Intensive care implications of epidemic thunderstorm asthma

Jai N. Darvall, Matthew Durie, David Pilcher, Geoffrey Wigmore, Craig French, Dharshi Karalapillai, Forbes McGain, Edward Newbigin, Timothy Byrne, Vineet Sarode, Ben Gelbart, Andrew Casamento, John Dyett, Ashley Crosswell, Joseph Vetro, Joseph McCaffrey, Gopal Taori, Ashwin Subramaniam, Christopher Macisaac, Anthony Cross & 2 others David Ku, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma. Design, setting and participants: Retrospective multicentre observational study. Meteorological, airborne particulate and pollen data, and a case series of 35 patients admitted to 15 intensive care units (ICUs) due to the thunderstorm asthma event of 21–22 November 2016, in Victoria, Australia, were analysed and compared with 1062 total ICU-admitted Australian patients with asthma in 2016. Main outcome measures: Characteristics and outcomes of total ICU versus patients with thunderstorm asthma, the association between airborne particulate counts and storm arrival, and ICU resource utilisation. Results: All 35 patients had an asthma diagnosis; 13 (37%) had a cardiac or respiratory arrest, five (14%) died. Compared with total Australian ICU-admitted patients with asthma in 2016, patients with thunderstorm asthma had a higher mortality (15% v 1.3%, P < 0.001), were more likely to be male (63% v 34%, P < 0.001), to be mechanically ventilated, and had shorter ICU length of stay in survivors (median, 31.8 hours [interquartile range (IQR), 14.8–43.6 hours] v 40.7 hours [IQR, 22.3–75.1 hours]; P = 0.025). Patients with cardiac arrest were more likely to be born in Asian or subcontinental countries (5/10 [50%] v 4/25 [16%]; relative risk, 3.13; 95% CI, 1.05–9.31). A temporal link was demonstrated between airborne particulate counts and arrival of the storm. The event used 15% of the public ICU beds in the region. Conclusion: Arrival of a triggering storm is associated with an increase in respirable airborne particles. Affected critically ill patients are young, have a high mortality, a short duration of bronchospasm, and a prior diagnosis of asthma is common.

Original languageEnglish
Pages (from-to)294-303
Number of pages10
JournalCritical Care and Resuscitation
Volume20
Issue number4
Publication statusPublished - Dec 2018

Cite this

Darvall, Jai N. ; Durie, Matthew ; Pilcher, David ; Wigmore, Geoffrey ; French, Craig ; Karalapillai, Dharshi ; McGain, Forbes ; Newbigin, Edward ; Byrne, Timothy ; Sarode, Vineet ; Gelbart, Ben ; Casamento, Andrew ; Dyett, John ; Crosswell, Ashley ; Vetro, Joseph ; McCaffrey, Joseph ; Taori, Gopal ; Subramaniam, Ashwin ; Macisaac, Christopher ; Cross, Anthony ; Ku, David ; Bellomo, Rinaldo. / Intensive care implications of epidemic thunderstorm asthma. In: Critical Care and Resuscitation. 2018 ; Vol. 20, No. 4. pp. 294-303.
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title = "Intensive care implications of epidemic thunderstorm asthma",
abstract = "Objective: To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma. Design, setting and participants: Retrospective multicentre observational study. Meteorological, airborne particulate and pollen data, and a case series of 35 patients admitted to 15 intensive care units (ICUs) due to the thunderstorm asthma event of 21–22 November 2016, in Victoria, Australia, were analysed and compared with 1062 total ICU-admitted Australian patients with asthma in 2016. Main outcome measures: Characteristics and outcomes of total ICU versus patients with thunderstorm asthma, the association between airborne particulate counts and storm arrival, and ICU resource utilisation. Results: All 35 patients had an asthma diagnosis; 13 (37{\%}) had a cardiac or respiratory arrest, five (14{\%}) died. Compared with total Australian ICU-admitted patients with asthma in 2016, patients with thunderstorm asthma had a higher mortality (15{\%} v 1.3{\%}, P < 0.001), were more likely to be male (63{\%} v 34{\%}, P < 0.001), to be mechanically ventilated, and had shorter ICU length of stay in survivors (median, 31.8 hours [interquartile range (IQR), 14.8–43.6 hours] v 40.7 hours [IQR, 22.3–75.1 hours]; P = 0.025). Patients with cardiac arrest were more likely to be born in Asian or subcontinental countries (5/10 [50{\%}] v 4/25 [16{\%}]; relative risk, 3.13; 95{\%} CI, 1.05–9.31). A temporal link was demonstrated between airborne particulate counts and arrival of the storm. The event used 15{\%} of the public ICU beds in the region. Conclusion: Arrival of a triggering storm is associated with an increase in respirable airborne particles. Affected critically ill patients are young, have a high mortality, a short duration of bronchospasm, and a prior diagnosis of asthma is common.",
author = "Darvall, {Jai N.} and Matthew Durie and David Pilcher and Geoffrey Wigmore and Craig French and Dharshi Karalapillai and Forbes McGain and Edward Newbigin and Timothy Byrne and Vineet Sarode and Ben Gelbart and Andrew Casamento and John Dyett and Ashley Crosswell and Joseph Vetro and Joseph McCaffrey and Gopal Taori and Ashwin Subramaniam and Christopher Macisaac and Anthony Cross and David Ku and Rinaldo Bellomo",
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Darvall, JN, Durie, M, Pilcher, D, Wigmore, G, French, C, Karalapillai, D, McGain, F, Newbigin, E, Byrne, T, Sarode, V, Gelbart, B, Casamento, A, Dyett, J, Crosswell, A, Vetro, J, McCaffrey, J, Taori, G, Subramaniam, A, Macisaac, C, Cross, A, Ku, D & Bellomo, R 2018, 'Intensive care implications of epidemic thunderstorm asthma', Critical Care and Resuscitation, vol. 20, no. 4, pp. 294-303.

Intensive care implications of epidemic thunderstorm asthma. / Darvall, Jai N.; Durie, Matthew; Pilcher, David; Wigmore, Geoffrey; French, Craig; Karalapillai, Dharshi; McGain, Forbes; Newbigin, Edward; Byrne, Timothy; Sarode, Vineet; Gelbart, Ben; Casamento, Andrew; Dyett, John; Crosswell, Ashley; Vetro, Joseph; McCaffrey, Joseph; Taori, Gopal; Subramaniam, Ashwin; Macisaac, Christopher; Cross, Anthony; Ku, David; Bellomo, Rinaldo.

In: Critical Care and Resuscitation, Vol. 20, No. 4, 12.2018, p. 294-303.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Intensive care implications of epidemic thunderstorm asthma

AU - Darvall, Jai N.

AU - Durie, Matthew

AU - Pilcher, David

AU - Wigmore, Geoffrey

AU - French, Craig

AU - Karalapillai, Dharshi

AU - McGain, Forbes

AU - Newbigin, Edward

AU - Byrne, Timothy

AU - Sarode, Vineet

AU - Gelbart, Ben

AU - Casamento, Andrew

AU - Dyett, John

AU - Crosswell, Ashley

AU - Vetro, Joseph

AU - McCaffrey, Joseph

AU - Taori, Gopal

AU - Subramaniam, Ashwin

AU - Macisaac, Christopher

AU - Cross, Anthony

AU - Ku, David

AU - Bellomo, Rinaldo

PY - 2018/12

Y1 - 2018/12

N2 - Objective: To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma. Design, setting and participants: Retrospective multicentre observational study. Meteorological, airborne particulate and pollen data, and a case series of 35 patients admitted to 15 intensive care units (ICUs) due to the thunderstorm asthma event of 21–22 November 2016, in Victoria, Australia, were analysed and compared with 1062 total ICU-admitted Australian patients with asthma in 2016. Main outcome measures: Characteristics and outcomes of total ICU versus patients with thunderstorm asthma, the association between airborne particulate counts and storm arrival, and ICU resource utilisation. Results: All 35 patients had an asthma diagnosis; 13 (37%) had a cardiac or respiratory arrest, five (14%) died. Compared with total Australian ICU-admitted patients with asthma in 2016, patients with thunderstorm asthma had a higher mortality (15% v 1.3%, P < 0.001), were more likely to be male (63% v 34%, P < 0.001), to be mechanically ventilated, and had shorter ICU length of stay in survivors (median, 31.8 hours [interquartile range (IQR), 14.8–43.6 hours] v 40.7 hours [IQR, 22.3–75.1 hours]; P = 0.025). Patients with cardiac arrest were more likely to be born in Asian or subcontinental countries (5/10 [50%] v 4/25 [16%]; relative risk, 3.13; 95% CI, 1.05–9.31). A temporal link was demonstrated between airborne particulate counts and arrival of the storm. The event used 15% of the public ICU beds in the region. Conclusion: Arrival of a triggering storm is associated with an increase in respirable airborne particles. Affected critically ill patients are young, have a high mortality, a short duration of bronchospasm, and a prior diagnosis of asthma is common.

AB - Objective: To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma. Design, setting and participants: Retrospective multicentre observational study. Meteorological, airborne particulate and pollen data, and a case series of 35 patients admitted to 15 intensive care units (ICUs) due to the thunderstorm asthma event of 21–22 November 2016, in Victoria, Australia, were analysed and compared with 1062 total ICU-admitted Australian patients with asthma in 2016. Main outcome measures: Characteristics and outcomes of total ICU versus patients with thunderstorm asthma, the association between airborne particulate counts and storm arrival, and ICU resource utilisation. Results: All 35 patients had an asthma diagnosis; 13 (37%) had a cardiac or respiratory arrest, five (14%) died. Compared with total Australian ICU-admitted patients with asthma in 2016, patients with thunderstorm asthma had a higher mortality (15% v 1.3%, P < 0.001), were more likely to be male (63% v 34%, P < 0.001), to be mechanically ventilated, and had shorter ICU length of stay in survivors (median, 31.8 hours [interquartile range (IQR), 14.8–43.6 hours] v 40.7 hours [IQR, 22.3–75.1 hours]; P = 0.025). Patients with cardiac arrest were more likely to be born in Asian or subcontinental countries (5/10 [50%] v 4/25 [16%]; relative risk, 3.13; 95% CI, 1.05–9.31). A temporal link was demonstrated between airborne particulate counts and arrival of the storm. The event used 15% of the public ICU beds in the region. Conclusion: Arrival of a triggering storm is associated with an increase in respirable airborne particles. Affected critically ill patients are young, have a high mortality, a short duration of bronchospasm, and a prior diagnosis of asthma is common.

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SN - 1441-2772

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Darvall JN, Durie M, Pilcher D, Wigmore G, French C, Karalapillai D et al. Intensive care implications of epidemic thunderstorm asthma. Critical Care and Resuscitation. 2018 Dec;20(4):294-303.