Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk?

Abstract

The aim of the study was to characterize patients at risk of asthma exacerbation during spring thunderstorms and identify potential measures to ameliorate the impact of those events.A case-control study was conducted among patients aged 7±60 yrs, who attended Wagga Hospital (NSW, Australia) for asthma during the period of 1 June 1997 to 31 October 1997. One hundred and eighty-three patients who attended on 30 and 31 October 1997 were the cases and the remaining 121 patients were the controls. Questionnaire data were obtained from 148 (81%) cases and 91 (75%) controls.One hundred and thirty-eight (95%) cases who attended during the thunderstorm gave a history of hayfever prior to the event compared to 66 (74%) controls who attended at other times (odds ratio (OR) 6.01, 95% confidence interval (CI) 2.55± 14.15); 111 (96%) cases were allergic to rye grass pollen compared to 47 (64%) controls (OR 23.6, 95% CI 6.6±84.3). Among subjects with a prior diagnosis of asthma (64% cases and 82% controls), controls (56%) were more likely to be taking inhaled steroids at time of the thunderstorm than cases (27%, OR 0.3, 95% CI 0.16±0.57).History of hayfever and allergy to rye grass are strong predictors for asthma exacerbation during thunderstorms in spring. The lower rate of inhaled steroid use in thunderstorm cases suggests that this treatment may be effective in preventing severe attacks during thunderstorms. Eur Respir J 2000; 16: 3±8.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

“…Moreover, true asthma exacerbations may occur during dry days in some patients naturally exposed to pollens (1943,1944), probably because pollen allergens can be born by submicronic particles which can penetrate deeply into the airways (399). Thunderstorm-induced asthma is often, but not always, associated with pollen sensitization (401,404,(1945)(1946)(1947).…”

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“…Severe asthma exacerbations may occur in patients with newly diagnosed [21] or well-controlled [22] asthma or even by atopic patients with no previous asthma symptoms [23]. Exacerbations, by definition and in clinical practice, are identified by a change from and return to previous status, i.e.…”

A trans-disciplinary overview of case reports of thunderstorm-related asthma outbreaks and relapse

“…In Melbourne, two large asthma outbreaks (rapid increase in hospital or general practitioner visits for asthma) coincided with thunderstorms [14]. In Wagga Wagga, 215 asthmatic subjects attended the local emergency department, 41 of whom required admission to hospital [18]. In south eastern Australia, MARKS et al [19] observed that the incidence of excess hospital attendances for asthma during late spring and summer was strongly linked to the occurrence of thunderstorm outflows and demonstrated that the arrival of a thunderstorm outflow was accompanied by a large increase in the concentration of ruptured pollen grains in ambient air.…”