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Abstract
To examine the changes in airways in bronchial asthma (BA) during an asthma attack
causing death, we performed morphometric analysis of autopsied lungs from three outpatients
who died of severe acute asthma attacks (group A) and compared these to five patients
who died of non-status asthmaticus (group B). Controls (group NL) were four patients
who died of diseases other than respiratory disorders. Area proportions of bronchial
glands to bronchial wall (gland [percent]) and of goblet cells to total epithelial
layer (goblet [percent]) and the intraluminal amount of mucus in the airways (MOR)
were measured in a paraffin section. There were no significant differences in age,
sex, smoking history, duration of BA history, and dosage of glucocorticoids received
between groups A and B. Although both groups A and B showed significantly larger values
of gland (percent) in the central airways and of inflammatory cell numbers in the
airway walls than did group NL, no significant differences were observed between groups
A and B. In contrast, markedly significant increases in goblet (percent) and in MOR
were observed in group A compared to groups B and NL. These increases in group A were
more dominant in the peripheral airway: 30-fold and threefold increases of group B
in goblet (percent) and MOR, respectively. Furthermore, MOR significantly correlated
with goblet (percent) in the peripheral airways (p less than 0.05). These findings
suggest that a marked increase in goblet cells of the airways is a feature characteristic
of patients with BA who die of a severe acute attack.