Target people with hayfever in thunderstorm asthma prevention: experts


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Experts are calling for a “ramp up” of efforts to manage asthma, including targeting people who do not know they may be affected by the condition

Dr Michael Sutherland, a respiratory physician at Austin Health and Epworth HealthCare in Victoria, told MJA InSight that a particular worry was the fact that last month’s thunderstorm asthma event affected people who were unaware that they had asthma.

“The real worry is for people who have never had an asthma attack before, or people with seasonal asthma that isn’t being treated,” Dr Sutherland told MJA InSight.

“It was conspicuous that the severe long-term asthmatics, many of whom are allergic to rye-grass, were not represented in admission statistics, probably because of inhaled steroids, asthma plans, and staying indoors. So, inhaled steroids appear to be protective.”

He encouraged prescribers to be on the lookout for people with hayfever who “wheeze and sneeze,” and to consider prescribing preventers, relievers and an asthma management plan for allergy season.

Professor Helen Reddel, a respiratory physician and research lead at the Woolcock Institute of Medical Research, spoke to MJA InSight about a 2001 study, conducted by Professor Guy Marks on thunderstorm asthma events in Wagga Wagga, which showed the people most likely to be affected by thunderstorm asthma were people with rye grass allergy.

About a third of the people affected in the 2001 study had not had asthma before.

One study showed that a large increase in the concentration of pollen grains in ambient air accompanied the arrival of thunderstorm outflow.

“Shortly after this occurred, there was the first call to the ambulance,” Prof Reddel told MJA InSight.

As a result of the research, public message alerts reminding people with asthma in the Wagga Wagga region to use their preventer inhaler are now sent out during spring and summer.

“There is also a system set up with the weather bureau to notify local health professionals when there are outflow thunderstorms so they can prepare,” Prof Reddel said.

“So yes, it can be predicted, and what has been done in NSW can be looked at for other states.”

She said there are some key lessons to take from the thunderstorm asthma event in Melbourne.

“From the research in Wagga Wagga, we know that people taking preventer inhalers are less likely to come in [for emergency care] on a thunderstorm day.”

Victoria’s coroner is set to investigate the eight deaths linked to the Melbourne event in November.

The day after the event, Associate Professor Cenk Suphioglu, the Deakin environmental allergist who discovered the link between rye grass and thunderstorm-related asthma epidemics, said that people with hayfever should consider themselves at risk from such 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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2 Comments

  1. Debbie Rigby
    13/12/2016

    Highlights the role for community pharmacists to have a discussion with consumers when they ask for something for their hay fever i.e. Oral antihistamines or INCS. And relying on Ventolin in acute situations is obviously not enough. But having a spacer for serious exacerbations like in thunderstorm asthma is a must (potentially life-saving). NAC and Asthma Australia have some excellent resources on asthma first-aid.

  2. Bruce ANNABEL
    13/12/2016

    I became complacent about my asthma believing I was managing it very well with a well known preventer, avoiding the triggers and exercising regularly. That was until three years ago when eating a meal at, what I thought at the time, a good restaurant that included ingredient(s) not disclosed on the menu that caused a major immediate asthma attack. Fortunately my medication was only 150 metres away and I managed to get there before I couldn’t breathe at all! Subsequently I have smartened up my act including swapping preventer, ensuring I’m resolute in taking it morning and night, being far more careful with avoiding triggers and having a Ventolin inhaler with me EVERYWHERE I go including in my computer bag, the car, gym bag, at home, when training swim/bike/run, at the movies and particularly at restaurants!
    Apart from prescribing and transacting very little advice is rendered by my GP (I’m about to change) or pharmacists where there remains a massive untapped opportunity to engage with patients on a meaningful and vital health issue.

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