How the Lungs and Breathing Are Affected by Asthma

Modern medicine has prevented young asthmatic patients from dying as a result of the disease. Young asthmatic patients die only when their attack of breathlessness is not treated at all or insufficiently treated and lasts for hours or days ( so-called status asthmaticus). During my tow and a half years of work in pathology I found only one young ( a seventeen year old girl) asthmatic patient who died in the status asthmaticus, from the nearly 600 autopsies performed. This girl had been admitted to the hospital much too late and died despite the attempts of a famous asthma specialist and his team. This girl showed no outer signs of severe asthma. An incision in the thoracic cavity, however, showed that the lung, usually collapsed in these cases, was completely filled with air. There was very little blood remaining in the lung and when pressed at any point, a small dent remained. The trachea and the main bronchi were filled with viscous jelly-like mucus which clung to the walls so strongly that it was almost impossible to remove it with tweezers. Every airway visible to the eye was plugged with mucus. Even after an incision into the lung, the air trapped behind the mucus could not escape. The tissue specimens which I removed for closer examination floated on the fixing agent like small air cushions. Any layman could have seen that this young girl suffocated as a result of the mucus build-up.

I still like to use the microscopic pictures from this case as lecture material because they clearly show the changes in the lung associated with asthma. All bronchial walls were enlarged, the layer of smooth muscle was broadened, and the number of cell nuclei multiplied, thus increasing the number of muscle fibers. The mucus glands were tremendously enlarged and filled with the same mucus filing the lumina of the airways. The mucosal membrane of the bronchial tubes was viscid, saturated with fluid and characterized by a clear enlargement of the basal membrane beneath the cylindrical epithelium. Of course, in a microscopic view of the cells, no evidence could be found of the increased volume of air contained in the lungs the most impressive finding of the autopsy. The consequence of hyperventilation could be seen in the abnormally enlarged alveoli which contained the remains of other cells which had died. The girl had suffered from an allergic form of asthma, because large numbers of brightly red-stained eosinophils had infiltrated the bronchial mucosa and the mucus in the bronchial lumina. A microscopic examination of other inner organs showed no pathological changes except for the oxygen deficiency. Had the girl been brought to the hospital earlier, she would probably be alive today.

A bronchus in an asthmatic patient. plugs of viscid mucus obstruct the lumina and the bronchial mucosa is swollen. The bronchial muscle is cramped in an asthma attack. ( The drawing shows a thickening of the bronchial muscle). If this chronic change persists for long, the air sacs are continuously over inflated. In this manner, chronic asthma may develop into emphysema.