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Haddadzadeh Shoushtari M, Afrakhteh S, Borsi SH, Raji H, Idani E. Pulmonary Function Tests in Thunderstorm-associated Respiratory Symptoms: A Cross-sectional Study. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:40-45. [PMID: 38322159 PMCID: PMC10839138 DOI: 10.30476/ijms.2023.96337.2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/27/2022] [Accepted: 12/25/2022] [Indexed: 02/08/2024]
Abstract
Background Epidemic thunderstorm asthma is an observed increase in cases of acute bronchospasm following thunderstorms. This study aimed to compare the frequency of obstructive airway disease or bronchial hyperresponsiveness in subjects with thunderstorm-associated respiratory symptoms with subjects with similar symptoms presented at other times. Methods A cross-sectional study from June to November of 2013 was conducted on subjects with thunderstorm-associated respiratory symptoms living in Ahvaz City, Iran. Thunderstorm-associated subjects were presented with asthmatic symptoms in thunderstorms, and other patients presented with similar symptoms at other times. Baseline spirometry was performed on patients to examine the presence of obstructive airway disease. In all patients with normal spirometry, a provocation test was applied. A comparison of qualitative and quantitative variables was made using the Chi-square and independent t test, respectively. All analyses were carried out using SPSS Statistics Version 22. A P value less than 0.05 was considered statistically significant. Results Out of 584 subjects, 300 and 284 participants were in thunderstorm-associated and non-thunderstorm-associated groups, respectively. After the final analysis, 87 (30.6%) and 89 (33.3%) of the thunderstorm-associated subjects and non-thunderstorm-associated group, respectively, had pieces of evidence of airflow limitation (P=0.27). Among the patients with normal spirometry, 161 (81.72%) of the thunderstorm-associated patients and 100 (56.17%) patients of the non-thunderstorm-associated symptoms group had a positive methacholine challenge test result (P<0.001). Conclusion Most of the patients with thunderstorm-associated respiratory symptoms had no obvious evidence of airflow limitation in spirometry.
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Affiliation(s)
- Maryam Haddadzadeh Shoushtari
- Air Pollution and Respiratory Diseases Research Center, Enviromental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sakineh Afrakhteh
- Department of Internal Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Hamid Borsi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Chronic Respiratory Diseases Research Center, Shahid Beheshti University of Medical Sciences,Tehran, Iran
| | - Hanieh Raji
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Esmail Idani
- Chronic Respiratory Diseases Research Center, Shahid Beheshti University of Medical Sciences,Tehran, Iran
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Straub A, Fricke V, Olschewski P, Seubert S, Beck C, Bayr D, Kolek F, Plaza MP, Leier-Wirtz V, Kaschuba S, Traidl-Hoffmann C, Buermann W, Gerstlauer M, Damialis A, Philipp A. The phenomenon of thunderstorm asthma in Bavaria, Southern Germany: a statistical approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:2678-2694. [PMID: 34607495 DOI: 10.1080/09603123.2021.1985971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Higher incidences of asthma during thunderstorms can pose a serious health risk. In this study, we estimate the thunderstorm asthma risk using statistical methods, with special focus on Bavaria, Southern Germany. In this approach, a dataset of asthma-related emergency cases for the study region is combined with meteorological variables and aeroallergen data to identify statistical relationships between the occurrence of asthma (predictand) and different environmental parameters (set of predictors). On the one hand, the results provide evidence for a weak but significant relationship between atmospheric stability indices and asthma emergencies in the region, but also show that currently thunderstorm asthma is not a major concern in Bavaria due to overall low incidences. As thunderstorm asthma can have severe consequences for allergic patients, the presented approach can be important for the development of emergency strategies in regions affected by thunderstorm asthma and under present and future climate change conditions.
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Affiliation(s)
- Annette Straub
- Institute for Geography, University of Augsburg, Augsburg, Germany
| | - Verena Fricke
- Institute for Geography, University of Augsburg, Augsburg, Germany
| | - Patrick Olschewski
- Professorship for Regional Climate Change and Health, University of Augsburg, Augsburg, Germany
| | - Stefanie Seubert
- Institute for Geography, University of Augsburg, Augsburg, Germany
| | - Christoph Beck
- Institute for Geography, University of Augsburg, Augsburg, Germany
| | - Daniela Bayr
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Franziska Kolek
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria P Plaza
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Vivien Leier-Wirtz
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Sigrid Kaschuba
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Claudia Traidl-Hoffmann
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | | | - Michael Gerstlauer
- Department of Pediatric Pneumology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Athanasios Damialis
- German Research Centre for Environmental Health, Chair and Institute of Environmental Medicine, Technical University of Munich and Helmholtz Centre Munich, Augsburg, Germany
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Andreas Philipp
- Institute for Geography, University of Augsburg, Augsburg, Germany
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Ngaruiya C, Bernstein R, Leff R, Wallace L, Agrawal P, Selvam A, Hersey D, Hayward A. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 2022; 22:1234. [PMID: 35729507 PMCID: PMC9210736 DOI: 10.1186/s12889-022-13399-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. METHODS A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). RESULTS Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. CONCLUSIONS An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA.
| | - Robyn Bernstein
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lydia Wallace
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Denise Hersey
- Director, Dana Medical Library, University of Vermont, Burlington, VT, USA
| | - Alison Hayward
- Division of Global Emergency Medicine, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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Goudarzi G, Birgani YT, Assarehzadegan MA, Neisi A, Dastoorpoor M, Sorooshian A, Yazdani M. Prediction of airborne pollen concentrations by artificial neural network and their relationship with meteorological parameters and air pollutants. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:251-264. [PMID: 35669831 PMCID: PMC9163240 DOI: 10.1007/s40201-021-00773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/21/2021] [Indexed: 06/15/2023]
Abstract
After the early rainfall in the autumn of 2013, respiratory syndromes spread in the Khuzestan province of Iran with the most severity in Ahvaz. There have been recurring outbreaks in recent years. Considering that pollen-derived airborne allergens are regarded as key aeroallergens and the main cause of allergic rhinitis and asthma, this work aimed to forecast total pollen concentration in Ahvaz through an artificial neural network (ANN), followed by evaluating the pollen spatial distribution across the city and the association between pollen concentrations and environmental parameters. The utilized ANN in this work included an input layer with 13 parameters, a hidden layer of five neurons, and an output layer. Data were classified into training, validation, and testing sets. The ANN was implemented with 70% and 80% of data for training. The value of the correlation coefficient for the data validation of these two networks was 0.89 and 0.92, respectively. The results also indicated that despite the difference in the mean concentration of the pollens in various areas of Ahvaz, this difference was not statistically significant (P > 0.05). Furthermore, there was a negative correlation between the concentration of total pollen and relative humidity, precipitation, and air pressure. However, it had a positive correlation with temperature. Consequently, considering the logistical challenges of monitoring bioaerosols in the air, the ANN approach could predict total pollen concentrations. Therefore, in addition to measurements, the ANN technique can be a good tool to enable authorities to mitigate the impact of airborne pollen on people.
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Affiliation(s)
- Gholamreza Goudarzi
- Air Pollution and Respiratory Diseases (APRD) Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Yaser Tahmasebi Birgani
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad-Ali Assarehzadegan
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolkazem Neisi
- Air Pollution and Respiratory Diseases (APRD) Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dastoorpoor
- Department of Biostatistics and Epidemiology, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Sorooshian
- Department of Chemical and Environmental Engineering, University of Arizona, Tucson, AZ USA
- Department of Hydrology and Atmospheric Sciences, University of Arizona, Tucson, AZ USA
| | - Mohsen Yazdani
- Department of Environmental Health Engineering, School of Public Health, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chatelier J, Chan S, Tan JA, Stewart AG, Douglass JA. Managing Exacerbations in Thunderstorm Asthma: Current Insights. J Inflamm Res 2021; 14:4537-4550. [PMID: 34526800 PMCID: PMC8436255 DOI: 10.2147/jir.s324282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/25/2021] [Indexed: 12/23/2022] Open
Abstract
Epidemic thunderstorm asthma (ETSA) occurs following a thunderstorm due to the interaction of environmental and immunologic factors. Whilst first reported in the 1980s, the world's largest event in Melbourne, Australia, on November 21, 2016 has led to a wealth of clinical literature seeking to identify its mechanisms, susceptibility risk factors, and management approaches. Thunderstorm asthma (TA) typically presents during an aeroallergen season in individuals sensitized to perennial rye grass pollen (RGP) in Australia, or fungus in the United Kingdom, in combination with meteorological factors such as thunderstorms and lightning activity. It is now well recognized that large pollen grains, which usually lodge in the upper airway causing seasonal allergic rhinitis (SAR), are ruptured during these events, leading to sub-pollen particles respirable to the lower respiratory tract causing acute asthma. The identified risk factors of aeroallergen sensitization, specifically to RGP in Australians with a history of SAR, and individuals born in Australia of South-East Asian descent as a risk factor for TA has been key in selecting appropriate patients for preventative management. Moreover, severity-determining risk factors for ETSA-related asthma admission or mortality, including pre-existing asthma or prior hospitalization, poor inhaled corticosteroid adherence, and outdoor location at the time of the storm are important in identifying those who may require more aggressive treatment approaches. Basic treatments include optimizing asthma control and adherence to inhaled corticosteroid therapy, treatment of SAR, and education regarding TA to increase recognition of at-risk days. Precision treatment approaches may be more beneficial in select individuals, including the use of allergen immunotherapy and even biologic treatment to mitigate asthma severity. Finally, we discuss the importance of environmental health literacy in the context of concerns surrounding the increased frequency of ETSA due to climate change and its implications for the frequency and severity of future events.
