Case 1, image 1: This 20 year old woman died of complications of asthma. She was at a friend's house and complained of shortness of breath, chest tightness, nausea and vomiting. Reportedly, she turned blue before collapsing. She was diagnosed with asthma at age 5. She also was injected heroin and morphine was detected in the antemortem. As an aside, the manner of death was deemed as natural. The medical investigator did not think intravenous injection of morphine would trigger the asthma. Of note, crushed up and snorted pills may be an asthma trigger.

Case 1, image 2: Lots of eosinophils within the submucosa

Case 1, image 3: Somewhat prominent basement membrane and smooth muscle hypertrophy, although this is a fairly large airway. I think it is a soft call.

Case 1, image 4: A closer look at the basement membrane. The respiratory epithelium has sloughed off, which is not unusual in postmortem histology.

Case 2, image 1: This 44-year-old male died of status asthmaticus. A few days prior to death, he complained of sudden onset of shortness of breath and chest tightness while power washing carts within an enclosed room. Past medical history included seasonal allergies and reactive airways. Note the increased vascularity and increase submucosal mucus glands.

Case 2, image 2: Prominent peribronchiolar mixed inflammatory infiltrate with eosinophilic predominance with marked increased vascularity.

Case 2, image 3: There is mucus plugging of airways with mucoid material containing numerous eosinophils and shed epithelial cells.

Asthma is a chronic inflammatory disorder of the airways that is characterized by reversible airflow obstruction and bronchial hyperresponsiveness. Symptoms include difficulty breathing, wheezing and coughing.

Grossly, the lungs may be hyperinflated and meet at the midline when you remove the chest plate. Mucus plugs can sometimes occlude the airways.

Key histologic features include prominence of mucous plugs within airways, inflammation (especially eosinophils) around the airway walls, thickening of the subepithelial basement membrane, smooth muscle cell hyperplasia and goblet cell hyperplasia within submucosal glands.

Upper respiratory infections (especially viral infections) can be triggers for asthma attacks.