Carroll N, Carello S, Cooke C, James A
Dept of Pulmonary Physiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia.
Eur Respir J. 1996 Apr;9(4):709-15. doi: 10.1183/09031936.96.09040709.
Fatal attacks of asthma usually occur against a background of chronic persistent symptoms, presumably due to chronic airway inflammation and changes in airway wall structure. Death from asthma is usually attributed to excessive airway narrowing due to a combination of muscle spasm and mucous plugging. To test the hypothesis that airway wall structure and/or the inflammatory cell profile are related to the duration of a fatal attack of asthma, inflammatory cell profiles and airway structure were examined in cases of fatal asthma and related to the duration of the fatal attack. In transverse sections of large and small airways from subjects dying from asthma, the numbers of eosinophils, neutrophils and lymphomononuclear cells were counted. The amount of smooth muscle shortening, the areas of airway wall, smooth muscle, mucous gland and cartilage were measured. Cell counts, airway dimensions and muscle shortening were compared in cases dying within 2 h of the fatal attack (short duration) and those dying more than 5 h after the onset of the fatal attack (long duration). In cases with fatal attacks of short duration, the numbers of neutrophils and the mucous gland area were increased and the numbers of eosinophils were reduced compared to cases with fatal attacks of long duration. Lymphocyte numbers, airway wall thickness, the areas of smooth muscle and cartilage and the amount of smooth muscle shortening were similar in the two groups. These findings suggest fatal attacks of asthma may be triggered by an inflammatory stimulus and suggest that increased production of mucous may contribute to sudden death in such cases.
致命性哮喘发作通常发生在慢性持续性症状的背景下，推测是由于慢性气道炎症和气道壁结构改变所致。哮喘死亡通常归因于肌肉痉挛和黏液阻塞共同导致的气道过度狭窄。为了验证气道壁结构和/或炎症细胞谱与致命性哮喘发作持续时间相关的假设，对致命性哮喘病例的炎症细胞谱和气道结构进行了检查，并与致命发作的持续时间相关联。在死于哮喘的受试者的大气道和小气道横切面上，对嗜酸性粒细胞、中性粒细胞和淋巴单核细胞的数量进行了计数。测量了平滑肌缩短量、气道壁、平滑肌、黏液腺和软骨的面积。比较了在致命发作后2小时内死亡（短持续时间）的病例和在致命发作开始后5小时以上死亡（长持续时间）的病例的细胞计数、气道尺寸和肌肉缩短情况。与长持续时间致命发作的病例相比，短持续时间致命发作的病例中性粒细胞数量和黏液腺面积增加，嗜酸性粒细胞数量减少。两组的淋巴细胞数量、气道壁厚度、平滑肌和软骨面积以及平滑肌缩短量相似。这些发现表明，致命性哮喘发作可能由炎症刺激引发，并表明黏液分泌增加可能导致此类病例的猝死。
