Asthma-related sudden death: Clinicopathological features in 14 cases

Abstract Background Asthma-related sudden deaths are rare. While most deaths occur in hospitalised individuals with severe asthma, it has been reported that sudden and unexpected death may occur in subjects with only mild disease. Objective To describe the exact causes of sudden death according to autopsy findings in asthmatic patients. Methods In this study, the clinicopathological features of 14 cases of asthmatic patients victims of sudden death, and autopsied in the Department of Forensic Medicine and Pathology (Garches, France) over a 19-year period are reported. Results Subjects were aged between 18 and 58 years (average = 39.3 years), with a male to female ratio of 9/5. Deaths occurred either at home, in another private place, in jail, in public place, but never at the hospital. Overweight and positive toxicology were common associated findings (respectively six individuals = 40%; four individuals = 28.6%). Conclusion Our study highlights the complexity of the mechanism of death, as asphyxia following bronchial diffuse obstruction is not always the only cause of sudden death in asthmatic patients: acute complications directly related to asthmatic hypo- or anoxia such as an ischemic cardiomyopathy, even in young individuals, may not be underestimated, because they considerably obscure the prognosis. More, a deleterious effect of long-term drugs may be present (particularly heart anomalies or biochemical disequilibrium) with acute aggravation due to asthmatic asphyxia. Last, control of overweight and alcohol/cannabis consummation should be intensified, as they are frequently associated to sudden death in our series of asthmatic patients.