title: Asthma deaths confounded by substance abuse. An assessment of fatal asthma.
abstract: BACKGROUND
  The Chicago region has been identified as having a very high death rate from asthma in patients aged 5 to 34 years. We investigated circumstances surrounding the fatal attack to determine whether the death was from asthma, of indeterminate cause, or coincidental to asthma.
  
  
  METHODS
  Cases of asthma deaths from the Office of the Medical Examiner, where the deceased were younger than 46 years of age, were used to determine clinical, toxicologic, and pathologic findings relevant to asthma. Toxicologic results were compared with homicide victims.
  
  
  RESULTS
  From 102 cases of fatal asthma, 46 cases were classified as deaths from asthma and 17 cases were considered probably from asthma as toxicologic tests were negative. Twenty-three cases were of indeterminate cause in that the acute respiratory symptoms were accompanied by substance use or alcohol consumption. Fourteen cases were not caused by asthma but were substance related, primarily cocaine. Overall, 29 of 92 (31.5%) cases were confounded by substance abuse or alcohol ingestion, which is almost as high as in homicide victims (38/82 [46.3%]). Mucus plugging of bronchi and or hyperinflation in fatal asthma occurred 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%).
  
  
  CONCLUSIONS
  Some of the reported rise in asthma deaths is a reflection of substance use or alcohol consumption similar to that seen in victims of homicide. In that patients with asthma are hypersensitive to alpha-adrenergic agonists, the use of cocaine may be especially dangerous and induce fatal ventricular dysrhythmias.
authors.affiliation: Department of Medicine, Northwestern University Medical School, Chicago.
authors.forename: T
authors.initials: T
authors.lastname: Levenson
authors.forename: P A
authors.initials: PA
authors.lastname: Greenberger
authors.forename: E R
authors.initials: ER
authors.lastname: Donoghue
authors.forename: B D
authors.initials: BD
authors.lastname: Lifschultz
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D002641:Chicago / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications*