8/5/2016

Asthama | Forensic Pathology Online

Asthama|ForensicPathologyOnline

Asthama
WrittenbyDr.D.Rao

ASTHMADEATHS
Scenepresenceofinhalers
Historymaybeabsent/incorrectanyallergenexposure?Iatrogeniccauseofattacke.g.bronchoscopy,B
blockersetc
Externalexcludetrauma/subcutaneousemphysema
Internal
Lungshyperinflationoutlinesofribspresentonsurfacelungsmayresistpressuretocollapsethem
petechialhaemorrhagebeneathvisceralpleuraairwayplugging(occlusive,tenacious,viscid)congested/
oedematousmucosa
Histology
Mucuspluggingofairways(increasedbronchialglandsecretions,upregulationofmucingeneMUC5AC
gobletcellhyperplasia)
Epithelialloss(desquamationatlevelofcolumnarcellsleavingintactbasallayer.Clumpsofepithelialcells
(creolabodies)seeninsputumofasthmatics,especiallyduringexacerbations.Maybeduetodamagefrom
eosinophilgranuleproteinsselectivedownregulationofintercellularadhesionsorviralinfection.May
contributetohyperresponsivenessduetoexposureofunderlyingsensorynerves,alossofepitheliumderived
relaxingfactorsandareducedmucociliaryclearance)
Neutrophiliaofairwaywalls(neuralsensitivityandsuddenairwaynarrowing)
Bronchialglandductectasia/gobletcellmetaplasiaaroundnecksofglands(duetoraisedintrabronchial
pressureduringacuteasthmaattacksobstructionofmouthsofmucusglandsbyviscidmucusplugsand
weakeningofductwallssecondarytoperiductalinflammatoryinfiltrate
Inflammationofbronchialwallspredominantlyeosinophilsandlymphocytes(CD8+cytotoxicTcells)higher
numberofbasophils(whichcanreleasehistamine,leukotrienesandcytokineswhichmaycontributetopoor
diseaseoutcome)

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8/5/2016

Asthama | Forensic Pathology Online

Remodellingofairways(increasetotalwallareaduetoincreasedsmoothmusclethickening,cartilage/
basementmembranethickeningandincreaseinmucusglandarea)
Airwaybloodvesseldilatation/permeability(increaseinflammatoryexudate)
Causeofdeathdetermination
Asthmaonitsownnotenoughneedevidenceofdiseaseseverity(severeinflammation/mucusplugs
inadequatetreatmenthistory/complianceproblems/knownseveredisease)
DifferentialDiagnosis
PEcancauserecurrentwheezeandreactiveoutpouringofmucus(butnottenaciousnopluggingnot
infiltratedwithinflammatorycells)
COPDmaycoexistmicroscopicfeaturesofemphysemamaybevisiblepresenceofRightVentricular
HypertrophyshouldalertonetoCOPD)
SickleCellcrisesmaybeprecipitatedbysevereasthma/hypoxia
Anaphylaxiscangetedema/plugging/hyperinflationnoairwayremodeling(nb.SerumBtryptase(markerof
mastcelldegranulation)maybeofhelp,butnotverysensitive)
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