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.