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Affiliation(s)
- Josh Chatelier
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Chan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Immunology Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Ju Ann Tan
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alastair G Stewart
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Melbourne, Victoria, Australia
- ARC Centre for Personalised Therapeutics Technologies, University of Melbourne, Melbourne, Victoria, Australia
| | - Jo Anne Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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6
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Climate change, air pollution, and allergic respiratory diseases: a call to action for health professionals. Chin Med J (Engl) 2021; 133:1552-1560. [PMID: 32590458 PMCID: PMC7386356 DOI: 10.1097/cm9.0000000000000861] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Rising emissions of greenhouse gases in the atmosphere have warmed the planet substantially and are also accompanied by poor air quality. The increased prevalence of allergic airway disease worldwide can be partially attributed to those global environmental changes. Climate change and air pollution pose adverse impacts on respiratory allergies, and that the mechanisms are complex and interactive. Adverse weather conditions, such as extreme temperatures, can act directly on the respiratory tract to induce allergic respiratory illnesses. Thunderstorms and floods can alter the production and distribution of aeroallergens while wildfires and dust storms increase air pollution, and therefore indirectly enhance health risks. Concentrations of particulate matter and ozone in the air have been projected to increase with climate warming and air stagnation, and the rising temperatures and CO2 increase pollen, molds, and spores, which escalate the risk of allergic respiratory diseases. The synergistic effects of extreme heat and aeroallergens intensify the toxic effect of air pollutants, which in turn augment the allergenicity of aeroallergens. With the Earth's climate change, migration of humans and plants shift the living environments and allergens of susceptible people. Urban residents are exposed to multiple factors while children are sensitive to environmental exposure. Since climate change may pose many unexpected and persistent effects on allergic respiratory diseases, health professionals should advocate for effective mitigation and adaptation strategies to minimize its respiratory health effects.
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AlQuran A, Batra M, Harry Susanto N, Holland AE, Davies JM, Erbas B, Lampugnani ER. Community Response to the Impact of Thunderstorm Asthma Using Smart Technology. ALLERGY & RHINOLOGY 2021; 12:21526567211010728. [PMID: 33996193 PMCID: PMC8083005 DOI: 10.1177/21526567211010728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/27/2022]
Abstract
Background The most severe thunderstorm asthma (TA) event occurred in Melbourne on the 21st November 2016 and during this period, daily pollen information was available and accessible on smart devices via an App. An integrated survey within the App allows users to self-report symptoms. Objective To explore patterns of symptom survey results during the period when the TA event occurred. Methods Symptom data from the Melbourne Pollen Count and Forecast App related to asthma history, hay fever symptoms, and medication use was explored. A one-week control period before and after the event was considered. Chi-square tests and logistic regression were used to assess associations between sex, age, symptoms, and medication use. Results Of the 28,655 responses, during the 2016 pollen season, younger (18 to 40 years) males, with no hay fever and no asthma were the most single and regular responders. During the TA event for new users, sex was only significantly associated with hay fever (p = 0.008) of which 60.2% of females’ responses reported having hay fever, while 43% of males’ responses did not. Those with mild symptoms peaked during the TA event. Conclusions Many individuals completed the survey on the app for the first time during the TA event indicating the potential of digital technologies to be used as indicators of health risk among populations at risk of TA events.
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Affiliation(s)
- Ala AlQuran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Mehak Batra
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Nugroho Harry Susanto
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Indonesia Research Partnership on Infectious Diseases, Jakarta, Indonesia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Alfred Health, Melbourne, Australia.,Institute for Breathing and Sleep, Melbourne, Australia
| | - Janet M Davies
- School of Biomedical Science, Institute of Health and Biomedical Innovation, Queensland University of Technology, and Office of Research, Metro North Hospital and Health Service, Brisbane Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Faculty of Public Health, Universitas AirLangga, Surabaya, Indonesia
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8
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Retrospective analysis of epidemic thunderstorm asthma in children in Yulin, northwest China. Pediatr Res 2021; 89:958-961. [PMID: 32454517 DOI: 10.1038/s41390-020-0980-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND An epidemic of thunderstorm asthma in pediatric patients occurred in Yulin, a northwest city of China, on 11 September 2018. We described the epidemic and retrospectively analyzed the demographic and clinical aspects of the involved children. METHODS The caseload data of patients were collected from the hospital information system in Yulin Pediatric Hospital. The detailed document of hospitalized children with thunderstorm asthma was sourced from the medical records. RESULTS The mean number of daily visits to emergency/outpatient department and the daily admission to hospital were 2.7 and 16 times, respectively, than on the other days of September. A gender prominence of males was observed in both emergency/outpatient and inpatient department. Among the 51 hospitalized children with detailed medical records, 56% of them had never experienced or were diagnosed with asthma and 25% had confirmed diagnosis of asthma. Sixty-seven percent had a history of allergic rhinitis during August and September. Seventy-six percent of the hospitalized children presented as moderate asthma. Ninety-four percent of the pediatric patients had positive IgE against mugwort pollen and 78% were monosensitized to pollen. CONCLUSION Thunderstorm asthma can affect children, especially who has allergic rhinitis or asthma without preventive management. Mugwort is also an aeroallergen in thunderstorm asthma attacks. IMPACT Thunderstorm can induce asthma attacks in children with allergic rhinitis owing to mugwort and aggravate symptoms in children with confirmed diagnosis of asthma. Children with mugwort allergy are susceptible to thunderstorm asthma and a preponderance of boys was observed. Better identification of allergic children to mugwort, giving suitable protective measures during thunderstorm and standard therapy to existing allergic situation could be a benefit for children at risk of thunderstorm asthma.
