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‘Thunder fever’ link between storms and asthma flare-ups

ON 17 JUNE 2021, something very unusual happened in dozens of hospitals in the east of England: emergency room attendance for people with asthma attacks increased by 560% compared to the daily average.

On the same day, asthma-related calls to out-of-hours GP services in the area soared by 422%, while the number of sudden asthma symptoms calling NHS 111 jumped by 193 %.

A subsequent survey by the UK Health Safety Agency (UKHSA), published in the International Journal of Environmental Research and Public Health, found it to be one of the biggest spikes in asthma attacks ever recorded in the UK – and it all boiled down to one thing. , thunderstorms, the day before.

Numerous studies have shown a link between thunderstorms and subsequent asthma flare-ups.

Scientific interest in the connection peaked after a particularly violent wave of attacks in Melbourne, Australia, in 2016, when hospitals across the city recorded the largest-ever episode of thunderstorm-related asthma attacks after bad weather hit the area.

The number of injuries jumped 672% within hours and 10 people died from asthma exacerbations.

“At one point all the intensive care beds in Melbourne were full, mostly with asthma patients, and young people (the youngest was 18) were dying from their attacks,” says Ian Pavord, professor of respiratory medicine at the University of Oxford.

It’s unclear exactly how storms make asthma worse. But their effects always seem to be much worse during hay fever season, when pollen levels are at their highest – usually around late June and early July in the UK.

Indeed, last week millions of hay fever sufferers were warned of an impending phenomenon called ‘thunder fever’ – a combination of high pollen counts and thunderstorms that could exacerbate their symptoms.

A popular theory is that the air turbulence created by storms means that strong updrafts “suck” pollen grains into the clouds. There, moisture penetrates the pollen grains and causes them to swell and rupture.

This releases much smaller fragments of pollen protein, which fall to Earth before being inhaled.

Normally, pollen grains settle in the nose or upper airways – where they cause irritation in people with hay fever – but are too large to enter the narrow passages of the lower airways.

However, the much smaller particles from the popped kernels can enter these passages – and cause inflammation of the lining of the airways that triggers severe asthma symptoms.

The big question is why so many asthmatics fall ill after storms when they have access to a range of highly effective drugs – such as inhaled steroids – that can prevent such flare-ups.

Most asthma patients are prescribed a “preventer” steroid inhaler (usually brown) to be taken daily to prevent inflammation of the lungs which could cause wheezing and shortness of breath. They will also have a rescue inhaler (usually blue) to use when asthma symptoms appear, which works by dilating the airways to improve airflow.

But studies show that up to 60% of patients routinely skip doses of the preventer inhaler or don’t bother using it if they don’t have any symptoms. When symptoms appear, they rely on the rescue inhaler.

“It may help, but it doesn’t address the underlying problem of inflammation deep within the airways,” says Professor Pavord.

“Many of these patients have mild asthma and find it difficult to commit to regular daily use of a brown inhaler.

“Yet every year we see deaths in people with mild asthma. I have seen patients who have used their blue inhalers almost 100 times in 24 hours and have not improved.”

The solution, according to Professor Pavord, is to completely change course in the treatment of asthma.

Instead of using two separate inhalers, he says, evidence now suggests lives could potentially be saved if patients received both drugs – to prevent asthma and to treat symptoms – in one inhaler, to be used only at the first sign of wheezing or shortness of breath, such as that caused suddenly by a thunderstorm.

These combination inhalers – brand names Seretide, Symbicort Smart and Fostair – are already available on the NHS but are licensed for daily use in patients whose asthma is not well controlled despite daily use of a pump” preventive”, the current method of treatment.

Switching to “as needed” use, says Professor Pavord, is less hassle for patients, but with equally good results.

Indeed, a study, published in the journal BMJ Evidence-Based Medicine last December, looked at asthma symptoms in 8,000 patients who stuck to their daily dose of steroids – using their painkiller only. when needed – or used the combination inhaler every few weeks or months, whenever they felt their symptoms appear.

The results showed that occasional use of a two-in-one pump was equally effective in controlling asthma, while reducing the use of steroid medications which can have side effects such as a sore throat, voice hoarse and oral thrush, a fungal fungus. infection in the mouth.

Meanwhile, the UKHSA may introduce asthma-specific red alerts, alongside weather and pollen forecasts, during the hay fever season.

Asthma UK advises asthmatics who have already been hit by thunderstorms, or are worried about triggering an attack, should carry their reliever inhaler with them at all times, stay indoors before, during and after a storm and keep windows closed to stop the storm. leads the pollen to penetrate inside.

© Daily Mail