Thunderstorm asthma
{{Short description|Biometeorological phenomenon}}
{{Use dmy dates|date=April 2022}}
File:Tamworth Storm 15th Feb 2006 a.sized.jpg, Australia]]
Image:Misc pollen colorized.jpg image of pollen grains from a variety of common plants]]
Thunderstorm asthma (also referred to in the media as thunder fever or a pollen bomb{{cite web |title=A change in the pollen season – but is it worse than normal? |url=https://blog.metoffice.gov.uk/2022/06/10/a-change-in-the-pollen-season-but-is-it-worse-than-normal/ |website=UK Met Office |access-date=20 July 2022 |language=en |date=10 June 2022}}) is the triggering of an asthma attack by environmental conditions directly caused by a local thunderstorm. Due to the acute nature of the onset and wide exposure of local populations to the same triggering conditions, severe epidemic thunderstorm asthma events can put significant and unmanageable stress on public health facilities.
Widely recognised but not fully understood, it has been proposed that during a thunderstorm, pollen grains can absorb moisture and then burst into much smaller fragments with these fragments being easily dispersed by wind.{{Cite news |last=Sample |first=Ian |date=November 25, 2016 |title=Thunderstorm asthma: how seasonal weather can affect human health |work=The Guardian |url=https://www.theguardian.com/science/2016/nov/24/melbourne-suffers-most-lethal-episode-of-thunderstorm-asthma |access-date=December 11, 2022}}{{Cite web|url=https://pubmed.ncbi.nlm.nih.gov/?term=thunderstorm+asthma|title=thunderstorm asthma - PubMed - NCBI|last=pubmeddev|website=www.ncbi.nlm.nih.gov|language=en|access-date=2019-08-27}} While larger pollen grains are usually filtered by hairs in the nose, the smaller pollen fragments are able to pass through and enter the lungs, triggering the asthma attack.Suphioglu C. Thunderstorm Asthma Due to Grass Pollen. Int Arch Allergy Immunol 1998;116:253–260. {{doi|10.1159/000023953}}Taylor, P.E. & Jonsson, H. Thunderstorm asthma. Curr Allergy Asthma Rep (2004) 4: 409. {{doi|10.1007/s11882-004-0092-3}}Dabrera G, Murray V, Emberlin J, Ayres JG, Collier C, Clewlow Y, Sachon P. Thunderstorm asthma: an overview of the evidence base and implications for public health advice. QJM. 2013 Mar;106(3):207-17. {{doi|10.1093/qjmed/hcs234}}. {{PMID|23275386}}D'Amato G, Vitale C, D'Amato M, Cecchi L, Liccardi G, Molino A, Vatrella A, Sanduzzi A, Maesano C, Annesi-Maesano I. Thunderstorm-related asthma: what happens and why. Clin Exp Allergy. 2016 Mar;46(3):390-6. {{doi|10.1111/cea.12709}}. {{PMID|26765082}}
History
The phenomenon of thunderstorm asthma has been recognised since the 1980s, with an event in Birmingham, England, in July 1983 often considered the first prominent example.{{Cite journal|last1=Packe|first1=G. E.|last2=Ayres|first2=JonG.|title=Asthma Outbreak During a Thunderstorm|date=1985-07-27|url=http://www.sciencedirect.com/science/article/pii/S0140673685915107|journal=The Lancet|series=Originally published as Volume 2, Issue 8448|language=en|volume=326|issue=8448|pages=199–204|doi=10.1016/S0140-6736(85)91510-7|pmid=2862383|s2cid=22213257|issn=0140-6736|url-access=subscription}} A 2013 study which reviewed instances of abnormally high asthma-related admissions to emergency departments between 1983 and 2013 identified strong correlation between those instances and thunderstorms, while noting that such events were so rare that very little detailed research into the phenomenon had occurred.{{Cite journal|last1=Dabrera|first1=G.|last2=Murray|first2=V.|last3=Emberlin|first3=J.|last4=Ayres|first4=J. G.|last5=Collier|first5=C.|last6=Clewlow|first6=Y.|last7=Sachon|first7=P.|date=2013-03-01|title=Thunderstorm asthma: an overview of the evidence base and implications for public health advice|url=https://academic.oup.com/qjmed/article/106/3/207/1565254|journal=QJM: An International Journal of Medicine|language=en|volume=106|issue=3|pages=207–217|doi=10.1093/qjmed/hcs234|pmid=23275386|issn=1460-2725|doi-access=free}}
A significant impetus in the study of the phenomenon occurred after an event in November 2016 in Melbourne, Australia. Recognised as the most severe epidemic thunderstorm asthma event on record, the onset overwhelmed the city's ambulance system and some local hospitals, saw a ten-fold increase in asthma cases presenting to emergency departments compared with average, and resulted in ten deaths.{{Cite journal|last1=Thien|first1=F.|last2=Beggs|first2=P. J.|last3=Csutoros|first3=S.|last4=Darvall|first4=J.|last5=Hew|first5=M.|last6=Davies|first6=J. M.|date=2018-06-01|title=The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors|url=https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30120-7/fulltext|journal=The Lancet|language=en|volume=2|issue=6|pages=255–263|doi=10.1016/S2542-5196(18)30120-7 |pmid=29880157 |hdl=10536/DRO/DU:30113260|hdl-access=free}}{{cite web|url=http://www.abc.net.au/news/2016-11-24/thunderstorm-asthma-three-patients-critical/8052800|title='Thunderstorm asthma': Three people remain critical, at least four dead|last=Wright|first=Patrick|date=24 November 2016|work=ABC Online|access-date=24 November 2016}}[http://www.abc.net.au/news/2016-11-23/thunderstorm-asthma-student-days-away-from-graduating/8048894 "'Thunderstorm asthma': Four people now believed dead, could have been more, minister says"] ABC News, 23 November 2016. Accessed 23 November 2016.{{Cite news|url=http://www.abc.net.au/news/2016-11-27/sixth-person-dies-from-thunderstorm-asthma-emergency/8061380|title=Sixth person dies from thunderstorm asthma emergency|date=2016-11-27|newspaper=ABC News|language=en-AU|access-date=2016-11-27}}{{cite web|url=https://www.bbc.com/news/world-australia-38121579|title='Thunderstorm asthma' deaths in Melbourne rise to nine|date=29 November 2016|work=BBC Online|access-date=29 November 2016}}{{Cite news|url=http://www.abc.net.au/news/2017-01-25/thunderstorm-asthma-ninth-death-in-victoria/8212096|title=Thunderstorm asthma: Ninth death in Victoria after freak weather event in 2016|date=25 January 2017|work=ABC News|access-date=25 January 2017}} One month later, an epidemic thunderstorm asthma event in Kuwait resulted in at least 5 deaths and many admissions to the ICU.[http://gdnonline.com/details.html?id=147475 Five expats die of asthma as rain lashes Kuwait. Gulf Digital News, 2016]{{Dead link|date=September 2023 |bot=InternetArchiveBot |fix-attempted=yes }}{{cite web|url=http://www.kuna.net.kw/ArticleDetails.aspx?id=2579311&language=en |title=KUNA: Five people die in 2 days due to asthma attacks - health official|date=December 2, 2016|website=kuna.net.kw|access-date=8 December 2016}}
Since then there have been further reports of epidemic thunderstorm asthma events in Wagga Wagga, Australia; London, England; Naples, Italy;D'Amato, G., Liccardi, G. and Frenguelli, G. (2007), Thunderstorm-asthma and pollen allergy. Allergy, 62: 11–16. {{doi|10.1111/j.1398-9995.2006.01271.x}} Atlanta, United States;Grundstein A, Sarnat SE, Klein M, Shepherd M, Naeher L, Mote T, Tolbert P. Thunderstorm associated asthma in Atlanta, Georgia. Thorax. 2008 Jul;63(7):659-60. {{doi|10.1136/thx.2007.092882}}. {{PMID|18587040}} and Ahvaz, Iran.Forouzan A, Masoumi K, Haddadzadeh Shoushtari M, Idani E, Tirandaz F, Feli M, Assarehzadegan MA, Asgari Darian A. An overview of thunderstorm-associated asthma outbreak in southwest of Iran. J Environ Public Health. 2014;2014:504017. {{doi|10.1155/2014/504017}}. {{PMID|25093023}}
Statistics
