Continued loss of asthma control following epidemic thunderstorm asthma

Foo, Chuan T.; Yee, Ellen Ly; Young, Alan; Denton, Eve; Hew, Mark; O’Hehir, Robyn E; Radhakrishna, Naghmeh; Matthews, Sarah; Conron, Matthew; Harun, Nur-Shirin; Lachapelle, Philippe; Douglass, Jo A; Irving, Louis; Lee, Joy; Stevenson, Wendy; McDonald, Christine F; Langton, David; Banks, Ceri; Thien, Francis

doi:10.5415/apallergy.2019.9.e35

Cited by 5 publications

(9 citation statements)

References 16 publications

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“…Additionally, 66% of respondents who neither had a prior doctor diagnosis of asthma nor any prior symptoms suggestive of undiagnosed asthma described asthma symptoms over the same period. While these findings are similar to those reported in a previous study [5], our data also suggest that majority of individuals in these subgroups continue to remain symptomatic over the 36-month follow-up period, with less than a third of them reporting a reduction in frequency of their asthma symptoms.…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, it is known that the likelihood of developing a late asthmatic response is increased with higher doses of inhaled allergen [14]. Subsequently, ETSA has been postulated to constitute a massive small airway allergen challenge inducing persistent airway inflammation with nonspecific bronchial hyperresponsiveness, with resultant loss of asthma control or development of de novo asthma in susceptible individuals [5]. Observations from this study provide further support for this theory with >85% of individuals with previously well controlled asthma, and >60% with no prior diagnosis or symptoms suggestive of undiagnosed asthma, reporting asthma symptoms at 12, 24, and 36 months after the initial ETSA event.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, 28% (n=49) described 'persistent' symptoms. These were a subset of a collaborative multicenter cohort described in our previous publication [5].…”

Section: Symptomatologymentioning

confidence: 99%

“…The natural history of asthma symptoms in individuals affected by such catastrophic events remains unclear due to the paucity of data available. One study suggested a pivotal change in asthma trajectory with both loss of asthma control and persistence of de novo asthma in certain individuals 12 months after an ETSA event [5]. Whether these phenomena persist over time remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Natural history of asthma symptoms after epidemic thunderstorm asthma: a 3-year longitudinal study

Foo

Fernando

Cohen

et al. 2020

Asia Pacific Allergy

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Background: The world's most catastrophic epidemic thunderstorm asthma event (ETSA) affected Melbourne in 2016. Little is known about the natural history of individuals affected by such extreme events. Objective: In this single center prospective 3-year longitudinal study, symptomatology and behaviors of individuals affected by ETSA were assessed. Methods: Standardized telephone questionnaire was used to evaluate frequency of asthma symptoms, inhaled corticosteroid preventer use, asthma action plan ownership, and healthcare utilization. Questionnaires were administered at 12, 24, and 36 months after 2016 ETSA. Subgroup analyses of the 'current', 'past', 'possible,' and 'no asthma' subgroups were also conducted. Results: Two hundred and eight, 164, and 112 completed questionnaires were analyzed in 2017, 2018, and 2019, respectively. Seventy to eighty five percent of respondents reported ongoing asthma symptoms in any given year, of which 20%-28% experienced weekly symptoms. Nearly 50% of respondents were prescribed preventers, with approximately 45% adherent at least 5 days a week. Less than 40% had an asthma action plan and 15%-20% sought urgent medical attention for asthma over the follow-up period. Among 106 individuals with 3 consecutive years of completed questionnaires, those with no prior doctor diagnosis of asthma were significantly more likely to be asymptomatic on follow-up than those with a prior doctor diagnosis of asthma (p = 0.02). Subgroup analyses suggest that large proportions of respondents with 'past' and 'no asthma' continue to remain symptomatic throughout the 36-month period. Conclusion: In individuals affected by ETSA, we found evidence of ongoing loss of asthma control in those with previously well controlled asthma, and the persistence of symptoms suggestive of asthma in those with no history or symptoms suggestive of prior asthma, even after 36 months from initial ETSA. Low rates of inhaler adherence and asthma action plan ownership may contribute to increased morbidity and mortality from future ETSA events. Further research is required to confirm these findings.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…Importantly, 28% (n=49) described 'persistent' symptoms. These were a subset of a collaborative multicenter cohort described in our previous publication [5].…”

Section: Symptomatologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Natural history of asthma symptoms after epidemic thunderstorm asthma: a 3-year longitudinal study

Foo

Fernando

Cohen

et al. 2020

Asia Pacific Allergy

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“…Ali et al [35] reported cases of near-fatal and fatal asthma caused by storms in Kuwait on December 1 st , 2016; 17 patients were admitted with near-fatal asthma, 93.8% had a previous history of asthma, with an average duration of 9 years, 33.3% reported receiving inhaled corticosteroids from their physician and 93.8% relying only on a short-acting β2-agonist to control their asthma; 68.8% reported being outdoors during the storm and eleven patients were diagnosed with fatal asthma. Foo et al [45] reported, in individuals affected by TA, evidence of continuous loss of asthma control in those with previously well-controlled asthma and persistence of symptoms suggestive of asthma in those without a history or symptoms suggestive of previous asthma, even after 36 months of initial TA. Suboptimal rates of adherence to inhaled preventive and having an asthma action plan may contribute to the risk of asthma exacerbation and susceptibility to future episodes of AT.…”

mentioning

confidence: 99%

Thunderstorm allergy and asthma: state of the art

et al. 2021

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Thunderstorm-triggered asthma (TA) can be defined as the occurrence of acute asthma attacks immediately following a thunderstorm during pollen seasons. Outbreaks have occurred across the world during pollen season with the capacity to rapidly inundate a health care service, resulting in potentially catastrophic outcomes for allergicpatients. TA occurs when specific meteorological and aerobiological factors combine to affect predisposed atopic patients with IgE-mediated sentitization to pollen allergens. Thunderstorm outflows can concentrate aeroallergens, most commonly grass pollen but also other pollens such as Parietaria and moulds in TA, at ground level to release respirable allergenic particles after rupture by osmotic shock related to humidity and rainfall. Inhalation of high concentrations of these aeroallergens by sensitized individuals can induce early asthmatic responses which can be followed by a late inflammatory phase. There is evidence that, during pollen season, thunderstorms can induce allergic asthma outbreaks, sometimes also severe asthma crisis and sometimes deaths in patients suffering from pollen allergy. It has been observed that changes in the weather such as rain or humidity may induce hydratation of pollen grains during pollen seasons and sometimes also their fragmentation which generates atmospheric biological aerosols carrying allergens. Asthma attacks are induced for the high concentration at ground level of pollen grains which may release allergenic particles of respirable size after rupture by osmotic shock. In other words, it is a global health problem observed in several cities and areas of the world that can strike without sufficient warning, inducing sometimes severe clinical consequences also with deaths of asthma patients. Due to constant climate change, future TA events are likely to become more common, more disastrous and more unpredictable, as a consequence it is important to have deep knowledge on this topic to prevent asthma attacks. Other environmental factors, such as rapid changes in temperature and agricultural practices, also contribute to causing TA.

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