Health 2025, 17(3): 299-307 |
Back to browse issues page
Article Type:
Subject:
History
Received: 2025/05/20 | Accepted: 2025/07/18 | Published: 2025/07/30
Received: 2025/05/20 | Accepted: 2025/07/18 | Published: 2025/07/30
How to cite this article
Mousavi B, Behzad Basirat Z. Pro-Inflammatory and Anti-Inflammatory Cytokines in Sulfur Mustard Exposed Survivors; An Analytical Review. Iran J War Public Health 2025; 17 (3) :299-307
URL: http://ijwph.ir/article-1-1596-en.html
URL: http://ijwph.ir/article-1-1596-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rights and permissions
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Authors
B. Mousavi *1, Z. Behzad Basirat2
1- Prevention Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
2- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
2- Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
Abstract (614 Views)
Introduction: This study reviewed the impact of sulfur mustard on biomarkers, particularly the expression of pro-inflammatory and anti-inflammatory cytokines, among exposed survivors after approximately 10 to 30 years of exposure. The review collected studies on human exposure to sulfur mustard. Sulfur mustard exposure was associated with alteration of biomarkers, including pro-inflammatory mediators (IL-1β, IL-6, TNF-α, BDNF, GM-CSF) and anti-inflammatory mediators (IL-4, IL-10). The long-term effects of sulfur mustard on inflammatory biomarkers warrant further, in-depth mechanistic studies to elucidate potential therapeutic interventions targeting these pathways.
Conclusion: Sulfur mustard induces significant changes in inflammatory markers, including pro-inflammatory (e.g., TNF-α, IL-1β, IL-6) and anti-inflammatory cytokines. These changes indicate activation of the innate immune system and initiation of a severe inflammatory response.
Conclusion: Sulfur mustard induces significant changes in inflammatory markers, including pro-inflammatory (e.g., TNF-α, IL-1β, IL-6) and anti-inflammatory cytokines. These changes indicate activation of the innate immune system and initiation of a severe inflammatory response.
Keywords:
References
1. Kozlov MY, Ashvits IV. History of the use of chemical weapons for military purposes and the possibility of their current use. Sci Bull Omsk State Med Univ. 2024;4(1):75-86. [Link] [DOI:10.61634/2782-3024-2024-13-75-86]
2. Butera E, Zammataro A, Pappalardo A, Trusso Sfrazzetto G. Supramolecular sensing of chemical warfare agents. Chempluschem. 2021;86(4):681-95. [Link] [DOI:10.1002/cplu.202100071]
3. Amini H, Solaymani-Dodaran M, Mousavi B, Alam Beladi SN, Soroush MR, Abolghasemi J, et al. Long-term health outcomes among survivors exposed to sulfur mustard in Iran. JAMA Netw Open. 2020;3(12):e2028894. [Link] [DOI:10.1001/jamanetworkopen.2020.28894]
4. Taebi G, Soroush M, Modirian E, Khateri S, Mousavi B, Ganjparvar Z, et al. Human costs of Iraq's chemical war against Iran; An epidemiological study. Iran J War Public Health. 2015;7(2):115-21. [Persian] [Link]
5. Mehdizadeh P, Ghanei M, Pourreza A, Akbari-Sari A, Mousavi B, Darroudi R. Healthcare utilization and expenditures among Iranian chemical warfare survivors exposed to sulfur mustard. Arch Iran Med. 2022;25(4):241-9. [Link] [DOI:10.34172/aim.2022.40]
6. Mousavi B, Asgari M, Soroush M, Montazeri A. Psychiatric disorder and quality of life in female survivors of the Iran-Iraq war; Three decades after injuries. Iran J War Public Health. 2021;13(1):41-7. [Link]