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9
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Cecchi L, Scala E, Caronni S, Citterio S, Asero R. Allergenicity at component level of sub-pollen particles from different sources obtained by osmolar shock: A molecular approach to thunderstorm-related asthma outbreaks. Clin Exp Allergy 2021; 51:253-261. [PMID: 33070421 DOI: 10.1111/cea.13764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND The so-called "thunderstorm asthma" (TA) is an uncommon but dramatic outbreak of asthma attacks occurring during a thunderstorm in the pollen and moulds season. Mechanisms which make the pollen able to enter the deeper airways and provoke severe asthma symptoms are still unclear. OBJECTIVE To test the hypothesis that sub-pollen particles (SPPs) originated from the rupture by an osmotic shock of pollen associated with TA contain allergens. METHODS After hydration, SPPs released from pollen grains of grass, pellitory, olive, cypress, ragweed and birch were isolated and determined by microscopy. Allergens were determined by in vitro ELISA inhibition tests indirectly using the sera from 10 polyreactive patients. An inhibition <50% was considered as negative, 50%-75% moderate and > 75% complete. RESULTS The inhibition experiments showed that the SPPs from birch and cypress were unable to inhibit serum IgE reactivity to Bet v 1 and Cup a 1, respectively. Ragweed SPPs inhibited ragweed pollen extract and Amb a 1 by 75.8 ± 0.11% and 81.2 ± 0.15%, respectively. Olive and pellitory SPPs retained almost the whole IgE-binding capability in all cases tested. Grass SPPs inhibited 32 ± 0.06% of Lolium perenne Lol p 1 and 65% of Phleum pratense extracts, but results were highly variable for individual allergens (97.5%-0.03% for Phl p 2, 45.3 ± 0.12% for Phl p 5, 24.7 ± 0.22% for Phl p 6, and 38.3 ± 0.2% for Phl p 1). CONCLUSIONS Inhibition experiments confirm the hypothesis that SSPs obtained after the osmotic shock of pollen involved in TA, namely grass, pellitory and olive tree pollen, contain allergens and therefore they can induce severe asthma attacks during thunderstorms.
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Affiliation(s)
- Lorenzo Cecchi
- SOS Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy.,Centre of Bioclimatology, University of Florence, Florence, Italy
| | - Enrico Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - Sarah Caronni
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milano, Italy
| | - Sandra Citterio
- Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milano, Italy
| | - Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
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10
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Thien F, Davies JM, Hew M, Douglass JA, O'Hehir RE. Thunderstorm asthma: an overview of mechanisms and management strategies. Expert Rev Clin Immunol 2020; 16:1005-1017. [PMID: 32960102 DOI: 10.1080/1744666x.2021.1826310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Epidemic thunderstorm asthma (ETSA) is due to a complex interaction of environmental and individual susceptibility factors, with outbreaks reported globally over the last four decades. Australia has been particularly susceptible with nearly half of episodes reported internationally, culminating in the catastrophic Melbourne 2016 event. AREAS COVERED Reported ETSA episodes are reviewed for common environmental and meteorological risk factors. Allergen aerobiology interaction with thunderstorm activity and rapid weather condition changes is examined. Assessment of the clinical and immunological data highlights risk factors for ETSA presentation, hospital admission, and intensive care admission. Risk factors associated with ETSA deaths are evaluated. Public health strategies, as well as pharmacological and immunological management approaches to reduce individual susceptibility and prevent ETSA are discussed. EXPERT OPINION Improved understanding of the specific meteorological factors predisposing to the greatest risk of ETSA to improve forecasting is required. Better monitoring of aeroallergen levels in areas of greatest geographic risk, with further research into allergen aerobiology underpinning mechanisms of allergen exposure is needed. The role of climate change in increasing the risk of ETSA outbreaks requires further research. Public awareness and education are required to reduce exposure, and to improve uptake of pharmacological and immunological risk reduction and preventive strategies.
