Characterization of autopsy-proven fatal asthma patients in São Paulo, Brazil

Mauad, Thaís; Ferreira, Diogenes S.; Costa, Maria Beatriz G; Araujo, Bianca; Silva, Luiz Fernando F.; Martins, Mílton A.; Wenzel, Sally E.; Dolhnikoff, Marisa

doi:10.1590/s1020-49892008000600007

Cited by 18 publications

(12 citation statements)

References 27 publications

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“…Moreover, a child is admitted to a hospital from an ED approximately once every 6 hr. While asthma fatalities were rare in this database, most asthma fatalities occur outside of the hospital and represent tragedies that can and must be prevented 25, 26. Clearly, ED asthma presentations are common and warrant attention from clinicians, administrators, and policy‐makers.…”

Section: Discussionmentioning

confidence: 97%

“…While asthma fatalities were rare in this database, most asthma fatalities occur outside of the hospital and represent tragedies that can and must be prevented. 25,26 Clearly, ED asthma presentations are common and warrant attention from clinicians, administrators, and policy-makers. The large sample size allowed this study to identify important epidemiological trends and outcome information.…”

Section: Discussionmentioning

confidence: 99%

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Asthma presentations by children to emergency departments in a Canadian province: A population‐based study

Rosychuk

Voaklander

Klassen

et al. 2010

Pediatric Pulmonology

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Acute asthma is an important and relatively common ED presentation in childhood. Despite guidelines and improved treatments, this study failed to identify decreased presentation rates over time; disparities were based on age, sex, and socio-economic/cultural status. Few children were reassessed within a week of their ED visit. Further study is required to understand the factors associated with these variations and the effectiveness of interventions targeted at specific groups to reduce the asthma-related ED visits.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Asthma presentations by children to emergency departments in a Canadian province: A population‐based study

Rosychuk

Voaklander

Klassen

et al. 2010

Pediatric Pulmonology

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“…Our fatal asthma population is characterized by low use of inhaled steroids and lack of regular medical care, all known risk factors for asthma complications and death, and lung functions studies were absent in the majority of patients (21). An important confounding factor is that all COPD patients were using inhaled and low dose oral corticosteroid, whereas a smaller number of the asthmatics used them regularly.…”

Section: Discussionmentioning

confidence: 99%

Airway Dimensions in Fatal Asthma and Fatal COPD: Overlap in Older Patients

Senhorini¹,

Ferreira²,

Shiang³

et al. 2013

COPD: Journal of Chronic Obstructive Pulmonary Disease

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In some patients with chronic asthma clinical and physiological similarities with COPD may exist, such as partial reversibility to bronchodilators and persistent expiratory airflow obstruction. However, pathological data comparing both diseases in patients of similar age and disease severity are scarce. We compared large and small airway dimensions in 12 younger (mean age 32 yrs) and 15 older (mean age 65 yrs) non-smoker adult fatal asthma patients with 14 chronic smokers with severe, fatal COPD (mean age 71 yrs). Using H&E, Movat pentachrome staining and image analysis, we quantified large airway basement membrane (BM) thickness (μm), submucosal gland area and large and small airway inner wall, smooth muscle and outer wall areas. Areas were normalized by BM perimeter (μm(2)/μm). Younger adult fatal asthma patients had thicker BM, smooth muscle, and outer wall areas in both small and large airways when compared to COPD patients. In older asthmatics there was an overlap in BM thickness and airway structure in small airways. Inner wall layer in large and small airway level and submucosal gland areas were similar among groups. In conclusion, there are airway histological structural similarities between fatal asthma and fatal COPD. Older fatal asthmatics present overlapping airway structural features with younger adult fatal asthmatics and severe COPD patients. Our data contributes to a better understanding of asthma pathology in the elderly.

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“…All had a history of asthma and no other lung disease. Clinical data including treatment, smoking habits, duration of disease and previous hospitalisations were obtained by administering a questionnaire to the relatives 19. Three control subjects were studied, all non-smokers with no history of asthma, wheeze, use of asthma medications or other lung disease and no gross or microscopic evidence of asthma at autopsy.…”

Section: Methodsmentioning

confidence: 99%

Increased myoepithelial cells of bronchial submucosal glands in fatal asthma

Green

Williams

James

et al. 2009

Thorax

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Background: Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion. Objectives: To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma. Methods: Autopsied lungs from 12 patients with fatal asthma (FA), 12 patients with asthma dying of nonrespiratory causes (NFA) and 12 non-asthma control cases (NAC) were obtained through the Prairie Provinces Asthma Study. Transverse sections of segmental bronchi from three lobes were stained for mucus and smooth muscle actin and the area fractions of mucous plugs, mucous glands and myoepithelial cells determined by point counting. The fine structure of the myoepithelial cells was examined by electron microscopy. Results: FA was characterised by significant increases in mucous gland (p = 0.003), mucous plug (p = 0.004) and myoepithelial cell areas (p = 0.017) compared with NAC. When the ratio of myoepithelial cell area to total gland area was examined, there was a disproportionate and significant increase in FA compared with NAC (p = 0.014). Electron microscopy of FA cases revealed hypertrophy of the myoepithelial cells with increased intracellular myofilaments. The NFA group showed changes in these features that were intermediate between the FA and NAC groups but the differences were not significant. Conclusions: Bronchial mucous glands and mucous gland myoepithelial cell smooth muscle actin are increased in fatal asthma and may contribute to asphyxia due to mucous plugging.The World Health Organization estimates that 255 000 people died of asthma in 2005 and that 300 million people are currently affected by asthma.

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Characterization of autopsy-proven fatal asthma patients in São Paulo, Brazil

Cited by 18 publications

References 27 publications

Asthma presentations by children to emergency departments in a Canadian province: A population‐based study

Asthma presentations by children to emergency departments in a Canadian province: A population‐based study

Airway Dimensions in Fatal Asthma and Fatal COPD: Overlap in Older Patients

Increased myoepithelial cells of bronchial submucosal glands in fatal asthma

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