7. Soroush MR, Ganjparvar Z, Mousavi B. Human casualties and war: Results of a national epidemiologic survey in Iran. Arch Iran Med. 2020;23(4 Suppl 1):S33-7. [Link] [DOI:10.34172/aim.2020.s7]
8. Mousavi B, Maftoon F, Soroush M, Mohammad K, Majdzadeh R. Health care utilization and expenditure in war survivors. Arch Iran Med. 2020;23(4 Suppl 1):S9-15. [Link] [DOI:10.34172/aim.2020.s3]
9. Zafarghandi MR, Soroush MR, Mahmoodi M, Naieni KH, Ardalan A, Dolatyari A, et al. Incidence of cancer in Iranian sulfur mustard exposed veterans: A long-term follow-up cohort study. Cancer Causes Control. 2013;24(1):99-105. [Link] [DOI:10.1007/s10552-012-0094-8]
10. Kehe K, Balszuweit F, Steinritz D, Thiermann H. Molecular toxicology of sulfur mustard-induced cutaneous inflammation and blistering. Toxicology. 2009;263(1):12-9. [Link] [DOI:10.1016/j.tox.2009.01.019]
11. Soroush M, Akhavizadegan H, Mousavi B. Health problems in survivors exposed to sulfur mustard with severe respiratory complications. Iran J War Public Health. 2020;12(2):109-14. [Persian] [Link] [DOI:10.29252/ijwph.12.2.109]
12. Morcuende A, Navarrete F, Nieto E, Manzanares J, Femenía T. Inflammatory biomarkers in addictive disorders. Biomolecules. 2021;11(12):1824. [Link] [DOI:10.3390/biom11121824]
13. Medzhitov R. The spectrum of inflammatory responses. Science. 2021;374(6571):1070-5. [Link] [DOI:10.1126/science.abi5200]
14. Danforth DN. The role of chronic inflammation in the development of breast cancer. Cancers. 2021;13(15):3918. [Link] [DOI:10.3390/cancers13153918]
15. Michaud M, Balardy L, Moulis G, Gaudin C, Peyrot C, Vellas B, et al. Proinflammatory cytokines, aging, and age-related diseases. J Am Med Dir Assoc. 2013;14(12):877-82. [Link] [DOI:10.1016/j.jamda.2013.05.009]
16. Monastero RN, Pentyala S. Cytokines as biomarkers and their respective clinical cutoff levels. Int J Inflam. 2017;2017:4309485. [Link] [DOI:10.1155/2017/4309485]
17. Yaraee R, Ghazanfari T, Ebtekar M, Ardestani SK, Rezaei A, Kariminia A, et al. Alterations in serum levels of inflammatory cytokines (TNF, IL-1alpha, IL-1beta and IL-1Ra) 20 years after sulfur mustard exposure: Sardasht-Iran cohort study. Int Immunopharmacol. 2009;9(13-14):1466-70. [Link] [DOI:10.1016/j.intimp.2009.09.001]
18. Jayaraman P, Sada-Ovalle I, Nishimura T, Anderson AC, Kuchroo VK, Remold HG, et al. IL-1β promotes antimicrobial immunity in macrophages by regulating TNFR signaling and caspase-3 activation. J Immunol. 2013;190(8):4196-204. [Link] [DOI:10.4049/jimmunol.1202688]
19. Ghasemi H, Javadi MA, Ardestani SK, Mahmoudi M, Pourfarzam S, Mahdavi MRV, et al. Alteration in inflammatory mediators in seriously eye-injured war veterans, long-term after sulfur mustard exposure. Int Immunopharmacol. 2020;80:105897. [Link] [DOI:10.1016/j.intimp.2019.105897]
20. Mishra N, Agarwal R. Research models of sulfur mustard- and nitrogen mustard-induced ocular injuries and potential therapeutics. Exp Eye Res. 2022;223:109209. [Link] [DOI:10.1016/j.exer.2022.109209]
21. Tapak M, Sadeghi S, Ghazanfari T, Mossafa N, Mirsanei SZ, Masiha Hashemi SM. Mesenchymal stem cell therapy mitigates acute and chronic lung damages of sulfur mustard analog exposure. Iran J Allergy Asthma Immunol. 2024;23(5):563-77. [Link] [DOI:10.18502/ijaai.v23i5.16751]
