TY - JOUR
T1 - The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors
AU - Thien, Francis
AU - Beggs, Paul J.
AU - Csutoros, Danny
AU - Darvall, Jai
AU - Hew, Mark
AU - Davies, Janet M.
AU - Bardin, Philip G.
AU - Bannister, Tony
AU - Barnes, Sara
AU - Bellomo, Rinaldo
AU - Byrne, Timothy
AU - Casamento, Andrew
AU - Conron, Matthew
AU - Cross, Anthony
AU - Crosswell, Ashley
AU - Douglass, Jo A.
AU - Durie, Matthew
AU - Dyett, John
AU - Ebert, Elizabeth
AU - Erbas, Bircan
AU - French, Craig
AU - Gelbart, Ben
AU - Gillman, Andrew
AU - Harun, Nur-Shirin
AU - Huete, Alfredo
AU - Irving, Louis
AU - Karalapillai, Dharshi
AU - Ku, David
AU - Lachapelle, Philippe
AU - Langton, David
AU - Lee, Joy
AU - Looker, Clare
AU - MacIsaac, Christopher
AU - McCaffrey, Joseph
AU - McDonald, Christine F.
AU - McGain, Forbes
AU - Newbigin, Edward
AU - O'Hehir, Robyn
AU - Pilcher, David
AU - Prasad, Shivonne
AU - Rangamuwa, Kanishka
AU - Ruane, Laurence
AU - Sarode, Vineet
AU - Silver, Jeremy D.
AU - Southcott, Anne Marie
AU - Subramaniam, Ashwin
AU - Suphioglu, Cenk
AU - Susanto, Nugroho Harry
AU - Sutherland, Michael F.
AU - Taori, Gopal
AU - Taylor, Philip
AU - Torre, Paul
AU - Vetro, Joseph
AU - Wigmore, Geoffrey
AU - Young, Alan C.
AU - Guest, Charles
N1 - Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Background: A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies.Methods: Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions.Findings: Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74–2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28–16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died.Interpretation: Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma.
AB - Background: A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies.Methods: Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions.Findings: Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74–2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28–16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died.Interpretation: Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma.
UR - https://www.scopus.com/pages/publications/85047875558
U2 - 10.1016/S2542-5196(18)30120-7
DO - 10.1016/S2542-5196(18)30120-7
M3 - Article
C2 - 29880157
AN - SCOPUS:85047875558
SN - 2542-5196
VL - 2
SP - E255-E263
JO - The Lancet Planetary Health
JF - The Lancet Planetary Health
IS - 6
ER -