The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission

Mark Hew, Joy Lee, Nugroho H. Susanto, Shivonne Prasad, Philip G. Bardin, Sara Barnes, Laurence Ruane, Anne M. Southcott, Andrew Gillman, Alan Young, Kanishka Rangamuwa, Robyn E. O'Hehir, Christine McDonald, Michael Sutherland, Matthew Conron, Sarah Matthews, Nur Shirin Harun, Philippe Lachapelle, Jo A. Douglass, Louis Irving & 4 others David Langton, Jennifer Mann, Bircan Erbas, Francis Thien

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016. Objective: Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital. Methods: Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed. Results: We interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83). Conclusions: In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.

Original languageEnglish
Pages (from-to)122-130
Number of pages9
JournalAllergy: European Journal of Allergy and Clinical Immunology
Volume74
Issue number1
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Asian
  • asthma
  • emergency
  • epidemic
  • ethnicity
  • hospitalization
  • Indian
  • rhinitis
  • thunderstorm

Cite this

Hew, Mark ; Lee, Joy ; Susanto, Nugroho H. ; Prasad, Shivonne ; Bardin, Philip G. ; Barnes, Sara ; Ruane, Laurence ; Southcott, Anne M. ; Gillman, Andrew ; Young, Alan ; Rangamuwa, Kanishka ; O'Hehir, Robyn E. ; McDonald, Christine ; Sutherland, Michael ; Conron, Matthew ; Matthews, Sarah ; Harun, Nur Shirin ; Lachapelle, Philippe ; Douglass, Jo A. ; Irving, Louis ; Langton, David ; Mann, Jennifer ; Erbas, Bircan ; Thien, Francis. / The 2016 Melbourne thunderstorm asthma epidemic : Risk factors for severe attacks requiring hospital admission. In: Allergy: European Journal of Allergy and Clinical Immunology. 2019 ; Vol. 74, No. 1. pp. 122-130.
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title = "The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission",
abstract = "Background: The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016. Objective: Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital. Methods: Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed. Results: We interviewed 1435/2248 (64{\%}) of thunderstorm-affected patients, of whom 164 (11.4{\%}) required hospital admission. Overall, rhinitis was present in 87{\%}, and current asthma was present in 28{\%}. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95{\%} CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95{\%} CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95{\%} CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95{\%} CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95{\%} CI 1.56, 18.83). Conclusions: In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.",
keywords = "Asian, asthma, emergency, epidemic, ethnicity, hospitalization, Indian, rhinitis, thunderstorm",
author = "Mark Hew and Joy Lee and Susanto, {Nugroho H.} and Shivonne Prasad and Bardin, {Philip G.} and Sara Barnes and Laurence Ruane and Southcott, {Anne M.} and Andrew Gillman and Alan Young and Kanishka Rangamuwa and O'Hehir, {Robyn E.} and Christine McDonald and Michael Sutherland and Matthew Conron and Sarah Matthews and Harun, {Nur Shirin} and Philippe Lachapelle and Douglass, {Jo A.} and Louis Irving and David Langton and Jennifer Mann and Bircan Erbas and Francis Thien",
year = "2019",
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Hew, M, Lee, J, Susanto, NH, Prasad, S, Bardin, PG, Barnes, S, Ruane, L, Southcott, AM, Gillman, A, Young, A, Rangamuwa, K, O'Hehir, RE, McDonald, C, Sutherland, M, Conron, M, Matthews, S, Harun, NS, Lachapelle, P, Douglass, JA, Irving, L, Langton, D, Mann, J, Erbas, B & Thien, F 2019, 'The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission' Allergy: European Journal of Allergy and Clinical Immunology, vol. 74, no. 1, pp. 122-130. https://doi.org/10.1111/all.13609

The 2016 Melbourne thunderstorm asthma epidemic : Risk factors for severe attacks requiring hospital admission. / Hew, Mark; Lee, Joy; Susanto, Nugroho H.; Prasad, Shivonne; Bardin, Philip G.; Barnes, Sara; Ruane, Laurence; Southcott, Anne M.; Gillman, Andrew; Young, Alan; Rangamuwa, Kanishka; O'Hehir, Robyn E.; McDonald, Christine; Sutherland, Michael; Conron, Matthew; Matthews, Sarah; Harun, Nur Shirin; Lachapelle, Philippe; Douglass, Jo A.; Irving, Louis; Langton, David; Mann, Jennifer; Erbas, Bircan; Thien, Francis.

In: Allergy: European Journal of Allergy and Clinical Immunology, Vol. 74, No. 1, 01.2019, p. 122-130.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - The 2016 Melbourne thunderstorm asthma epidemic

T2 - Risk factors for severe attacks requiring hospital admission

AU - Hew, Mark

AU - Lee, Joy

AU - Susanto, Nugroho H.

AU - Prasad, Shivonne

AU - Bardin, Philip G.

AU - Barnes, Sara

AU - Ruane, Laurence

AU - Southcott, Anne M.

AU - Gillman, Andrew

AU - Young, Alan

AU - Rangamuwa, Kanishka

AU - O'Hehir, Robyn E.

AU - McDonald, Christine

AU - Sutherland, Michael

AU - Conron, Matthew

AU - Matthews, Sarah

AU - Harun, Nur Shirin

AU - Lachapelle, Philippe

AU - Douglass, Jo A.

AU - Irving, Louis

AU - Langton, David

AU - Mann, Jennifer

AU - Erbas, Bircan

AU - Thien, Francis

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N2 - Background: The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016. Objective: Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital. Methods: Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed. Results: We interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83). Conclusions: In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.

AB - Background: The world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016. Objective: Among thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital. Methods: Thunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed. Results: We interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83). Conclusions: In epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.

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KW - asthma

KW - emergency

KW - epidemic

KW - ethnicity

KW - hospitalization

KW - Indian

KW - rhinitis

KW - thunderstorm

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