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. 2003 Jul;115(1):6-11.
doi: 10.1016/s0002-9343(03)00241-9.

Characterization of airway plugging in fatal asthma

Laura M Kuyper  1 , Peter D Paré, James C Hogg, Rodney K Lambert, Diana Ionescu, Ryan Woods, Tony R Bai
Affiliations

Characterization of airway plugging in fatal asthma

Laura M Kuyper et al. Am J Med. 2003 Jul.

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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Comment in

  • The role of mucus in fatal asthma.
    Hays SR, Fahy JV. Hays SR, et al. Am J Med. 2003 Jul;115(1):68-9. doi: 10.1016/s0002-9343(03)00260-2. Am J Med. 2003. PMID: 12867239 No abstract available.
  • Mucus and fatal asthma.
    Groneberg DA, Wagner U, Chung KF. Groneberg DA, et al. Am J Med. 2004 Jan 1;116(1):66-7; author reply 67. doi: 10.1016/j.amjmed.2003.08.023. Am J Med. 2004. PMID: 14706672 No abstract available.

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