Contribution of Opiates in Sudden Asthma Deaths

Abstract

Asthma is a common disease in the United States and is frequently encountered during medicolegal autopsies. Patients are often young and have a witnessed collapse or are found dead. Opiate abuse is also pervasive and is repeatedly seen in death investigations. All cases over a 7-year period involving asthma investigated at the Wayne County Medical Examiner's Office were reviewed for demographics, circumstances, autopsy toxicology findings, and cause and manner of death. Ninety-four cases met these criteria. Ten cases (10.5%) were positive for opiates, 8 listed drugs as the cause of death, and 2 listed asthma. Of cases with established asthma opiate positivity, 8 (80%) were found dead, and only one had a witnessed collapse. Compared with those without opiate abuse, asthmatic patients abusing opiates had a higher mean age, no reported respiratory symptoms immediately preceding death, and higher frequency of being found dead. A discernable difference exists between deaths in asthmatic patients in the presence of opiates and those without. These findings indicate that it may be possible to predict the presence of opiates given history investigation information, thereby focusing toxicology panels to promote cost-effective practices when ordering supportive tests.

Asthme et usage de cannabis, de cocaïne ou d’héroïne

“…Chez 102 sujets dont le décès était attribué à un asthme, l'analyse toxicologique sanguine était positive dans 31,5 % des cas pour des SPA et dans 9 % des cas pour les opiacés [79]. Enfin, dans la série de Hlavaty et al [92], une autopsie était réalisée chez 94 sujets décédés subitement. Dans 72 % des cas, l'asthme était mentionné comme cause du décès.…”

Asthme et usage d’héroïne

“…De même, dans les études transversales, cas-témoins et longitudinales, le diagnostic de l'asthme reposait sur des critères cliniques dans la majorité des études (12/15). Dans les 4 études rétrospectives de dossiers de patients décédés [51][52][53][54], le diagnostic reposait sur les données des certificats de décès indiquant que l'asthme était la cause principale du décès. Dans 2 de ces 4 études, l'autopsie retrouvait des signes d'asthme (bouchons muqueux obstruant les lumières bronchiques et inflammation de la muqueuse bronchique) chez 70 % [51] et chez 98 % des sujets [52].…”

Utilization of opioid versus non‐opioid analgesics in Medicaid and CHIP enrolled children with current asthma

“…1,2 There has been increasing number of case reports that associated recreation drug use, such as abuse of cocaine and the opioid heroin with asthma exacerbation. 3,4 Opioids might worsen asthma through two mechanisms. The activation of the microglia by opioids through the toll-like receptors 4 (TLR4) resulting in release of proinflammatory mediators such as cytokines, interleukins, and prostaglandins as well as release of histamine from mast cells.…”