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Affiliation(s)
- Francis Thien
- Eastern Health Clinical School, Box Hill Hospital , Melbourne, Australia.,Monash University , Melbourne, Australia
| | - Janet M Davies
- Queensland University of Technology , Brisbane, Australia.,Metro North Hospital and Health Service , Brisbane, Australia
| | - Mark Hew
- Monash University , Melbourne, Australia.,Allergy, Asthma & Clinical Immunology, Alfred Health , Melbourne, Australia
| | - Jo A Douglass
- Royal Melbourne Hospital , Parkville, Australia.,Department of Medicine, University of Melbourne , Melbourne, Australia
| | - Robyn E O'Hehir
- Monash University , Melbourne, Australia.,Allergy, Asthma & Clinical Immunology, Alfred Health , Melbourne, Australia
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11
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Kevat A. Thunderstorm Asthma: Looking Back and Looking Forward. J Asthma Allergy 2020; 13:293-299. [PMID: 32982317 PMCID: PMC7501467 DOI: 10.2147/jaa.s265697] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/06/2020] [Indexed: 01/15/2023] Open
Abstract
Epidemic thunderstorm asthma has been reported to have occurred around twenty times over the past three decades in locations around the world. Thunderstorm asthma events are characterized by a significant increase in asthma presentations, which on occasion can overwhelm local medical services and result in fatalities. This review article presents the epidemiological data underpinning previous thunderstorm asthma events and analyzes what is known about the etiology of this unusual phenomenon. The evidence behind published risk factors, both at the individual and population level, is discussed. Research from the fields of allergy, pulmonology, meteorology, and climatology is drawn together and critically reviewed to surmise future predictions regarding thunderstorm asthma episodes. Finally, evidence-based individual, community, and environmentally targeted preventive strategies are presented.
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Affiliation(s)
- Ajay Kevat
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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12
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Foo CT, Yee EL, Young A, Denton E, Hew M, O'Hehir RE, Radhakrishna N, Matthews S, Conron M, Harun NS, Lachapelle P, Douglass JA, Irving L, Lee J, Stevenson W, McDonald CF, Langton D, Banks C, Thien F. Continued loss of asthma control following epidemic thunderstorm asthma. Asia Pac Allergy 2019; 9:e35. [PMID: 31720246 PMCID: PMC6826110 DOI: 10.5415/apallergy.2019.9.e35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/15/2019] [Indexed: 11/22/2022] Open
Abstract
Background Epidemic thunderstorm asthma (ETSA) severely affected Melbourne, Australia in November 2016. There is scant literature on the natural history of individuals affected by ETSA. Objective A multicentre 12-month prospective observational study was conducted assessing symptomatology and behaviors of ETSA-affected individuals. Methods We used a structured phone questionnaire to assess asthma symptom frequency, inhaled preventer use, asthma action plan ownership and healthcare utilization over 12 months since the ETSA. Analysis of results included subgroup analyses of the “current,” “past,” “probable,“ and “no asthma” subgroups defined according to their original 2016 survey responses. Results Four hundred forty-two questionnaires were analyzed. Eighty percent of individuals reported ongoing asthma symptoms at follow-up, of which 28% were affected by asthma symptoms at least once a week. Risk of persistent asthma symptoms was significantly higher in those with prior asthma diagnosis, current asthma, and probable undiagnosed asthma (all p < 0.01). Of 442 respondents, 53% were prescribed inhaled preventers, of which 51% were adherent at least 5 days a week. Forty-two percent had a written asthma action plan and 16% had sought urgent medical attention for asthma in the preceding year. Conclusions Following an episode of ETSA, patients experience a pivotal change in asthma trajectory with both loss of asthma control and persistence of de novo asthma. Suboptimal rates of inhaled preventer adherence and asthma action plan ownership may contribute to asthma exacerbation risk and susceptibility to future ETSA episodes. Longer-term follow-up is needed to determine the extent and severity of this apparent change.
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Affiliation(s)
| | | | - Alan Young
- Eastern Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Eve Denton
- Alfred Health, Melbourne, VIC, Australia
| | - Mark Hew
- Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | - Robyn E O'Hehir
- Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
| | | | | | | | | | | | - Jo Anne Douglass
- Melbourne Health, Melbourne, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Louis Irving
- Melbourne Health, Melbourne, VIC, Australia.,The University of Melbourne, Parkville, VIC, Australia
| | - Joy Lee
- Austin Health, Melbourne, VIC, Australia
| | | | | | - David Langton
- Monash University, Melbourne, VIC, Australia.,Peninsula Health, Melbourne, VIC, Australia
| | - Ceri Banks
- Peninsula Health, Melbourne, VIC, Australia
| | - Francis Thien
- Eastern Health, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
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13
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Clayton-Chubb D, Con D, Rangamuwa K, Taylor D, Thien F, Wadhwa V. Thunderstorm asthma: revealing a hidden at-risk population. Intern Med J 2019; 49:74-78. [PMID: 29573176 DOI: 10.1111/imj.13800] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Epidemic thunderstorm asthma (ETSA) refers to large-scale acute bronchospasm events associated with thunderstorm. The most serious episode ever recorded occurred in Melbourne, Australia, in November 2016, where more than 3500 patients were treated in hospitals and 10 died. Previous work has been focused primarily on patient presentations to emergency departments. The prevalence of individuals with milder, non-emergent symptoms and who may be at risk of more serious episodes in the future has not previously been explored. AIM To characterise the nature and extent of respiratory symptoms in healthcare workers during the Melbourne ETSA event. METHODS A survey was conducted among staff and volunteers across Eastern Health, distributed on the intranet homepage, by email and by word of mouth. Anonymous survey questions were constructed to assess prior and current diagnoses of relevance, symptoms, and demography. RESULTS There were 515 participants (80% female, n = 411) of approximately 9000 potential respondents (~6% response rate) who completed the survey; 132 (25.6%) had symptoms suggestive of asthma during the Melbourne ETSA event, the majority of whom did not seek professional medical help. Notably, of those with ETSA-like symptoms, only 58 (43.9%) had a history of asthma, while 97 (73.5%) had a history of allergic rhinitis. Specifically, a history of allergic rhinitis (OR 2.77, P < 0.001), a history of asthma (OR 1.67, P = 0.037) and being of self-identified Asian ethnicity (OR 3.24, P < 0.001) were all strong predictors of ETSA-like symptoms. Being predominantly indoors was not protective. CONCLUSIONS Our study provides evidence of the presence of a large cohort of sufferers during the Melbourne ETSA event of 2016 that did not come to the attention of medical services, implying a potentially hidden and significant susceptible population. Further research should help clarify the true prevalence of vulnerability in the general population, with important public health implications.
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Affiliation(s)
- Daniel Clayton-Chubb
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Kanishka Rangamuwa
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Taylor
- Office of Research and Ethics, Eastern Health, Melbourne, Victoria, Australia
| | - Francis Thien
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Vikas Wadhwa
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
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14
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Harun NS, Lachapelle P, Douglass J. Thunderstorm-triggered asthma: what we know so far. J Asthma Allergy 2019; 12:101-108. [PMID: 31190900 PMCID: PMC6512777 DOI: 10.2147/jaa.s175155] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/14/2019] [Indexed: 01/01/2023] Open
Abstract
Thunderstorm-triggered asthma (TA) is the occurrence of acute asthma attacks immediately following a thunderstorm. Epidemics have occurred across the world during pollen season and have the capacity to rapidly inundate a health care service, resulting in potentially catastrophic outcomes for patients. TA occurs when specific meteorological and aerobiological factors combine to affect predisposed patients. Thunderstorm outflows can concentrate aeroallergens, most commonly grass pollen 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 are followed by a late inflammatory phase. Other environmental factors such as rapid temperature change and agricultural practices contribute to the causation of TA. The most lethal TA event occurred in Melbourne, Australia, in 2016. Studies on the affected individuals found TA to be associated with allergic rhinitis, ryegrass pollen sensitization, pre-existing asthma, poor adherence to inhaled corticosteroid preventer therapy, hospital admission for asthma in the previous year and outdoor location at the time of the storm. Patients without a prior history of asthma were also affected. These factors are important in extending our understanding of the etiology of TA and associated clinical indicators as well as possible biomarkers which may aid in predicting those at risk and thus those who should be targeted in prevention campaigns. Education on the importance of recognizing asthma symptoms, adherence to asthma treatment and controlling seasonal allergic rhinitis is vital in preventing TA. Consideration of allergen immunotherapy in selected patients may also mitigate risk of future TA. Epidemic TA events are predicted to increase in frequency and severity with climate change, and identifying susceptible patients and preventing poor outcomes is a key research and public health policy priority.
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Affiliation(s)
- Nur-Shirin Harun
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.,Lung Health Research Centre, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Philippe Lachapelle
- Department of Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia.,Pulmonary Division, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jo Douglass
- Lung Health Research Centre, The University of Melbourne, Melbourne, VIC, 3052, Australia.,Department of Immunology and Allergy, The Royal Melbourne Hospital, Melbourne, VIC, 3050, Australia
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15
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Sultana RV, McKenzie DP, Fahey MT, Sutherland M, Nimorakiotakis V. Beta-blocker use is an independent risk factor for thunderstorm asthma. Emerg Med Australas 2019; 31:955-960. [PMID: 30887729 DOI: 10.1111/1742-6723.13275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify risk factors for thunderstorm asthma (TA) in subjects ≥15 years of age from information available in routine clinical records. METHODS Retrospective and hospital-based case-control study of various clinical factors in all TA cases (n = 53) who presented to a single-site ED in November 2016 (TA16) and in a control group of patients (n = 156) who presented to the same ED with asthma during the pollen season over eight non-TA years. Bivariate analysis and multivariable logistic regression modelling was performed to calculate the odds of TA asthma in the presence of potential risk factors. RESULTS A logistic regression model revealed that the odds of TA were lower for age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.95-0.99), higher for Asian country of birth (OR 4.09, 95% CI 1.40-11.95) and higher for oral beta-blocker use (OR 6.43, 95% CI 1.58-26.33) compared to controls. No difference was found between TA16 cases and controls for allergies (to medication, grass pollen, animal), hayfever, smoking, oral non-steroidal anti-inflammatory drugs, or aspirin. Newly diagnosed asthma was higher in TA16 cases versus controls (32.1% vs 12.2%, P = 0.001). CONCLUSIONS Oral beta-blocker medications, younger age and Asian-born heritage are risk factors for TA. Further study is required to explore the potential association between beta-blockers and TA.
