ASTHMA DEATHS CONFOUNDED BY SUBSTANCE-ABUSE - AN ASSESSMENT OF FATAL ASTHMA

Background: The Chicago region has been identified as having a very hi gh death rate from asthma in patients aged 5 to 34 years. We investiga ted circumstances surrounding the fatal attack to determine whether th e death was from asthma, of indeterminate cause, or coincidental to as thma. Methods: Cases of asthma deaths from the Office of the Medical E xaminer,where the deceased were younger than 46 years of age, were use d to determine clinical, toxicologic, and pathologic findings relevant to asthma, Toxicologic results were compared with homicide victims. R esults: From 102 cases of fatal asthma, 46 cases were classified as de aths front asthma and 17 cases were considered probably from asthma as toxicologic tests were negative, Twenty-three cases were of indetermi nate cause in that the acute respiratory symptoms were accompanied by substance use or alcohol consumption, Fourteen cases were not caused b y asthma but were substance related, primarily cocaine. Overall, 29 of 92 (31.5%) cases were confounded by substance abuse or alcohol ingest ion, which is almost as high as in homicide victims (38/82 [48.3%]), M ucus plugging of bronchi and or hyperinflation in fatal asthma occurre d in 65 of 93 (69.9%) cases. Anti-inflammatory medications were being utilized by just two patients. Sufficient information was available to identify potentially fatal asthma in 6 of 20 cases (30%). Conclusion: Some of the reported rise in asthma deaths is a reflection of substan ce use or alcohol consumption similar to that seen in victims of homic ide, In that patients with asthma are hypersensitive to ar-adrenergic agonists, the use of cocaine may be especially dangerous and induce fa tal ventricular dysrhythmias.