Hlavaty Leigh, Hansma Patrick, Sung LokMan
From the *Department of Pathology at the University of Michigan, Ann Arbor; †Wayne County Medical Examiner's Office, Detroit; and ‡Department of Pathology, William Beaumont Hospital, Royal Oak, MI.
Am J Forensic Med Pathol. 2015 Mar;36(1):49-52. doi: 10.1097/PAF.0000000000000138.
Asthma is a common disease in the United States and is frequently encountered during medicolegal autopsies. Patients are often young and have a witnessed collapse or are found dead. Opiate abuse is also pervasive and is repeatedly seen in death investigations. All cases over a 7-year period involving asthma investigated at the Wayne County Medical Examiner's Office were reviewed for demographics, circumstances, autopsy toxicology findings, and cause and manner of death. Ninety-four cases met these criteria. Ten cases (10.5%) were positive for opiates, 8 listed drugs as the cause of death, and 2 listed asthma. Of cases with established asthma opiate positivity, 8 (80%) were found dead, and only one had a witnessed collapse. Compared with those without opiate abuse, asthmatic patients abusing opiates had a higher mean age, no reported respiratory symptoms immediately preceding death, and higher frequency of being found dead. A discernable difference exists between deaths in asthmatic patients in the presence of opiates and those without. These findings indicate that it may be possible to predict the presence of opiates given history investigation information, thereby focusing toxicology panels to promote cost-effective practices when ordering supportive tests.
哮喘在美国是一种常见疾病，在法医学尸检中经常遇到。患者通常很年轻，有目击的昏厥情况或被发现死亡。阿片类药物滥用也很普遍，在死因调查中屡见不鲜。对韦恩县法医办公室在7年期间调查的所有涉及哮喘的病例进行了回顾，以了解人口统计学、情况、尸检毒理学结果以及死因和死亡方式。94例符合这些标准。10例（10.5%）阿片类药物检测呈阳性，8例将药物列为死因，2例将哮喘列为死因。在确诊哮喘且阿片类药物呈阳性的病例中，8例（80%）被发现死亡，只有1例有目击的昏厥情况。与无阿片类药物滥用的患者相比，滥用阿片类药物的哮喘患者平均年龄更高，死前无呼吸道症状报告，且被发现死亡的频率更高。有阿片类药物存在的哮喘患者死亡情况与无阿片类药物存在的哮喘患者死亡情况之间存在明显差异。这些发现表明，根据病史调查信息有可能预测阿片类药物的存在，从而在订购支持性检测时使毒理学检测项目更具针对性，以促进成本效益高的做法。
