What is the morphology of asthma?

Morphology of Asthma

What is the morphology of asthma?


Microscopic Features (Histological Changes)

  1. Airway Inflammation

    • Dense infiltration of:

      • Eosinophils (hallmark)

      • Mast cells

      • T lymphocytes

      • Macrophages

    • Peribronchial inflammation affecting submucosa and epithelium.

  2. Epithelial Changes

    • Shedding of bronchial epithelium (denudation).

    • Goblet cell hyperplasia → increased mucus secretion.

  3. Basement Membrane Thickening

    • Thickened subepithelial basement membrane due to collagen deposition, especially type III and type V collagen.

  4. Smooth Muscle Hypertrophy & Hyperplasia

    • Increase in size and number of bronchial smooth muscle cells → contributes to bronchoconstriction.

  5. Submucosal Gland Enlargement

    • Hypertrophy and hyperplasia of mucous glands → excessive mucus production.

  6. Mucus Plugging

    • Lumen of the bronchi and bronchioles is filled with thick mucus, inflammatory cells, and debris.

  7. Curschmann Spirals

    • Coiled, whorled mucus plugs containing shed epithelial cells are seen in sputum.

  8. Charcot-Leyden Crystals

    • Crystals of eosinophil-derived proteins (e.g., major basic protein) are found in sputum or tissue sections.

Macroscopic Features (Gross Changes)

  1. Hyperinflated Lungs

    • Lungs appear overexpanded due to air trapping (especially in severe or fatal asthma).

  2. Mucus Plugs

    • Thick, sticky mucus plugs obstruct bronchi and bronchioles; they are visible on cut sections of the lung.

  3. Pale and Puffy Bronchial Walls

    • Due to edema and inflammation.

  4. Areas of Atelectasis

    • Some alveoli may be collapsed due to blocked airways.

  5. No consolidation (usually) unlike bacterial pneumonia, asthma does not typically involve alveolar consolidation unless complicated.

 Summary Table

Feature Microscopic Findings Macroscopic Findings
Airway Inflammation Eosinophils, mast cells, lymphocytes in bronchial walls Thickened bronchial walls
Goblet Cell Hyperplasia Increased mucus-secreting cells Visible mucus plugs in airways
Basement Membrane Thickened due to collagen deposition Not visible grossly
Smooth Muscle Hypertrophy and hyperplasia Airway narrowing (noted during dissection)
Mucus Excess production, Curschmann spirals, Charcot-Leyden crystals Plugging of airways with thick mucus
Lung Appearance - Hyperinflated, pale, areas of collapse (atelectasis)


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