22. Cruz-Hernandez A, Mendoza RP, Nguyen K, Harder A, Evans CM, Bauer AK, et al. Mast cells promote nitrogen mustard-mediated toxicity in the lung associated with proinflammatory cytokine and bioactive lipid mediator production. Toxicol Sci. 2021;184(1):127-41. [Link] [DOI:10.1093/toxsci/kfab107]
23. Hassanpour H, Mojtahed M, Fallah AA, Najafi-Chaleshtori S. Effect of mustard analogs on cytokine profile in rodents: A systematic review and meta-analysis. Int Immunopharmacol. 2024;143(Pt 2):113465. [Link] [DOI:10.1016/j.intimp.2024.113465]
24. Panahi Y, Jadidi-Niaragh F, Jamalkandi SA, Ghanei M, Pedone C, Nikravanfard N, et al. Immunology of chronic obstructive pulmonary disease and sulfur mustard induced airway injuries: Implications for immunotherapeutic interventions. Curr Pharm Des. 2016;22(20):2975-96. [Link] [DOI:10.2174/1381612822666160307150818]
25. Salpea KD, Maubaret CG, Kathagen A, Ken-Dror G, Gilroy DW, Humphries SE. The effect of pro-inflammatory conditioning and/or high glucose on telomere shortening of aging fibroblasts. PLoS One. 2013;8(9):e73756. [Link] [DOI:10.1371/journal.pone.0073756]
26. Sierawska O, Małkowska P, Taskin C, Hrynkiewicz R, Mertowska P, Grywalska E, et al. Innate immune system response to burn damage-focus on cytokine alteration. Int J Mol Sci. 2022;23(2):716. [Link] [DOI:10.3390/ijms23020716]
27. Haines DD, Cowan FM, Tosaki A. Evolving strategies for use of phytochemicals in prevention and long-term management of cardiovascular diseases (CVD). Int J Mol Sci. 2024;25(11):6176. [Link] [DOI:10.3390/ijms25116176]
28. Kempf CL, Song JH, Sammani S, Bermudez T, Reyes Hernon V, Tang L, et al. TLR4 ligation by eNAMPT, a novel DAMP, is essential to sulfur mustard-induced inflammatory lung injury and fibrosis. Eur J Respir Med. 2024;6(1):389-97. [Link] [DOI:10.31488/EJRM.141]
29. Amiri M, Jafari M, Azimzadeh Jamalkandi S, Davoodi SM. Atopic dermatitis-associated protein interaction network lead to new insights in chronic sulfur mustard skin lesion mechanisms. Expert Rev Proteomics. 2013;10(5):449-60. [Link] [DOI:10.1586/14789450.2013.841548]
30. Khaheshi I, Keshavarz S, Imani Fooladi AA, Ebrahimi M, Yazdani S, Panahi Y, et al. Loss of expression of TGF-βs and their receptors in chronic skin lesions induced by sulfur mustard as compared with chronic contact dermatitis patients. BMC Dermatol. 2011;11:2. [Link] [DOI:10.1186/1471-5945-11-2]
31. Hirano T. IL-6 in inflammation, autoimmunity and cancer. Int Immunol. 2021;33(3):127-48. [Link] [DOI:10.1093/intimm/dxaa078]
32. Angelini DJ, Dorsey RM, Willis KL, Hong C, Moyer RA, Oyler J, et al. Chemical warfare agent and biological toxin-induced pulmonary toxicity: could stem cells provide potential therapies? Inhal Toxicol. 2013;25(1):37-62. [Link] [DOI:10.3109/08958378.2012.750406]
33. Ershler WB, Keller ET. Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med. 2000;51:245-70. [Link] [DOI:10.1146/annurev.med.51.1.245]
34. Ghaedi GH, Nasiri L, Hassanpour H, Mehdi Naghizadeh M, Abdollahzadeh A, Ghazanfari T. Evaluation of serum BDNF, IL-1β, and IL-6 levels alongside assessing mental health and life satisfaction in sulfur mustard-chemical veterans. Int Immunopharmacol. 2024;143(Pt 2):113479. [Link] [DOI:10.1016/j.intimp.2024.113479]
35. Panahi Y, Ghanei M, Vahedi E, Ghazvini A, Parvin S, Madanchi N, et al. Effect of recombinant human IFNγ in the treatment of chronic pulmonary complications due to sulfur mustard intoxication. J Immunotoxicol. 2014;11(1):72-7. [Link] [DOI:10.3109/1547691X.2013.797525]
