Thunderstorm asthma

High levels of pollen trigger attacks

By Dr Andy Whittamore

At least two people have died as a result of their asthma being aggravated by thunderstorms which hit the city of Melbourne this week. Emergency services were overwhelmed by nearly 1,900 calls in the space of a few hours, with hundreds of people reporting asthma attacks. One hospital in Melbourne ran out of inhalers and there were dangerously long waits for ambulances.

Epidemics of this magnitude are not common, but thunderstorm-aggravated asthma is something I hear about as a GP every year from my patients in the UK.

The reason many people with asthma - and some people who didn’t even know they had asthma - struggle at times of thunderstorms is because of the atmospheric conditions and the way they affect pollen.

A significant number of people with asthma have allergic asthma. The triggers vary from person to person, but in the case of Melbourne residents were largely related to higher levels of pollens being drawn into the air by the humid stormy conditions which then turned them into smaller particles. These smaller particles can be more deeply inhaled into the lungs, causing a greater degree of irritation and inflammation.

Dr Andy WhittamorePeople have been asking why Melbourne was hit by this event. This part of Australia is well known for its changeable weather. When hot inland temperatures meet the cool southern ocean with very strong cold fronts, the clash can bring about storms.

It is spring in Australia. Like many other parts of the world, spring is associated with high pollen levels. In Melbourne, levels of rye pollen particles in the air were reported to be more than double the normal range.

In the UK we’re facing the opposite, but equally deadly, climate - cold winter months with plummeting temperatures and cold and flu viruses leading to double the number of asthma deaths typically reported in summer.

In Melbourne, workloads for healthcare teams across the city were intense, with emergency services handling six times the number of calls they would normally receive.

It is very sad to hear reports of the people who died from asthma. I am sure the ambulance and hospital services were responsible for many lives saved as they worked under immense pressure to treat the hundreds reporting breathing problems. This is likely to be the tip of the iceberg, however. Many people with asthma would have managed their own symptoms and many others would have ignored the warning signs.

We know from the National Review of Asthma Deaths (NRAD) that a large proportion of people who died from asthma did not seek any medical advice or were not receiving adequate levels of care for their asthma. Many of the deaths in NRAD appear to have been in people with milder asthma as well as those who were clearly struggling with poorly-controlled asthma.

We need doctors, nurses and pharmacists to work with their patients to understand their asthma better and to end complacency. Having asthma symptoms more than twice a week is a sign of inflammation in the airways. It just takes one extra factor – a particularly bad virus or a thunderstorm - to put someone in a critical condition and at risk of death.

How to take care of your asthma:

  • Be aware of your triggers
  • Take your preventative medication regularly
  • If you do have allergy-related asthma use preventative nasal sprays or antihistamines
  • Make sure you ask your doctor or nurse for a written asthma action plan – so that you know what to do
  • Carry a reliever inhaler at all times

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