Do long periods of asphyxiation trigger the proliferation of pulmonary macrophages and the formation of giant cells? Three groups have been defined: six autopsy cases with time periods of suffocation >25 min (long protracted asphyxiation), eight cases with estimated time periods of suffocation 10-25 min (short protracted asphyxiation) and nine cases where death had occurred immediately (very severe trauma). The stain used was haematoxylin and eosin (H&E), and the immunohistochemical stainings were performed using antibodies CD 68, MRP 8, MRP 14 and NP 57. The intraalveolar macrophages and giant cells were counted in H&E sections. For the immunohistochemical stainings, a scoring was used in order to compare the groups. In protracted asphyxiation, the number of intraalveolar macrophages was definitely elevated. A significant increase of giant cells was observed in the cases of long protracted asphyxiation. CD 68 showed clearly elevated numbers in both asphyxiation groups. Early-stage macrophages are significantly increased in protracted asphyxiation. With increasing time periods of asphyxiation, the results become more significant. The results show that the length of the agony period stimulates the proliferation of pulmonary macrophages and the formation of giant cells.