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Affiliation(s)
- Ron V Sultana
- Emergency Department, Epworth Richmond Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dean P McKenzie
- Epworth HealthCare, Melbourne, Victoria, Australia.,Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Michael T Fahey
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Michael Sutherland
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Epworth HealthCare, Melbourne, Victoria, Australia
| | - Vasilios Nimorakiotakis
- Emergency Department, Epworth Richmond Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Hew M, Lee J, Susanto NH, Prasad S, Bardin PG, Barnes S, Ruane L, Southcott AM, Gillman A, Young A, Rangamuwa K, O'Hehir RE, McDonald C, Sutherland M, Conron M, Matthews S, Harun N, Lachapelle P, Douglass JA, Irving L, Langton D, Mann J, Erbas B, Thien F. The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission. Allergy 2019; 74:122-130. [PMID: 30243030 DOI: 10.1111/all.13609] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/14/2018] [Accepted: 08/08/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016. OBJECTIVE Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital. METHODS Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed. RESULTS We interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83). CONCLUSIONS In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.
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Affiliation(s)
- Mark Hew
- Alfred Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Joy Lee
- Alfred Health Melbourne Victoria Australia
| | | | | | - Philip G. Bardin
- Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | | | | | | | | | - Alan Young
- Eastern Health Melbourne Victoria Australia
| | | | - Robyn E. O'Hehir
- Alfred Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Christine McDonald
- Austin Health Melbourne Victoria Australia
- Melbourne University Melbourne Victoria Australia
| | - Michael Sutherland
- Austin Health Melbourne Victoria Australia
- Melbourne University Melbourne Victoria Australia
| | - Matthew Conron
- Melbourne University Melbourne Victoria Australia
- St Vincent's Health Melbourne Victoria Australia
| | | | | | | | - Jo A. Douglass
- Melbourne University Melbourne Victoria Australia
- Melbourne Health Melbourne Victoria Australia
| | - Louis Irving
- Melbourne University Melbourne Victoria Australia
- Melbourne Health Melbourne Victoria Australia
| | - David Langton
- Monash University Melbourne Victoria Australia
- Peninsula Health Melbourne Victoria Australia
| | | | - Bircan Erbas
- La Trobe University Melbourne Victoria Australia
| | - Francis Thien
- Monash University Melbourne Victoria Australia
- Eastern Health Melbourne Victoria Australia
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17
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Ali F, Behbehani N, Alomair N, Taher A. Fatal and near-fatal thunderstorm asthma epidemic in a desert country. Ann Thorac Med 2019; 14:155-160. [PMID: 31007768 PMCID: PMC6467023 DOI: 10.4103/atm.atm_258_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Reports of thunderstorm asthma in the Middle East are few. This study is the first to report on cases of near-fatal and fatal thunderstorm asthma in Kuwait on December 1, 2016. METHODS: We conducted a chart review and interview with adult patients admitted to Mubarak Al-Kabir Hospital with near-fatal asthma, defined as an exacerbation requiring intubation and mechanical ventilation or hypercapnia with a PaCO2≥6 kPa. Information, including patient age, gender, occupation, asthma history, medication usage, and clinical outcome, was collected. For fatal asthma cases, patients' data were collected from the Forensic Department at the Kuwait Ministry of Interior. RESULTS: A total of 17 patients were admitted with near-fatal asthma. Fifteen patients (93.8%) had a prior history of asthma, with an average duration of 9 years. Five patients (33.3%) reported receiving a corticosteroid inhaler from their physician. Fifteen patients (93.8%) reported relying on a short-acting β2-agonist alone to manage their asthma. Eleven patients (68.8%) reported being outdoors during the storm. Eleven patients were diagnosed with fatal asthma. CONCLUSION: The study is the first to report on a thunderstorm-associated asthma epidemic in Kuwait and emphasizes the potential dangers associated with this entity.