36. Ghaedi G, Ghasemi H, Mousavi B, Soroush MR, Rahnama P, Jafari F, et al. Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study. Health Qual Life Outcomes. 2012;10:36. [Link] [DOI:10.1186/1477-7525-10-36]
37. Jafari F, Guitynavard F, Soroush M, Mousavi B. Quality of life in chemical war victims with sever pulmonary damage. Iran J War Public Health. 2012;4(1):46-52. [Persian] [Link]
38. Jafari F, Moien L, Soroush M, Mousavi B. Quality of life in chemical warfare victims with ophthalmic damage's spouses. Iran J War Public Health. 2011;3(3):8-12. [Persian] [Link]
39. Assari S, Lankarani MM, Montazeri A, Soroush MR, Mousavi B. Are generic and disease-specific health related quality of life correlated? The case of chronic lung disease due to sulfur mustard. J Res Med Sci. 2009;14(5):285-90. [Link]
40. Mousavi B, Ganjparvar Z, Soroush M, Vadieh S. Health problems among chemical warfare survivors with ophthalmologic injuries. Iran J War Public Health. 2009;1(2):36-47. [Persian] [Link]
41. Mousavi B, Soroush MR, Montazeri A. Quality of life in chemical warfare survivors with ophthalmologic injuries: The first results form Iran Chemical Warfare Victims Health Assessment Study. Health Qual Life Outcomes. 2009;7:2. [Link] [DOI:10.1186/1477-7525-7-2]
42. Mousavi B, Khateri S, Soroush MR, Amini R, Masumi M, Montazeri A. Comparing quality of life between survivors of chemical warfare exposure and conventional weapons: Results of a national study from Iran. J Med CBR Def. 2011;8. [Link]
43. Assari S, Soroush MR, Khoddami Vishteh HR, Mousavi B, Ghanei M, Karbalaeiesmaeil S. Marital relationship and its associated factors in veterans exposed to high dose chemical warfare agents. J Fam Reprod Health. 2008;2(2):69-74. [Link]
44. Wang T, He C. TNF-α and IL-6: The link between immune and bone system. Curr Drug Targets. 2020;21(3):213-27. [Link] [DOI:10.2174/1389450120666190821161259]
45. Gonzalez Caldito N. Role of tumor necrosis factor-alpha in the central nervous system: A focus on autoimmune disorders. Front Immunol. 2023;14:1213448. [Link] [DOI:10.3389/fimmu.2023.1213448]
46. Wormser U, Brodsky B, Proscura E, Foley JF, Jones T, Nyska A. Involvement of tumor necrosis factor-alpha in sulfur mustard-induced skin lesion; Effect of topical iodine. Arch Toxicol. 2005;79(11):660-70. [Link] [DOI:10.1007/s00204-005-0681-5]
47. Mehdizadeh S, Salaree M, Ebadi A, Aslan J, Jafari N. Health-related quality of life in chemical warfare victims with bronchiolitis obliterans. Iran J Nurs Res. 2011;6(21):6-14. [Persian] [Link]
48. Dadkhah M, Baziar M, Rezaei N. The regulatory role of BDNF in neuroimmune axis function and neuroinflammation induced by chronic stress: A new therapeutic strategies for neurodegenerative disorders. Cytokine. 2024;174:156477. [Link] [DOI:10.1016/j.cyto.2023.156477]
49. Smith KJ, Hurst CG, Moeller RB, Skelton HG, Sidell FR. Sulfur mustard: Its continuing threat as a chemical warfare agent, the cutaneous lesions induced, progress in understanding its mechanism of action, its long-term health effects, and new developments for protection and therapy. J Am Acad Dermatol. 1995;32(5 Pt 1):765-76. [Link] [DOI:10.1016/0190-9622(95)91457-9]
