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Role of mass gathering surveillance
Published in David L. Blazes, Sheri H. Lewis, Disease Surveillance, 2016
The real-time syndromic surveillance systems have been described as a legacy of the 2012 Olympic Games (Elliot et al. 2013). The systems and processes developed for Olympic Games have continued to operate as an Olympic legacy and have been subsequently used to complement seasonal public health surveillance programs and support the response to public health incidents: Enhancing seasonal influenza and respiratory surveillance during the winter using ED and OOH surveillance systems to triangulate intelligenceImproving the ability to support national heat wave and cold weather plans by monitoring ED attendances for heat/sun stroke in the summer and falls and sprains during periods of extreme cold weatherUsing new systems in the impact assessment programs of the new live attenuated influenza vaccine and rotavirus vaccinesProviding situational awareness during national air pollution incidentsUsing ED data to monitor the occurrence of incidents of thunderstorm asthma (Elliot et al. 2014)
Asthma and Allergens
Published in Jonathan A. Bernstein, Mark L. Levy, Clinical Asthma, 2014
James L. Friedlander, Sachin Baxi, Wanda Phipatanakul
Intact pollens range from 10 to 100 μm, though most have diameters between 20 and 35 μm, while fungal spores range from 2 to 50 μm.38 These large particles are removed by the nasal mucosa and upper tracheobroncial passages. However, particles <5 μm generally reach the alveoli of the lungs.39 An intact pollen is too large to reach the alveoli, but studies have shown that submicronic pollen-derived bioaerosols can reach the alveoli. For example, ryegrass pollen ruptures on contact with water and releases microscopic starch particles (0.5–2.5 μm) containing a major grass allergen. Such bioaerosols have been shown to be expulsed from pollens and mold spores.40–43 While rain can wash pollen grains or spores from the air, the expulsed bioaerosols can trigger asthma exacerbations. Bioaerosols are thought to be associated with thunderstorm asthma epidemics.39,40–43 In Melbourne, in 1987, there was a fivefold increase in asthma emergency department (ED) visits in a 24-h period after a thunderstorm. In 1989, there was a tenfold increase with 277 ED visits.39,44 In 1994, in London, 40 patients presented with asthma flares within 24 h of a storm.45,46
2016 Thunderstorm-asthma epidemic in Melbourne, Australia: An analysis of patient characteristics associated with hospitalization
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Nur-Shirin Harun, Philippe Lachapelle, Gayan Bowatte, Caroline Lodge, George Braitberg, Louis Irving, Timothy Hinks, Shyamali Dharmage, Jo Douglass
Since future episodes of the weather events leading to thunderstorm asthma are highly likely, patients and healthcare providers need to be aware of the risk of asthma symptoms in individuals with allergic rhinitis. Our study suggests that asthma symptoms in those with seasonal allergic rhinitis are a likely indicator of risk in the setting of a TA event and so should be identified and treated. Treatment options for allergic rhinitis for which some evidence of efficacy in asthma exists includes intranasal corticosteroids and montelukast, although there has been some debate about the former and neither of these agents have been studied in a prospective manner in seasonal allergic asthma due to grass pollen sensitization.25–27 Recommended treatments for episodic asthma include seasonal inhaled asthma preventive inhaled corticosteroids with as needed short-acting beta 2 agonist, or as needed ICS/LABA (long-acting beta2-agonist) combination therapy, particularly in those likely to have poor adherence to regular preventer use.28,29 Allergen immunotherapy has efficacy in allergic rhinoconjunctivitis due to grass pollens, and a recently published retrospective analysis provides evidence that sensitized individuals were protected from TA by grass pollen sublingual tablet immunotherapy, reinforcing the potential role of immunotherapy in TA.30–32
Thunderstorm asthma epidemic – management challenges experienced by general practice clinics
Published in Journal of Asthma, 2021
Ambereen S. Farouque, Rae Walker, Bircan Erbas
Epidemics of asthma associated with thunderstorm weather have been the object of medical curiosity since the first accounts appeared in the literature in the 1980’s [4,5]. However, the phenomenon of a thunderstorm fueling asthma presentations of epidemic proportions, placing pressure on health services was not appreciated until thunderstorm incident in 1994 in the southeast of England [6]. Thunderstorm asthma epidemics occur when individuals inhale air carrying a high concentration of airborne allergens [7]. In Australia, a five to ten-fold rise in hospital attendances of asthma exacerbation patients during late spring thunderstorms and the allergen has been identified as ryegrass pollen [8,9]. Vulnerable individuals are those sensitized to the triggering allergen or those who suffer from allergic rhinitis (with or without asthma) or those exposed to open air not taking preventative asthma medication [9]. Adding to the uncertainty is not all thunderstorms produce a surge in asthma cases [1]. All these factors combined lead to what is truly a difficult to predict patient surge event.
A proposed explanation for thunderstorm asthma and leukemia risk near high-voltage power lines: a supported hypothesis
Published in Electromagnetic Biology and Medicine, 2018
A popular theory to explain thunderstorm asthma has been that as a storm approaches, air-borne pollen grains are caught in updrafts and drawn into the humid cloud–base where they swell and rupture from osmotic shock (D’amato et al., 2007) their allergenic contents then being swept back to earth in strong down-drafts where they are able to be inhaled deep into the lungs (Taylor and Johsson, 2004). Despite a high pollen count consistently being identified as associated with thunderstorm asthma, the reason why such widespread and even fatal asthma attacks occur only during some thunderstorms is not established. Asthma problems are known to be more common during wet weather (O’leary et al., 2005b), but not with such drastic effects as thunderstorm asthma. So what is different about thunderstorms?