Patients with thunderstorm asthma or severe asthma in Melbourne: a comparison

AuthorsSutherland, M.F.
Portelli, E.L.
Collins, A.L.
Rahman, M.A.
McDonald, C.F.
TypeResearch Letter
JournalMedical Journal of Australia
PubMed ID29129175
Year of Publication2018
URLhttps://www.ncbi.nlm.nih.gov/pubmed/29129175
DOI/10.5694/mja17.00780
Download 105694mja17_00780_.pdf (124.8 KB)
AbstractThe Melbourne epidemic thunderstorm asthma (ETA) event of 21/22 November 2016 was unprecedented in size and health impact.1 There is an urgent need to understand the characteristics of the people who were affected. We therefore sought to characterise the patients with ETA who attended Austin Health, a metropolitan teaching hospital in the northern suburbs of Melbourne, during the event, and to compare them with patients with severe asthma.
The study was approved by the Austin Health Human Research Ethics Committee (reference, LNR/17/Austin/319). All adults who attended the emergency department with a diagnosis of asthma on 21/22 November were offered an appointment with a dedicated ETA clinic. Patients underwent clinical assessment and completed the Asthma Control Questionnaire. Spirometry before and after bronchodilator use, radio-allergosorbent testing (RAST), and skin prick testing for aeroallergens were undertaken, and exhaled nitric oxide, total serum IgE, and peripheral blood eosinophil count assessed. Data for the adult patients with ETA were compared with those of adult patients from our severe asthma clinic who had previously undergone similar testing.
Of 203 patients with ETA who attended the emergency department on 21/22 November 2016, 145 were adults, of whom 31 (21%) attended for follow-up and underwent full assessment by our census date of 22 June 2017. The other patients declined an appointment, failed to attend, or have not yet completed full testing. The demographic characteristics (age, sex) of attendees and non-attendees were similar.
The ETA group had better lung function, fewer current asthma symptoms, and higher levels of sensitisation to rye grass than the severe asthma group (Box). Notably, most ETA patients had a very high RAST result for rye grass (≥ 17.5 kIU/L). Levels of fungal and dust mite sensitisation in the two groups did not differ significantly. The use of inhaled corticosteroids with long acting β-agonists and omalizumab was more frequent in the severe asthma group. Despite their reduced lung function, none of the severe asthma group attended the emergency department or was admitted to hospital during the thunderstorm event.
Box
Characteristics of patients with epidemic thunderstorm asthma (attending the emergency department at Austin Health) or with severe asthma (attending the severe asthma clinic at Austin Health)
These results suggest that rye grass pollen was the principal allergen for patients who presented to hospital with ETA. An earlier community study of allergic rhinitis found that a high level RAST result for grass pollen (17.5 kIU/L or more) was associated with a 50-fold relative risk (compared with non-allergic controls) of rhinitis and asthma symptoms when exposed to grass pollen.2 Combined with our findings, this suggests that a high level positive RAST result for rye grass may be useful for predicting the likelihood of risk of ETA in individuals with allergic rhinitis, with or without asthma.
Omalizumab and inhaled corticosteroids attenuate early and late asthmatic responses to allergen challenge,3 and inhaled corticosteroids alleviate ETA.4 We also found that our patients with severe asthma, 70% of whom were sensitised to rye grass, appear to have been protected from ETA by current asthma preventer medications. Because of our small sample sizes, our findings must naturally be interpreted with caution.

http://www.ibas.org.au/what-we-do/publications/3872989


< More publications



Notch monitoring in sleepNOTCH MONITORING IN SLEEP

Sleep apnea is a condition where breathing is abnormal during sleep. There are two main forms of sleep apnea: obstructive and central. For obstructive sleep apnea, breathing is reduced because the airway...

SHiQ - COSAQSHIQ - COSAQ

Each year in Australia 260 people sustain a SCI, with over half losing full function in their arms and legs (quadriplegia). In addition to the primary disability, there is a very high rate of Obstructive...

NTC releases 'world first' heavy vehicle driver fatigue studyNTC RELEASES 'WORLD FIRST' HEAVY VEHICLE DRIVER FATIGUE STUDY

The National Transport Commission (NTC) and the Cooperative Research Centre for Alertness, Safety and Productivity (Alertness CRC) have released the results of what is hailed as a world-first study into heavy vehicle driver fatigue.

AAMRI Election Statement released on 25th March 2019AAMRI ELECTION STATEMENT RELEASED ON 25TH MARCH 2019

AAMRI released its election statement calling on politicians to commit to three main priorities: ensuring the MRFF reaches $20 billion by 2020-21, provide continued strong support for the NHMRC, and develop sustainable and rewarding career pathways.

IBAS Director Anna Burke unveils her portrait at Canberra's Parliament HouseIBAS DIRECTOR ANNA BURKE UNVEILS HER PORTRAIT AT CANBERRA'S PARLIAMENT HOUSE

Anna Burke had barely got into the swing of her speech at the unveiling of her portrait at Canberra's Parliament House when the ringing of bells caused half her audience to hurry away

National study offers hope for breathlessnessNATIONAL STUDY OFFERS HOPE FOR BREATHLESSNESS

A national medication study is aiming to help thousands of Australians who struggle every day with shortness of breath

Institute for Breathing and Sleep

Level 5, Harold Stokes Building, Austin Hospital
145 Studley Road
Heidelberg, Victoria, 3084

(03) 9496 5390

Email Us

Donate