Asthma Pathology

A 35-year-old man with a 15-year history of poorly controlled asthma presents with persistent dyspnea, chronic cough, and recurrent exacerbations despite regular inhaled corticosteroid use. High-resolution CT chest shows bronchial wall thickening and bronchus-to-artery ratio >1. Pulmonary function tests reveal fixed airflow obstruction (FEV₁/FVC ratio 0.58 with minimal bronchodilator response). Histology of a transbronchial biopsy shows smooth muscle layer thickness of 15 μm (normal <5 μm) and increased collagen deposition in the basement membrane zone. Which pathological process BEST explains his irreversible airflow obstruction?

A 28-year-old woman presents to the emergency department with acute onset dyspnea, chest tightness, and wheezing for the past 2 hours. She has a 10-year history of asthma triggered by dust and pollen. On examination, she is anxious, speaking in short sentences, with bilateral end-expiratory wheezes. Peak expiratory flow (PEF) is 40% of predicted. Chest X-ray shows hyperinflation with normal parenchyma. A sputum sample shows eosinophilia and Curschmann spirals. Which histopathological finding is MOST characteristic of the acute phase of her asthma exacerbation?

Which of the following cells is primarily responsible for the production of cysteinyl leukotrienes (LTC4, LTD4, LTE4) in acute asthma exacerbations?