Abstract
Purpose
Case reports suggest that deaths due to asthma can occur without airway plugging.
In this study, we examined the hypothesis that obstruction of the airway lumen by
an exudate containing mucus and cells is a key feature of fatal asthma attacks.
Methods
We quantified airway narrowing and lumenal content in 275 airways from 93 patients
with fatal asthma aged 10 to 49 years (59 white subjects and 34 Polynesian subjects,
including 19 children), compared with airways from control patients who died suddenly
without pulmonary diseases.
Results
The severity of lumenal occlusion ranged from 4% to 100% in these cases, but only
five airways showed less than 20% occlusion. Compared with controls, patients with
asthma had more lumenal occlusion (mean [± SD] open lumen, 42% ± 23% vs. 93% ± 8%),
greater mucus occlusion (28% ± 13% vs. 5% ± 6%), and more occlusion by cells (30%
± 17% vs. 3% ± 2%, all P<0.0001). Airway narrowing was greater in larger airways (P<0.0001) and older patients (P = 0.009). Greater lumen content was associated with a higher proportion of cells
(P = 0.003), and cells made up a higher proportion of the exudate in the small airways
(P<0.0001). Lumenal mucus was greater in younger patients with asthma (P = 0.0007) and in Polynesian patients with asthma (P = 0.04).
Conclusion
Airway lumenal obstruction by an exudate composed of mucus and cells is a major contributing
cause of fatal asthma in most patients.
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Article info
Publication history
Accepted:
March 10,
2003
Received:
July 16,
2002
Footnotes
☆Supported by the British Columbia Lung Association, a Canadian Institute of Respiratory and Circulatory Health Research grant (#42537), and a National Institutes of Health grant (#HL64068).
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
