Francis Thien1, Paul J Beggs2, Danny Csutoros3, Jai Darvall4, Mark Hew5, Janet M Davies6, Philip G Bardin7, Tony Bannister8, Sara Barnes9, Rinaldo Bellomo10, Timothy Byrne11, Andrew Casamento12, Matthew Conron13, Anthony Cross12, Ashley Crosswell13, Jo A Douglass4, Matthew Durie14, John Dyett15, Elizabeth Ebert8, Bircan Erbas16, Craig French17, Ben Gelbart18, Andrew Gillman17, Nur-Shirin Harun14, Alfredo Huete19, Louis Irving4, Dharshi Karalapillai20, David Ku9, Philippe Lachapelle14, David Langton21, Joy Lee11, Clare Looker3, Christopher MacIsaac14, Joseph McCaffrey22, Christine F McDonald23, Forbes McGain17, Edward Newbigin24, Robyn O'Hehir5, David Pilcher25, Shivonne Prasad15, Kanishka Rangamuwa15, Laurence Ruane9, Vineet Sarode26, Jeremy D Silver24, Anne Marie Southcott17, Ashwin Subramaniam21, Cenk Suphioglu27, Nugroho Harry Susanto16, Michael F Sutherland20, Gopal Taori9, Philip Taylor27, Paul Torre28, Joseph Vetro15, Geoffrey Wigmore14, Alan C Young29, Charles Guest3. 1. Eastern Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia. Electronic address: frank.thien@monash.edu. 2. Macquarie University, Sydney, NSW, Australia. 3. Department of Health and Human Services, Melbourne, VIC, Australia. 4. Melbourne Health, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia. 5. Alfred Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia. 6. Queensland University of Technology, Brisbane, QLD, Australia; Metro North Hospital and Health Service, