Contribution of asthma in opiate deaths

Purpose Several studies showed an association between asthma and opiate abuse. This retrospective study aimed to analyze the demographic, toxicologic, and seasonal differences in asthmatic and non-asthmatic subjects who died of opiates. In addition, the relationship between toxicological levels of opiates and histologic grade of lung inflammation was examined, to understand if it was possible to determine a predominance of drug vs. asthma in the mechanism of death. Methods Deaths from 2013 to 2018 involving opiates as the primary cause of death in Cook County were reviewed. Twenty-six cases of opiate deaths of individuals with a history of asthma and lung histology slides available were identified. In comparison, 40 cases of deaths due to opiates only were reviewed. A check-list system for the evaluation of the grade of microscopic inflammation in asthma was developed. Results Statistically significant differences were found between the groups concerning demography and toxicology. Our results suggest that the association between asthma and opiate in the determination of death may not be linked to the quantity of drug administered and the grade of inflammation in the lung tissue. Conclusion Our results confirm the importance of encouraging all asthmatic people to refrain from using opiates, regardless of the route of administration. The results of this study could be helpful for the forensic pathologists, showing the importance of histologic examination in all the autopsies on suspected opiate-related deaths and the necessity to include asthma in the death certificate whenever this condition is observed histologically.