Long-term pulmonary complications of chemical weapons exposure in former poison gas factory workers

Abstract

Context: Sulfur mustard (SM) and lewisite are vesicant chemical warfare agents that can cause skin blistering and chronic lung complications. During 1929–1945, a Japanese factory produced poisonous gases, which included SM, lewisite and other chemical weapons. The aim of this study was to investigate the chest computed tomography (CT) findings among long-term survivors who worked at this factory.

Methods: During 2009–2012, we evaluated chest CT findings from 346 long-term survivors who worked at the poison gas factory. Skin lesions were used as an indicator of significant exposure to vesicant agents.

Results: Among the 346 individuals, 53 (15%) individuals experienced skin lesions while working at the factory, and chest CT revealed abnormal findings in 179 individuals (52%). Emphysema was the most common CT finding and was observed in 75 individuals (22%), while honeycombing was observed in 8 individuals (2%). Emphysema and honeycombing were more prevalent among individuals with skin lesions, compared to individuals without skin lesions. Multivariate analyses revealed significant associations between the presence of emphysema and skin lesions (p = 0.008). Among individuals who never smoked, individuals with skin lesions (n = 26) exhibited a significantly higher rate of emphysema, compared to individuals without skin lesions (n = 200) (35% versus 7%, respectively; p < 0.001).

Conclusion: Among the long-term survivors who worked at the poison gas factory, a history of skin lesions was associated with the presence of emphysema, even among never smokers, which suggests that emphysema might be a long-term complication of exposure to chemical warfare agents.

• Chemical warfare
• respiratory disorder
• skin injury
• sulfur mustard

Acknowledgements

The authors thank Dr Kameda, Dr Yoshimatsu and Dr Taniwaki for reviewing the CT data.

Declaration of interest

The authors have no potential conflicts of interest with any companies/organizations whose products or services were discussed in this article. This work was partially supported by a grant for the group conducting “Research on the Aftereffects and Prognosis of Poison Gas Injuries” from the Japanese Ministry of Health, Labor and Welfare.

Supplementary material available online