An 11-year-old boy with cough and wheeze during spring has high IgE and eosinophilia. Histology of an acute attack is most likely to show which feature?

• A. Dilation of the bronchi with inflammatory destruction of the walls
• B. Thickening of the bronchial epithelial basement membrane by collagen and hypertrophy of smooth muscle
• C. Patchy areas of consolidation surrounding the bronchioles with neutrophilic infiltrate in affected alveoli
• D. Increased mucus production with goblet cell hyperplasia

Answer: (C)

In an acute allergic asthma attack, airway inflammation drives mucus hypersecretion and plugging. The airways become edematous and goblet cells proliferate, leading to increased mucus production that can obstruct the bronchioles. Eosinophils are typically present in the inflamed bronchi, and you may see mucus plugs with shed epithelium, but the hallmark airway change you can directly link to an acute phase among these options is the mucus overproduction due to goblet cell hyperplasia.

The other findings point to different processes: dilation and destruction of bronchial walls describes bronchiectasis, a chronic change; patchy neutrophilic consolidation around bronchioles suggests an infectious bronchopneumonia pattern; and basement membrane thickening with smooth muscle hypertrophy reflects chronic remodeling from long-standing inflammation rather than an acute attack.