Pathological Findings in Respiratory Failure

Patients in acute respiratory failure were classified into six groups on the basis of clinical and roentgenographic criteria to predict the pathological findings of emphysema and of interstitial fibrosis. At autopsy roentgenographic criteria permitted recognition of emphysema in 35 patients. Cough and sputum production did not correlate with the finding of mucous gland hyperplasia in bronchioles. In more than 20% of bronchioles examined Goblet cell metaplasia occurred significantly more frequently in men who died after acute respiratory failure (79%) than in a control group of men who died of other causes (34%). It was not related to age, smoking history, cough and sputum production, expiratory flow rates, Reid index, or to emphysema or pneumonia. Pneumonia, pulmonary edema, and pulmonary emboli were as frequent in the acute respiratory failure group as in the control group. Twenty-five percent of both groups had acute myocardial infarctions. The frequent association of goblet cell metaplasia with respiratory failure and death suggests that it plays a pathogenic role. Production of thick mucus by the epithelial lining of the small airways may produce respiratory failure.