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Epidemic Thunderstorm asthma warning: expected to become more frequent and severe due to climate change.

November 10, 2020 at 9:32 pm John Englart Leave a comment

VicHealth warning map for thunderstorm asthma forr 11 November 2020

This is an extreme weather warning for tomorrow (Wednesday 11 November 2020) for epidemic thunderstorm asthma. Anyone who suffers asthma or heyfever should have their medications and asthma plan ready. Risk is rated as moderate for tomorrow.

The Victorian Health Department advises:

“People with current, past or undiagnosed asthma or hay fever are considered to be at risk. Having both asthma and hay fever or poorly controlled asthma increases the risk further. Those at increased risk should:
* avoid exposure to any storms that may emerge, especially the wind gusts that precede them
* have a reliever appropriately available (as discussed with your doctor or pharmacist)
* remind themselves of their asthma action plan and have practical knowledge of the four steps of asthma first aid.”

The Age newspaper has reported on the risks in this article: ‘Big risk’: Thunderstorm asthma warnings amid windy, hot weather.

Vic Emergency warning for thunderstorm asthma for 11 November 2020

We haven’t done nearly enough scientific research in the southern hemisphere on the possible links between rising temperatures of climate change and increasing revalence of epidemic thunderstorm asthma events.

Melbourne seems particularly susceptible to these events here in Australia.

In 2019 the ABC highlighted in an article that Climate change could affect grass pollen seasons, and your hayfever.

A particularly deadly thunderstorm asthma event ocurred in November 2016 in Melbourne and surrounds with an estimated 10,000 people affected, and resulted in at least 10 direct deaths.

The Lancet Medical Journal article from 2018 described the impact of the 2016 Melbourne event that affected up to 10,000 people:

“Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74–2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28–16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died."

The coroner heard that about 14,000 people were taken to hospital and seven men and three women – aged 18 to 57 – died during the November 2016 thunderstorm asthma event. Only 3 of the 10 who died had asthma action plans.

Professor Jo Douglass, from Royal Melbourne hospital, highlighted a trend of the victims having spent time outdoors before their deaths, which occurred on a hot 38C day with lots of pollen in the air, ahead of a storm. According to the Guadian report, Douglass said respiratory arrest in the victims had occurred as soon as 15 minutes after the first signs of asthma or wheezing.

“The average time from complaint to respiratory arrest was very short,” she told the court. “Fifteen minutes does not really leave anyone time to do much.”

A recent scientific study by Price et al (2020) highlighted that “Because of climate change, future events are likely to become more common, more disastrous, and more unpredictable.”

“All 7 Melbourne epidemics occurred in November, when ryegrass pollination was at its peak.17 The distribution of grass pollens is dependent on the weather, and Melbourne’s high susceptibility to ETSA may be influenced by local weather patterns interacting with the environment. Hot northern winds tend to push aeroallergens from large grasslands down south toward a sensitized urban population.7 Thunderstorms aid in the dispersion of intact and ruptured pollen grains, leading to sensitized individuals inhaling high atmospheric levels of allergens within a short period of time.” outlined the researchers.

Price etal (2020) Thunderstorm asthma events in Australia

The researchers concluded that Health authorities needed to be more prepared and pro-active.

“ETSA is a global health issue that will most likely become more frequent and severe over the coming years due to climate change. Australia, being the country hit hardest and most often by these events, should prepare for future epidemics to avoid burdening our current health infrastructure. It is crucial for health professionals to identify potential biomarkers and risk factors in affected individuals. These may include existing sensitivity to seasonal allergenic grasses, prior history of allergic rhinitis, overall elevated titers of IgE, elevated grass pollen specific IgE, serum specific IgE to major grass allergens, such as Lol p 5 from ryegrass and its cross-reactive analogues in other grasses, and high RAST or positive skin prick tests to seasonal allergens. Determining these factors will help patients receive appropriate and effective treatment methods and reduce the aftermath of the 2016 Melbourne epidemic from happening again.”

References:

• Dwan Price, Kira M.Hughes, Francis Thien, Cenk Suphioglu,(October 2020) Epidemic Thunderstorm Asthma: Lessons Learned from the Storm Down-Under, Journal of Allergy and Clinical Immunology: In Practice, https://doi.org/10.1016/j.jaip.2020.10.022 (Open Access)
• Francis Thien, Paul J Beggs, Danny Csutoros, Jai Darvall, Mark Hew, Janet M Davies, (June 2018) The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors, The Lancet Planetary Health, DOI:https://doi.org/10.1016/S2542-5196(18)30120-7 (Open Access)
• Australian Associated Press, June 2018, Thunderstorm asthma deaths: only three victims had disease ‘action plan’, The Guardian.

Entry filed under: climate change info, health, news. Tags: climate impact, extreme weather, pollen, thunderstorm asthma.