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Al-Moamary MS, Alhaider SA, Allehebi R, Idrees MM, Zeitouni MO, Al Ghobain MO, Alanazi AF, Al-Harbi AS, Yousef AA, Alorainy HS, Al-Hajjaj MS. The Saudi initiative for asthma - 2024 update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2024; 19:1-55. [PMID: 38444991 PMCID: PMC10911239 DOI: 10.4103/atm.atm_248_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/31/2023] [Indexed: 03/07/2024] Open
Abstract
The Saudi Initiative for Asthma 2024 (SINA-2024) is the sixth version of asthma guidelines for the diagnosis and management of asthma for adults and children that was developed by the SINA group, a subsidiary of the Saudi Thoracic Society. The main objective of the SINA is to have guidelines that are up-to-date, simple to understand, and easy to use by healthcare workers dealing with asthma patients. To facilitate achieving the goals of asthma management, the SINA Panel approach is mainly based on the assessment of symptom control and risk for both adults and children. The approach to asthma management is aligned for age groups: adults, adolescents, children aged 5-12 years, and children aged <5 years. SINA guidelines have focused more on personalized approaches reflecting a better understanding of disease heterogeneity with the integration of recommendations related to biologic agents, evidence-based updates on treatment, and the role of immunotherapy in management. The medication appendix has also been updated with the addition of recent evidence, new indications for existing medication, and new medications. The guidelines are constructed based on the available evidence, local literature, and the current situation at national and regional levels. There is also an emphasis on patient-doctor partnership in the management that also includes a self-management plan.
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Affiliation(s)
- Mohamed Saad Al-Moamary
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami A. Alhaider
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Riyad Allehebi
- Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Majdy M. Idrees
- Department of Medicine, Respiratory Division, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed O. Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed O. Al Ghobain
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah F. Alanazi
- Department of Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Adel S. Al-Harbi
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan S. Alorainy
- Department of Respiratory Care, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohamed S. Al-Hajjaj
- Department of Paediatrics, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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2
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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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3
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Climate Change Factors and the Aerobiology Effect. Immunol Allergy Clin North Am 2022; 42:771-786. [DOI: 10.1016/j.iac.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Banasiak NC, Keil Heinonen SA, Filippelli AC. The Perfect Storm: Thunderstorm-Related Asthma. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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D'Amato G, Annesi-Maesano I, Urrutia-Pereira M, Del Giacco S, Rosario Filho NA, Chong-Neto HJ, Solé D, Ansotegui I, Cecchi L, Sanduzzi Zamparelli A, Tedeschini E, Biagioni B, Murrieta-Aguttes M, D'Amato M. Thunderstorm allergy and asthma: state of the art. Multidiscip Respir Med 2021; 16:806. [PMID: 35003735 PMCID: PMC8672486 DOI: 10.4081/mrm.2021.806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 01/22/2023] Open
Abstract
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 allergic patients. 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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Affiliation(s)
- Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality Hospital 'A. Cardarelli', Naples, Italy.,Medical School of Specialization in Respiratory Diseases, Federico II University of Naples, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department, IPLESP, Paris, France.,Research Director Co- Directrice/Deputy Director IDESP, INSERM, University of Montpellier, France
| | | | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | | | | | - Dirceu Solé
- Department of Pediatrics, Federal University of São Paulo, SP, Brazil
| | - Ignacio Ansotegui
- Department of Allergy and Immunology, Hospital Quiron Salud Bizkaia, Bilbao, Spain
| | | | - Alessandro Sanduzzi Zamparelli
- Division of Pneumology, High Speciality Hospital 'V. Monaldi', Federico II University of Naples Medical School, Naples, Italy
| | - Emma Tedeschini
- Department of Agricultural Food and Environmental Science, University of Perugia, Italy
| | - Benedetta Biagioni
- The Allergy Outpatient Clinic-, Division of Internal Medicine, IRCCS, Azienda Ospedaliera Universitaria, Bologna, Italy
| | | | - Maria D'Amato
- First Division of Pneumology, High Speciality Hospital 'V. Monaldi', Federico II University of Naples Medical School, Naples, Italy
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7
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Price D, Hughes KM, Thien F, Suphioglu C. Epidemic Thunderstorm Asthma: Lessons Learned from the Storm Down-Under. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1510-1515. [PMID: 33172604 DOI: 10.1016/j.jaip.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/06/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
Epidemic thunderstorm asthma (ETSA) is a global health problem that can strike without sufficient warning and can have catastrophic consequences. Because of climate change, future events are likely to become more common, more disastrous, and more unpredictable. To prevent loss of life and avoid surge events on health care infrastructure, identifying at-risk individuals and their potential biomarkers is the most prophylactic approach that can be taken to mitigate the deadly consequences of ETSA. In this review, we provide an update on the clinical mechanism, global prevalence, and characteristics of those patients moderately or severely at risk of ETSA. Identifying these patient characteristics will aid clinical professionals to provide suitable and personalized treatment plans and, in turn, avoid future loss of life.
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Affiliation(s)
- Dwan Price
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, VIC, Australia; NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia; Deakin AIRwatch Pollen and Spore Counting and Forecasting Facility, Deakin University, Burwood and Waurn Ponds, VIC, Australia
| | - Kira M Hughes
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia; Deakin AIRwatch Pollen and Spore Counting and Forecasting Facility, Deakin University, Burwood and Waurn Ponds, VIC, Australia
| | - Francis Thien
- Respiratory Medicine, Eastern Health, Box Hill Hospital and Monash University, Box Hill, VIC, Australia
| | - Cenk Suphioglu
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Waurn Ponds, VIC, Australia; NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Faculty of Science, Engineering and Built Environment, Deakin University, Burwood, VIC, Australia; Deakin AIRwatch Pollen and Spore Counting and Forecasting Facility, Deakin University, Burwood and Waurn Ponds, VIC, Australia.
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8
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Spina MF, Banfi PI, Nicolini A. Thunderstorm-asthma, two cases observed in Northern Italy. Multidiscip Respir Med 2020; 15:679. [PMID: 32983454 PMCID: PMC7499097 DOI: 10.4081/mrm.2020.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022] Open
Abstract
Thunderstorm asthma is a rare event: in this letter we describe two cases observed during the same month of 2018 at an Italian Emergency department, assessed by the same medical team and according to the same methodology and approach. Given the infrequency of such a phenomenon and the debate around its nature, frequency, and - at times - existence, we strongly believe it is important for all specialists who observe such cases to report them, building an evidence base to expand its knowledge and understanding.
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Affiliation(s)
| | | | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital of Sestri Levante (GE), Italy
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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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