The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors

Francis Thien, Paul J. Beggs, Danny Csutoros, Jai Darvall, Mark Hew, Janet M. Davies, Philip G. Bardin, Tony Bannister, Sara Barnes, Rinaldo Bellomo, Timothy Byrne, Andrew Casamento, Matthew Conron, Anthony Cross, Ashley Crosswell, Jo A. Douglass, Matthew Durie, John Dyett, Elizabeth Ebert, Bircan Erbas & 36 others Craig French, Ben Gelbart, Andrew Gillman, Nur Shirin Harun, Alfredo Huete, Louis Irving, Dharshi Karalapillai, David Ku, Philippe Lachapelle, David Langton, Joy Lee, Clare Looker, Christopher MacIsaac, Joseph McCaffrey, Christine F. McDonald, Forbes McGain, Edward Newbigin, Robyn O'Hehir, David Pilcher, Shivonne Prasad, Kanishka Rangamuwa, Laurence Ruane, Vineet Sarode, Jeremy D. Silver, Anne Marie Southcott, Ashwin Subramaniam, Cenk Suphioglu, Nugroho Harry Susanto, Michael F. Sutherland, Gopal Taori, Philip Taylor, Paul Torre, Joseph Vetro, Geoffrey Wigmore, Alan C. Young, Charles Guest

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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. Funding: None.

Original languageEnglish
Pages (from-to)e255-e263
Number of pages9
JournalThe Lancet Planetary Health
Volume2
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Cite this

Thien, Francis ; Beggs, Paul J. ; Csutoros, Danny ; Darvall, Jai ; Hew, Mark ; Davies, Janet M. ; Bardin, Philip G. ; Bannister, Tony ; Barnes, Sara ; Bellomo, Rinaldo ; Byrne, Timothy ; Casamento, Andrew ; Conron, Matthew ; Cross, Anthony ; Crosswell, Ashley ; Douglass, Jo A. ; Durie, Matthew ; Dyett, John ; Ebert, Elizabeth ; Erbas, Bircan ; French, Craig ; Gelbart, Ben ; Gillman, Andrew ; Harun, Nur Shirin ; Huete, Alfredo ; Irving, Louis ; Karalapillai, Dharshi ; Ku, David ; Lachapelle, Philippe ; Langton, David ; Lee, Joy ; Looker, Clare ; MacIsaac, Christopher ; McCaffrey, Joseph ; McDonald, Christine F. ; McGain, Forbes ; Newbigin, Edward ; O'Hehir, Robyn ; Pilcher, David ; Prasad, Shivonne ; Rangamuwa, Kanishka ; Ruane, Laurence ; Sarode, Vineet ; Silver, Jeremy D. ; Southcott, Anne Marie ; Subramaniam, Ashwin ; Suphioglu, Cenk ; Susanto, Nugroho Harry ; Sutherland, Michael F. ; Taori, Gopal ; Taylor, Philip ; Torre, Paul ; Vetro, Joseph ; Wigmore, Geoffrey ; Young, Alan C. ; Guest, Charles. / The Melbourne epidemic thunderstorm asthma event 2016 : an investigation of environmental triggers, effect on health services, and patient risk factors. In: The Lancet Planetary Health. 2018 ; Vol. 2, No. 6. pp. e255-e263.
@article{83b00133c2934a9e845803907ed3a787,
title = "The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors",
abstract = "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. Funding: None.",
author = "Francis Thien and Beggs, {Paul J.} and Danny Csutoros and Jai Darvall and Mark Hew and Davies, {Janet M.} and Bardin, {Philip G.} and Tony Bannister and Sara Barnes and Rinaldo Bellomo and Timothy Byrne and Andrew Casamento and Matthew Conron and Anthony Cross and Ashley Crosswell and Douglass, {Jo A.} and Matthew Durie and John Dyett and Elizabeth Ebert and Bircan Erbas and Craig French and Ben Gelbart and Andrew Gillman and Harun, {Nur Shirin} and Alfredo Huete and Louis Irving and Dharshi Karalapillai and David Ku and Philippe Lachapelle and David Langton and Joy Lee and Clare Looker and Christopher MacIsaac and Joseph McCaffrey and McDonald, {Christine F.} and Forbes McGain and Edward Newbigin and Robyn O'Hehir and David Pilcher and Shivonne Prasad and Kanishka Rangamuwa and Laurence Ruane and Vineet Sarode and Silver, {Jeremy D.} and Southcott, {Anne Marie} and Ashwin Subramaniam and Cenk Suphioglu and Susanto, {Nugroho Harry} and Sutherland, {Michael F.} and Gopal Taori and Philip Taylor and Paul Torre and Joseph Vetro and Geoffrey Wigmore and Young, {Alan C.} and Charles Guest",
year = "2018",
month = "6",
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doi = "10.1016/S2542-5196(18)30120-7",
language = "English",
volume = "2",
pages = "e255--e263",
journal = "The Lancet Planetary Health",
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Thien, F, Beggs, PJ, Csutoros, D, Darvall, J, Hew, M, Davies, JM, Bardin, PG, Bannister, T, Barnes, S, Bellomo, R, Byrne, T, Casamento, A, Conron, M, Cross, A, Crosswell, A, Douglass, JA, Durie, M, Dyett, J, Ebert, E, Erbas, B, French, C, Gelbart, B, Gillman, A, Harun, NS, Huete, A, Irving, L, Karalapillai, D, Ku, D, Lachapelle, P, Langton, D, Lee, J, Looker, C, MacIsaac, C, McCaffrey, J, McDonald, CF, McGain, F, Newbigin, E, O'Hehir, R, Pilcher, D, Prasad, S, Rangamuwa, K, Ruane, L, Sarode, V, Silver, JD, Southcott, AM, Subramaniam, A, Suphioglu, C, Susanto, NH, Sutherland, MF, Taori, G, Taylor, P, Torre, P, Vetro, J, Wigmore, G, Young, AC & Guest, C 2018, 'The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors' The Lancet Planetary Health, vol. 2, no. 6, pp. e255-e263. https://doi.org/10.1016/S2542-5196(18)30120-7

