title: The role of pharmacology and forensics in the death of an asthmatic.
abstract: Comprehensive investigation is necessary for determining the cause of death in cases with positive drug screens. We investigated the case of a male who reportedly expired from an acute asthma attack. He had limited access to both therapeutic drugs and drugs of abuse because he was a state prisoner. His autopsy was remarkable because the weights of his right and left lungs were 690 and 760 g, respectively. His upper airway was clear of debris. There was an abundant amount of blood and frothy fluid in the pulmonary parenchyma. There were no focal lesions. The pulmonary vasculature was unremarkable. Microscopic evaluation of the lung tissue showed that the bronchi contained dense inflammatory infiltrates consisting mostly of eosinophils and a few lymphocytes and plasma cells. Basement membrane thickening was evident in the bronchi, and mucous plugs were identified in some of the bronchial lumina. A morphine concentration of 80 ng/mL was found in the blood. Theophylline and albuterol were detected in trace amounts. The opinion of the coroner was that the patient died of an acute asthma attack, and the presence of morphine may have contributed to his death. A careful review of his medical history and the mechanisms of drug-induced asthma revealed that the etiology of his death was more likely due to heroin abuse and noncardiogenic pulmonary edema. Episodic exacerbations of his chronic asthma were a contributing factor in his demise. However, in and of itself, asthma was not responsible for his death. Pertinent information associated with this case is presented, along with additional findings of toxicological screens and other evidence demonstrating that his asthma treatment did not contribute to his death. In addition, opiate-induced asthma, as well as other drug-induced diseases that can contribute to mortality in patients who abuse narcotics, is reviewed.
authors.affiliation: Department of Emergency Medicine and Clinical Toxicology, UT Medical Group, Memphis, USA.
authors.forename: K
authors.initials: K
authors.lastname: Merigian
authors.forename: K
authors.initials: K
authors.lastname: Blaho
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000420:Albuterol / Q000032:analysis / Q000378:metabolism; D001249:Asthma / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D017809:Fatal Outcome; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D008168:Lung / Q000473:pathology* / Q000648:ultrastructure; D008297:Male; D009020:Morphine / Q000032:analysis / Q000378:metabolism; D011654:Pulmonary Edema / Q000139:chemically induced; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000401:mortality; D013806:Theophylline / Q000032:analysis / Q000378:metabolism
chemical_list: D003932:Heroin; D009020:Morphine; D013806:Theophylline; D000420:Albuterol