CIRCUMSTANCES SURROUNDING DEATHS FROM ASTHMA IN COOK COUNTY (CHICAGO)ILLINOIS

The death rate from asthma has been increasing in the U.S. and in many other countries and is considered unacceptably high. There is little information as to circumstances surrounding these fatalities that woul d lead to effective interventions to prevent deaths. In this study, ca ses of asthma deaths from the Office of the Medical Examiner in Cook C ounty, (Chicago), Illinois were identified in subjects 45 years of age or less who died from asthma. We reviewed clinical information surrou nding the deaths, contacted surviving kin, friends, or informants, and reviewed autopsy findings and toxicologic results. Deaths were classi fied as (1) from asthma, (2) probably from asthma, (3) of indeterminat e cause, and (4) coincidental to but not from asthma. From 39 cases fr om one pathologist's cases of asthma deaths during 1985-1992, deaths w ere from or probably from asthma in 22139 (56.4%) of cases. Eight (20. 5%) cases were classified as indeterminate because of a positive or un known asthma prodrome but in which toxicologic results were positive. Nine (23.1%) cases were classified as death coincidental to but not fr om asthma because of the absence of a prodrome of increased symptoms a ssociated with positive toxicologic results. Overall from 23 cases whe re some toxicologic testing was performed, 14 (60.8%) were positive, i ndividually or in combination, for cocaine, benzoylecgonine (cocaine m etabolite), codeine, phencyclidine (animal tranquilizer), morphine, me thadone, and ethanol (>0.8 g/L). Out-of-hospital asthma deaths in 39 s ubjects were complicated by a high incidence of illicit drug use, lack of identifiable managing physicians, lack of antiinflammatory medicat ions, and in some cases not having been examined by a physician in the past year. Concomitant use of cocaine and bronchodilators may be espe cially dangerous in patients with asthma.