50. Romano JA, Lukey BJ, Salem H, editors. Chemical warfare, chemical terrorism, and traumatic stress responses: An assessment of psychological impact. In: Chemical warfare agents: Chemistry, pharmacology, toxicology, and therapeutics. Boca Raton: CRC Press; 2007. [Link]
51. Golime R, Singh N. Chapter 29-Molecular interactions of chemical warfare agents with biological systems. In: Sensing of deadly toxic chemical warfare agents, nerve agent simulants, and their toxicological aspects. New York: Elsevier; 2023. p. 687-710. [Link] [DOI:10.1016/B978-0-323-90553-4.00028-7]
52. Boulle F, Van Den Hove DL, Jakob SB, Rutten BP, Hamon M, Van Os J, et al. Epigenetic regulation of the BDNF gene: Implications for psychiatric disorders. Mol Psychiatry. 2012;17(6):584-96. [Link] [DOI:10.1038/mp.2011.107]
53. Nasiri L, Hassanpour H, Ardestani SK, Ghazanfari T, Jamali D, Faghihzadeh E, et al. Health assessment of sulfur mustard-chemical veterans with various respiratory diseases: The result of a comparative analysis of biological health scores (BHS) through 50 biomarkers. Int Immunopharmacol. 2025;145:113767. [Link] [DOI:10.1016/j.intimp.2024.113767]
54. Lima Giacobbo B, Doorduin J, Klein HC, Dierckx RAJO, Bromberg E, De Vries EFJ. Brain-derived neurotrophic factor in brain disorders: Focus on neuroinflammation. Mol Neurobiol. 2019;56(5):3295-312. [Link] [DOI:10.1007/s12035-018-1283-6]
55. Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, et al. A large, cross-sectional observational study of serum BDNF, cognitive function, and mild cognitive impairment in the elderly. Front Aging Neurosci. 2014;6:69. [Link] [DOI:10.3389/fnagi.2014.00069]
56. Phillips C. Brain-derived neurotrophic factor, depression, and physical activity: Making the neuroplastic connection. Neural Plast. 2017;2017:7260130. [Link] [DOI:10.1155/2017/7260130]
57. Budni J, Bellettini-Santos T, Mina F, Garcez ML, Zugno AI. The involvement of BDNF, NGF and GDNF in aging and Alzheimer's disease. Aging Dis. 2015;6(5):331-41. [Link] [DOI:10.14336/AD.2015.0825]
58. Bhattacharya P, Thiruppathi M, Elshabrawy HA, Alharshawi K, Kumar P, Prabhakar BS. GM-CSF: An immune modulatory cytokine that can suppress autoimmunity. Cytokine. 2015;75(2):261-71. [Link] [DOI:10.1016/j.cyto.2015.05.030]
59. Hallsworth MP, Soh CP, Lane SJ, Arm JP, Lee TH. Selective enhancement of GM-CSF, TNF-alpha, IL-1 beta and IL-8 production by monocytes and macrophages of asthmatic subjects. Eur Respir J. 1994;7(6):1096-102. [Link] [DOI:10.1183/09031936.94.07061096]
60. Emad A, Emad Y. Increased granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) levels in BAL fluid from patients with sulfur mustard gas-induced pulmonary fibrosis. J Aerosol Med. 2007;20(3):352-60. [Link] [DOI:10.1089/jam.2007.0590]
61. Amiri S, Ghazanfari T, Yaraee R, Salimi H, Ebtekar M, Shams J, et al. Serum levels of GM-CSF 20 years after sulfur mustard exposure: Sardasht-Iran Cohort Study. Int Immunopharmacol. 2009;9(13-14):1499-503. [Link] [DOI:10.1016/j.intimp.2009.08.023]
62. Shiomi A, Usui T, Mimori T. GM-CSF as a therapeutic target in autoimmune diseases. Inflamm Regen. 2016;36:8. [Link] [DOI:10.1186/s41232-016-0014-5]
63. Keegan AD, Leonard WJ, Zhu J. Recent advances in understanding the role of IL-4 signaling. Fac Rev. 2021;10:71. [Link] [DOI:10.12703/r/10-71]
64. Matucci A, Vultaggio A, Maggi E, Kasujee I. Is IgE or eosinophils the key player in allergic asthma pathogenesis? Are we asking the right question?. Respir Res. 2018;19(1):113. [Link] [DOI:10.1186/s12931-018-0813-0]
