Sudden death secondary to respiratory etiologies: a series of over 170 cases

Abstract

<bold>Introduction:</bold> Respiratory pathologies can cause significant morbidity and mortality, especially in cases of acute exacerbation, inadequate initial assessment, or delayed emergency care. This study aims to analyze cases of sudden death due to respiratory causes, focusing on the victims' epidemiological profile, risk factors, and primary etiologies, to help implement prevention strategies. <bold>Methods:</bold> A retrospective study was conducted in the forensic department of Sfax, Tunisia, from January 1, 2016, to December 31, 2024. Among all deaths examined medico-legally, we identified cases of sudden death related to respiratory pathology. <bold>Results:</bold> A total of 1,568 sudden deaths were recorded, of which 176 were linked to respiratory causes. The sex ratio was 1.6, and the average age was 43 years (ranging from 1 to 81 years). Among the victims, 53.2% were unemployed. Regarding medical history, 67% had asthma, 11% had chronic obstructive pulmonary disease, and 26.1% had bronchiectasis. Associated morbidity factors included a history of cardiovascular disease in 35% and smoking in 67.5%. Most victims were under treatment, but 86% had poor adherence to their medications. Deaths occurred primarily in winter (72.6%), at night, and during sleep (82.6%), with 82.6% occurring at home. Forensic autopsies showed hyperaerated lungs in 82.6%, infection sites in 29.7%, and COVID-19 in 22.6% of cases. <bold>Conclusion:</bold> This study underscores the complexity of respiratory-related deaths. Beyond asphyxiation, many deaths could be prevented if exacerbations were treated as potentially fatal. This concept should be emphasized in both patient education and physician training.