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Affiliation(s)
- Fatima Ali
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Noura Alomair
- Ministry of Interior, General Department of Criminal Evidence, Department of Forensic Medicine, Farwaniyah, Kuwait
| | - Assad Taher
- Ministry of Interior, General Department of Criminal Evidence, Department of Forensic Medicine, Farwaniyah, Kuwait
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18
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Rabiee S, Mousavi H, Khafaie MA. Thunderstorm asthma outbreak, a rare phenomenon in southwest Iran: patients' perspectives. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:36158-36162. [PMID: 30362035 DOI: 10.1007/s11356-018-3478-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/16/2018] [Indexed: 06/08/2023]
Abstract
Previous studies that described thunderstorm asthma, which is a rare event, are not being well explained. This study was conducted, to describe the patient perspective on their asthma attack experience during Ahvaz post-rain phenomenon. We have interviewed patients present in the Naft clinic of Ahvaz, during 28th October and the first week of November 2015. Recruitment was continued as saturation ensued by 33 participants. An inductive content analysis was used to evaluate the interviews. The key finding indicated a climatic condition, direct or indirect contact with rain, history of allergy, and physical conditions are the main categories. The patient emphasized the importance of dust, humidity, first autumn rainfall, and environmental air pollution in occurrences of the event. When exposed to further rains (third rainfall onward), they were less likely to experience dyspnea or shortness of breath. However, being indoor or out at the time of rainfall reported not to be related to the onset of asthma exacerbation. This study yielded that patients' asthma outbreak is a climate-related health impact and many individual factors triggering this issue. Patients concerns need future investigation and public health emergency planning and response arrangements.
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Affiliation(s)
- Shohreh Rabiee
- Coronary Care Unit of Naft Hospital, National Oil Company, Ahvaz, Iran
| | - Hassan Mousavi
- Deputy of Health and Occupation Medicine, National Oil Company, Ahvaz, Iran
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Department of Public Health, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Deputy of Research and Development, Ahvaz Jundishapur University of Medical Sciences, Golestan, Ahvaz, Khuzestan, Iran.
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19
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Schumacher MJ. Thunderstorm asthma. Intern Med J 2018; 47:605-607. [PMID: 28503885 DOI: 10.1111/imj.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/01/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Schumacher
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, USA
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20
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Andrew E, Nehme Z, Bernard S, Abramson MJ, Newbigin E, Piper B, Dunlop J, Holman P, Smith K. Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma. BMJ 2017; 359:j5636. [PMID: 29237604 PMCID: PMC5727436 DOI: 10.1136/bmj.j5636] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the demand for emergency medical assistance during the largest outbreak of thunderstorm asthma reported globally, which occurred on 21 November 2016. DESIGN A time series analysis was conducted of emergency medical service caseload between 1 January 2015 and 31 December 2016. Demand during the thunderstorm asthma event was compared to historical trends for the overall population and across specific subgroups. SETTING Victoria, Australia. MAIN OUTCOME MEASURES Number of overall cases attended by emergency medical services, and within patient subgroups. RESULTS On 21 November 2016, the emergency medical service received calls for 2954 cases, which was 1014 more cases than the average over the historical period. Between 6 pm and midnight, calls for 1326 cases were received, which was 2.5 times higher than expected. A total of 332 patients were assessed by paramedics as having acute respiratory distress on 21 November, compared with a daily average of 52 during the historical period. After adjustment for temporal trends, thunderstorm asthma was associated with a 42% (95% confidence interval 40% to 44%) increase in overall caseload for the emergency medical service and a 432% increase in emergency medical attendances for acute respiratory distress symptoms. Emergency transports to hospital increased by 17% (16% to 19%) and time critical referrals from general practitioners increased by 47% (21% to 80%). Large increases in demand were seen among patients with a history of asthma and bronchodilator use. The incidence of out-of-hospital cardiac arrest increased by 82% (67% to 99%) and pre-hospital deaths by 41% (29% to 55%). CONCLUSIONS An unprecedented outbreak of thunderstorm asthma was associated with substantial increase in demand for emergency medical services and pre-hospital cardiac arrest. The health impact of future events may be minimised through use of preventive measures by patients and predictive early warning systems.
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Affiliation(s)
- Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC 3108, Australia 3108
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC 3108, Australia 3108
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Community Emergency Health and Paramedic Practice, Frankston, VIC 3199, Australia
| | - Stephen Bernard
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC 3108, Australia 3108
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Intensive Care Unit, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Ed Newbigin
- School of BioSciences, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Ben Piper
- Emergency Services Telecommunications Authority, Burwood East, VIC 3151, Australia 3151
| | - Justin Dunlop
- Emergency Management Unit, Ambulance Victoria, Melbourne, VIC 3000, Australia
| | - Paul Holman
- Emergency Management Unit, Ambulance Victoria, Melbourne, VIC 3000, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC 3108, Australia 3108
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Community Emergency Health and Paramedic Practice, Frankston, VIC 3199, Australia
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21
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Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America. Can Respir J 2017; 2017:8921917. [PMID: 28239256 PMCID: PMC5292365 DOI: 10.1155/2017/8921917] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM2.5 and CO were consistent across studies. The link between asthma and O3 varied across seasons. Regional variation exists in the role of SO2. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM10-2.5, PM10, O3, NO2, SO2, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.
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