The Melbourne epidemic thunderstorm asthma event 2016 : an investigation of environmental triggers, effect on health services, and patient risk factors. / Thien, Francis; Beggs, Paul J.; Csutoros, Danny; Darvall, Jai; Hew, Mark; Davies, Janet M.; Bardin, Philip G.; Bannister, Tony; Barnes, Sara; Bellomo, Rinaldo; Byrne, Timothy; Casamento, Andrew; Conron, Matthew; Cross, Anthony; Crosswell, Ashley; Douglass, Jo A.; Durie, Matthew; Dyett, John; Ebert, Elizabeth; Erbas, Bircan; French, Craig; Gelbart, Ben; Gillman, Andrew; Harun, Nur Shirin; Huete, Alfredo; Irving, Louis; Karalapillai, Dharshi; Ku, David; Lachapelle, Philippe; Langton, David; Lee, Joy; Looker, Clare; MacIsaac, Christopher; McCaffrey, Joseph; McDonald, Christine F.; McGain, Forbes; Newbigin, Edward; O'Hehir, Robyn; Pilcher, David; Prasad, Shivonne; Rangamuwa, Kanishka; Ruane, Laurence; Sarode, Vineet; Silver, Jeremy D.; Southcott, Anne Marie; Subramaniam, Ashwin; Suphioglu, Cenk; Susanto, Nugroho Harry; Sutherland, Michael F.; Taori, Gopal; Taylor, Philip; Torre, Paul; Vetro, Joseph; Wigmore, Geoffrey; Young, Alan C.; Guest, Charles.

In: The Lancet Planetary Health, Vol. 2, No. 6, 01.06.2018, p. e255-e263.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The Melbourne epidemic thunderstorm asthma event 2016

T2 - 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

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. Funding: None.

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. Funding: None.

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DO - 10.1016/S2542-5196(18)30120-7

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JO - The Lancet Planetary Health

JF - The Lancet Planetary Health

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