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The most frequent clinical presentation is the milder myopathic Type III form, which manifests with fluctuating proximal and axial myopathy with exercise intolerance and occasionally respiratory insufficiency [138] or rhabdomyolysis, although often with hepatomegaly, encephalopathy, and episodic lethargy, as well as vomiting and hypoglycemia often triggered by metabolic stress, episodes of which have been lethal in 5% of patients [140]

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Jen Riegle, a naturopathic physician and cofounder of IHAN, who pointed out that patients do better “when they can take [nebulized glutathione] every day for one of two months.” Even after a single treatment, she said, firefighters are so enthusiastic “that they have immediately sent other people in their department to us, and word has quickly spread to other departments.” That’s a testament to the therapeutic value of even a single dose of glutathione, she said — and to the fact these firefighters had endured “some of the most serious exposures I’ve ever seen,” she said