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“Thunderstorm Asthma” Spikes ED Visits

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“Thunderstorm asthma” outbreaks have a history of overwhelming community hospitals and emergency services.  Researchers recently conducted a study to determine if emergency department (ED) visits for older adults with COPD increased in the days surrounding a thunderstorm.  Read on to learn more about the connection between climate change, weather, and respiratory illness.

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

Do thunderstorm outbreaks bring more respiratory illnesses to the ED?

“Thunderstorm Asthma” Spikes ED Visits

For decades, scientists have predicted global warming will increase the number and intensity of inclement weather events. A band of violent thunderstorms moved through southeastern Australia in the fall of 2016 and triggered a wave of asthma attacks. Melbourne was hard hit with more than 8,000 people rushed to local emergency rooms. This was not the first time a strong storm caused an outbreak of “thunderstorm asthma” The first observed occurrence of the storm phenomenon was documented on July 6, 1985, in Birmingham, England.

An Unlikely Link

It may be difficult to believe that thunderstorms can actually trigger severe asthma attacks. But research has shown thunderstorms increase breathing problems in people with asthma and COPD.

The Study

Vulnerable groups, such as older adults and people with respiratory disease, are at risk for health problems as climate change ramps up weather events. A group of researchers led by Anupam Jena (Harvard) conducted a large study to determine if emergency department visits spiked in the days surrounding a thunderstorm for Medicare patients with respiratory problems and ages 65 and older. The study findings were recently published in JAMA Internal Medicine, August 2020.

Data Collection

The researchers used weather data for all 3,127 US counties from the US National Oceanic and Atmospheric Administration. The data was used to find days between January 1999 to December 2012 when counties had a thunderstorm. A Medicare database was then used to identify Medicare patient ED visits for acute respiratory illnesses during the same timeframe.

This was a large study.... just check out the numbers below:

  • 46,581,214 Medicare beneficiaries aged 65 and older
  • 12,334,021 (26.5%) had COPD
  • 4,891,027 (10.5%) had chronic asthma
  • 3,074,360 (6.6%) had both asthma and COPD

A total of 22 million ED visits and 822,000 county days with thunderstorms occurred during the study period.

**Thunderstorms were defined by higher than average winds, lightning, and precipitation levels.

Findings

The researchers found temperature and particulate matter (such as dust, pollen, spores, and smoke,) significantly increased before the thunderstorms and decreased after. Here's what they found:

The day before the thunderstorms

Above average ED visits peaked at 1.8 additional visits per million beneficiaries, with an additional:

  • 6.3 visits per million for asthma patients
  • 6.4 visits per million for COPD patients
  • 9.4 visits per million for patients with COPD and asthma

Overall, approximately 52,000 additional respiratory ED visits were estimated to occur in the 3 or more days surrounding a major storm over the 14-year study.

Interestingly, a similar association between thunderstorms and visits for the study controls, sepsis or pulmonary embolism, wasn’t found.

Perfect Storm or Calm Before the Storm?

It makes sense to think rain would wash away pollen and other respiratory irritants. But some thunderstorms, especially in the Spring and Summer can actually stir up large amounts of pollen. How does this happen?

  • Large amounts of pollen and spores pile up before a thunderstorm event.
  • A recipe of changes in wind speed, temperatures and humidity causes the pollen to be pulled into the air.
  • Rain wets the pollen and causes it to burst open, releasing hundreds of allergen particles.
  • Smaller particles can enter the small airways of the lungs, triggering an asthma attack or other respiratory symptoms.

Calm Before the Storm

The study’s authors theorize that “thunderstorm asthma” doesn’t really need a “perfect storm” to cause respiratory symptoms. The researchers found ED visits also increase with average thunderstorms and it’s actually the “calm before the storm” that sets things in motion.

  • Air flow significantly slows a week before the storm.
  • During this time, there is a large build-up of pollution particles.
  • EDs see a gradual increase in respiratory ailments in the week leading up to the storm.

Why Does it Matter?

Global warming will continue and we will experience an increase in thunderstorm frequency and severity. The study serves as a good reminder that weather is connected to health, especially in vulnerable populations.

Do you work in the ED? What are your thoughts?

References

Living with Asthma: Thunderstorm Asthma

"Thunderstorm Asthma": Respiratory Events During Thunderstorms

ASCIA Thunderstorm Asthma Fact Sheet

(Abstract) Emergency Visits for Thunderstorm-Related Respiratory Illnesses Among Older Adults

Thunderstorms and Your Health

I am a RN, MSN with over 25 years experience specializing in education, leadership and project management. I enjoy learning and sharing my experience to lift up other nurses.

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6 Comment(s)

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Well, I'll be darned. I had a severe asthma attack the night of my son's high school graduation, and there had been a fierce thunderstorm earlier in the day. I didn't go to the ER because I had a nebulizer and medication at home, but the next day I worked, I learned that the emergency room was overflowing with asthma patients suffering from the same symptoms, including several of the new graduates. I didn't know then that the two events (the storm and my asthma exacerbation) might have been related. Thank you for pointing this out, now I know to use my inhaler proactively before or during a thunderstorm!

I know mine has been worse with weather we have been having with lots of evening storms.

Hoosier_RN, MSN

Specializes in dialysis. Has 28 years experience.

The weather plays havoc with many things. I’ve always said it's the change in barometric pressure. I've seen residents in LTC blood pressures and blood sugars dance like crazy if they were brittle. I've seen dialysis equipment and dialysis accesses go nuts with extreme weather changes. So why not respiratory issues? My sinuses are severely distressed right before a storm...

Edited by Hoosier_RN

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

On 8/26/2020 at 12:12 PM, Marcia Sampson said:

I know mine has been worse with weather we have been having with lots of evening storms.

Your right, but they are just so relaxing to watch move in.

 

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 28 years experience.

9 hours ago, Hoosier_RN said:

 I've seen residents in LTC blood pressures and blood sugars dance like crazy if they were brittle. I've seen dialysis equipment and dialysis accesses go nuts with extreme weather changes. 

Interesting,  I am going to pay more attention and look for subtle patterns when the weather changes.  

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

My asthma isn't worsened by the barometric pressure but I get a migraine/sinus headache that won't quit until it rains...interesting.