65. Moin A, Khamesipour A, Hassan ZM, Ebtekar M, Davoudi SM, Vaez-Mahdavi MR, et al. Pro-inflammatory cytokines among individuals with skin findings long-term after sulfur mustard exposure: Sardasht-Iran Cohort Study. Int Immunopharmacol. 2013;17(3):986-90. [Link] [DOI:10.1016/j.intimp.2012.12.022]
66. Khazdair MR, Boskabady MH. Possible treatment approaches of sulfur mustard-induced lung disorders, experimental and clinical evidence, an updated review. Front Med. 2022;9:791914. [Link] [DOI:10.3389/fmed.2022.791914]
67. Panahi Y, Ghanei M, Hassani S, Sahebkar A. TGF-β and Th17 cells related injuries in patients with sulfur mustard exposure. J Cell Physiol. 2018;233(4):3037-47. [Link] [DOI:10.1002/jcp.26077]
68. Le Gros G, Ben-Sasson SZ, Seder R, Finkelman FD, Paul WE. Generation of interleukin 4 (IL-4)-producing cells in vivo and in vitro: IL-2 and IL-4 are required for in vitro generation of IL-4-producing cells. J Exp Med. 1990;172(3):921-9. [Link] [DOI:10.1084/jem.172.3.921]
69. Panahi Y, Ghanei M, Bashiri S, Hajihashemi A, Sahebkar A. Short-term curcuminoid supplementation for chronic pulmonary complications due to sulfur mustard intoxication: Positive results of a randomized double-blind placebo-controlled trial. Drug Res. 2015;65(11):567-73. [Link] [DOI:10.1055/s-0034-1389986]
70. Pourfarzam S, Ardestani SK, Jamali T, Ghazanfari H, Naghizadeh MM, Faghihzadeh S, et al. Distinct inflammatory profiles in mustard lung: A study of sulfur mustard-exposed patients with serious pulmonary complications. Int Immunopharmacol. 2025;146:113832. [Link] [DOI:10.1016/j.intimp.2024.113832]
71. Mosser DM, Zhang X. Interleukin-10: New perspectives on an old cytokine. Immunol Rev. 2008;226:205-18. [Link] [DOI:10.1111/j.1600-065X.2008.00706.x]
72. Ghazanfari Z, Ghazanfari T, Kermani-Jalilvand A, Yaraee R, Vaez-Mahdavi MR, Foroutan A, et al. Association of physical activity and IL-10 levels 20 years after sulfur mustard exposure: Sardasht-Iran cohort study. Int Immunopharmacol. 2009;9(13-14):1504-8. [Link] [DOI:10.1016/j.intimp.2009.08.025]
73. Hassanpour M, Hajihassani F, Abdollahpourasl M, Cheraghi O, Aghamohamadzade N, Rahbargazi R, et al. Pathophysiological effects of sulfur mustard on skin and its current treatments: Possible application of phytochemicals. Comb Chem High Throughput Screen. 2021;24(1):3-19. [Link] [DOI:10.2174/1386207323666200717150414]
74. De Vries JE. The role of IL-13 and its receptor in allergy and inflammatory responses. J Allergy Clin Immunol. 1998;102(2):165-9. [Link] [DOI:10.1016/S0091-6749(98)70080-6]
75. Nourani MR, Mahmoodzadeh Hosseini H, Azimzadeh Jamalkandi S, Imani Fooladi AA. Cellular and molecular mechanisms of acute exposure to sulfur mustard: A systematic review. J Recept Signal Transduct Res. 2017;37(2):200-16. [Link] [DOI:10.1080/10799893.2016.1212374]
76. Seyfizadeh N, Seyfizadeh N, Gharibi T, Babaloo Z. Interleukin-13 as an important cytokine: A review on its roles in some human diseases. ACTA MICROBIOLOGICA ET IMMUNOLOGICA HUNGARICA. 2015;62(4):341-78. [Link] [DOI:10.1556/030.62.2015.4.2]
77. Khazdair MR, Boskabady MH, Ghorani V. Respiratory effects of sulfur mustard exposure, similarities and differences with asthma and COPD. Inhal Toxicol. 2015;27(14):731-44. [Link] [DOI:10.3109/08958378.2015.1114056]