Chest
Volume 101, Issue 4, April 1992, Pages 916-921
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Clinical Investigations
Marked Goblet Cell Hyperplasia with Mucus Accumulation in the Airways of Patients Who Died of Severe Acute Asthma Attack

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To examine the changes in airways in bronchial asthma (BA) during an asthma attack causing death, we performed morphometric analysis of autopsied lungs from three outpatients who died of severe acute asthma attacks (group A) and compared these to five patients who died of non-status asthmaticus (group B). Controls (group NL) were four patients who died of diseases other than respiratory disorders. Area proportions of bronchial glands to bronchial wall (gland [percent]) and of goblet cells to total epithelial layer (goblet [percent]) and the intraluminal amount of mucus in the airways (MOR) were measured in a paraffin section. There were no significant differences in age, sex, smoking history, duration of BA history, and dosage of glucocorticoids received between groups A and B. Although both groups A and B showed significantly larger values of gland (percent) in the central airways and of inflammatory cell numbers in the airway walls than did group NL, no significant differences were observed between groups A and B. In contrast, markedly significant increases in goblet (percent) and in MOR were observed in group A compared to groups B and NL. These increases in group A were more dominant in the peripheral airway: 30-fold and threefold increases of group B in goblet (percent) and MOR, respectively. Furthermore, MOR significantly correlated with goblet (percent) in the peripheral airways (p<0.05). These findings suggest that a marked increase in goblet cells of the airways is a feature characteristic of patients with BA who die of a severe acute attack.

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MATERIALS AND METHODS

Autopsied lungs from eight patients with BA and four control patients from the past five yr were chosen for the present morphometric study. Clinical and laboratory data from the patients are shown in Table 1. Control lungs were obtained from four patients who died of nonrespiratory diseases, two of whom died of sudden coronary disease and two of whom died of cancer of the digestive tract (one female and three male patients; mean age, 64 ±4 yr [±SE]). All were clinically free of respiratory

RESULTS

A larger amount of mucus in the lumen was observed with the marked hyperplasia of goblet cells in the airways from patients in group A compared with those in groups B and NL. A representative light micrograph of a peripheral airway from a patient with BA in group A is shown in Figure 1.

No significant differences in the diameters of the central or peripheral airways were observed among the three groups. In central airways the diameter was 3.3 ±0.3 mm, 2.7 ±0.3 mm, and 3.1 ±0.3 mm in groups A, B,

DISCUSSION

In the present study, we found marked goblet cell hyperplasia with accumulation of mucus in the peripheral airways from patients who died of severe acute asthma attack.

The heterogeneity of the asthmatic population is known, as well as the type of death and the postmortem findings. Although increased production of viscid mucus causing airway plugging is known to be a common pathologic feature of deaths from asthma,4, 5, 6, 7 in some patients, sudden unexpected death occurs with the absence of

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    Manuscript received April 25; revision accepted July 1.

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