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Respir Med. 2013 Sep;107(9):1423-30. doi: 10.1016/j.rmed.2013.06.012. Epub 2013 Jul 5.

Effect of therapeutic arsenic exposure on pulmonary function.

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Division of Respiratory Medicine, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region.



Arsenic-contaminated drinking water has been associated with respiratory diseases and lung function impairment. Oral arsenic trioxide (ATO) is a standard treatment for acute promyelocytic leukaemia. This study aimed to explore the effect of therapeutic exposure to arsenic on lung function.


This was a case-control cross-sectional study on patients with haematological malignancies with or without exposure to ATO. Full lung function tests and serum Clara cell protein 16 (CC16) were measured.


There were 57 cases (arsenic exposed) and 57 matched controls (arsenic non-exposed) recruited. Among cases, the median duration of ATO exposure was 519 (194-1259) days. The mean FEV(1)/FVC ratio, FEV(1) (% predicted), and RV/TLC (%), as well as % subjects with FEV(1)/FVC below lower limits of normal (LLN), were similar in the two groups with or without arsenic exposure. However the mean TLC (% predicted) and DLCO/VA were significantly higher in arsenic-exposed versus non-exposed group (p = 0.01 and p = 0.008 respectively). There were mildly reduced FEV(1)/FVC ratio and FEF(25-75) (% predicted), largely within normal limits, among high level arsenic exposure compared with non-exposure (p = 0.01 and p = 0.05 respectively). Serum CC16 was comparable among both arsenic exposed and non-exposed groups.


Therapeutic use of oral ATO for a median of around 1.5 years was not associated with clinically significant lung function impairment.


APL; ATO; Arsenic trioxide; CC16; Clara cell protein; Clara cell protein 16; DLCO; DLCO/VA; FEF(25–75); FEV(1); FVC; IQR; Leukaemia; Lung function; RV; SD; TLC; acute promyelocytic leukaemia; arsenic trioxide; diffusing capacity corrected for haemoglobin; forced expiratory flow between 25% and 75% of FVC; forced expiratory volume in one second; forced vital capacity; interquartile range; residual volume; standard deviation; total lung capacity; transfer factor

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