Many of those affected during a thunderstorm asthma outbreak may have never experienced an asthma attack before.{{Cite news|url=http://www.cnn.com/2016/11/23/health/thunderstorm-asthma-australia/index.html |title='Thunder asthma:' Deadly illness caused by freak weather|author1=Reed Alexander |author2=James Griffiths |date=November 23, 2016|access-date=November 23, 2016|publisher=CNN}}
It has been found 95% of those that were affected by thunderstorm asthma had a history of hayfever, and 96% of those people had tested positive to grass pollen allergies, particularly rye grass.{{cite news|url=http://www.abc.net.au/news/2016-11-22/what-is-thunderstorm-asthma/8044920 |title=What is thunderstorm asthma? - ABC News (Australian Broadcasting Corporation) |newspaper=ABC News |date= 21 November 2016|access-date=2016-11-23}} A rye grass pollen grain can hold up to 700 tiny starch granules, measuring 0.6 to 2.5 μm, small enough to reach the lower airways in the lung.{{cite web|author=Peter Dockrill |url=http://www.sciencealert.com/thunderstorm-asthma-is-a-real-thing-that-s-killed-2-people-in-australia |title=Thunderstorm asthma is a real thing that's killed 2 people in Australia |website=ScienceAlert.com |date=2015-08-21 |access-date=2016-11-23}}D'Amato G, Annesi Maesano I, Molino A, Vitale C, D'Amato M. Thunderstorm-related asthma attacks.J Allergy Clin Immunol. 2017 Jun;139(6):1786-1787. {{doi|10.1016/j.jaci.2017.03.003}}. {{PMID|28342913}}{{Cite web|url=https://www.allergy.org.au/patients/asthma-and-allergy/thunderstorm-asthma|title=Thunderstorm asthma|date=2016|website=ASCIA - Australasian Society of Clinical Immunology and Allergy|access-date=2017-12-12}}
Prevention
Patients with a history of grass allergies should be tested for asthma and treated for the grass allergies and asthma if also present. Patients with known asthma should be treated and counseled on the importance of adherence to preventative medication protocols.{{Cite journal |last1=Harun |first1=Nur-Shirin |last2=Lachapelle |first2=Philippe |last3=Douglass |first3=Jo |author-link3=Jo Douglass |date=2019 |title=Thunderstorm-triggered asthma: what we know so far |journal=Journal of Asthma and Allergy |volume=12 |pages=101–108 |doi=10.2147/JAA.S175155 |issn=1178-6965 |pmc=6512777 |pmid=31190900 |doi-access=free}} Preventative treatment found useful for severe asthma includes Allergen immunotherapy (AIT) particularly sublingual immunotherapy (SLIT).{{Cite journal|last1=Lombardi|first1=Carlo|last2=Savi|first2=Eleonora|last3=Ridolo|first3=Erminia|last4=Passalacqua|first4=Giovanni|last5=Canonica|first5=Giorgio Walter|date=2017|title=Is allergic sensitization relevant in severe asthma? Which allergens may be culprit?|journal=The World Allergy Organization Journal|volume=10|issue=1|pages=2|doi=10.1186/s40413-016-0138-8|issn=1939-4551|pmc=5219672|pmid=28101292 |doi-access=free }}
Significant events
- {{Timeline-event|date={{Start date|1983|07|06|df=y}}|end_date={{End date|1983|07|07|df=y}}|event=Birmingham, England}}
- {{Timeline-event|date={{Start date|1987|11|08|df=y}}|event=Melbourne, Australia}}
- {{Timeline-event|date={{Start date|1989|11|29|df=y}}|end_date={{End date|1989|11|30|df=y}}|event=Melbourne, Australia}}
- {{Timeline-event|date={{Start date|1994|07|24|df=y}}|end_date={{End date|1994|07|25|df=y}}|event=London, England}}
- {{Timeline-event|date={{Start date|1997|10|30|df=y}}|event=Wagga Wagga, Australia}}
- {{Timeline-event|date={{Start date|2004|06|04|df=y}}|event=Naples, Italy}}
- {{Timeline-event|date={{Start date|2010|11|25|df=y}}|event=Melbourne, Australia}}
- {{Timeline-event|date={{Start date|2013|11|02|df=y}}|event=Ahvaz, Iran}}
- {{Timeline-event|date={{Start date|2016|11|21|df=y}}|event=Melbourne, Australia}}
- {{Timeline-event|date={{Start date|2016|12|01|df=y}}|event=Kuwait}} and Riyadh, Saudi Arabia
- {{Timeline-event|date={{Start date|2023|06|12|df=y}}|event=Thames Valley, England}}