"One airway, one disease"

Rhinitis and asthma are frequently linked together and should be considered as a single pathology in approaches to thunderstorm asthma, say doctors in MJA InSight

Referencing the “world’s most devastating outbreak of epidemic thunderstorm asthma” in Melbourne late last year, Australian public health physicians have looked at the causes behind the incident.

Writing in MJA InSight, professors from Monash University and Alfred Health in Melbourne say research suggests thunderstorm asthma events results from a “complex interaction of environmental factors and individual susceptibility factors”.

These include:

high concentrations of rye grass pollen in the air;
rainwater to rupture the rye grass pollen grains;
thunderstorm outflows;
prior sensitisation to rye grass pollen allergen;
history of seasonal allergic rhinitis; and
lower rate of inhaled corticosteroid use in those with diagnosed asthma.

Most patients with asthma also have rhinitis, say the authors, leading to the concept of “one airway, one disease”.

“The presence of allergic rhinitis commonly exacerbates asthma, increasing the risk of asthma attacks, emergency visits and admissions,” they write.

Healthcare practitioners should think of these conditions as “one pathology occurring at different sites along the single airway”.

Unfortunately current evidence does not support the feasibility of reliably predicting thunderstorm asthma outbreaks by using just meteorological data and pollen counts, they argue.

This “highlights the importance of education of patients on how vital it is that those at risk carry a reliever inhaler in the event of an unexpected asthma attack”.

Associate Professor Cenk Suphioglu, the Deakin environmental allergist who discovered the link between rye grass and thunderstorm-related asthma epidemics, also said that people with hayfever should consider themselves at risk and prepare for thunderstorm-related events.

“Just like people with food allergies carry an EpiPen, I believe that hay fever suffers should consider carrying a Ventolin puffer, especially if thunderstorms are predicted after a bout of hot weather.”

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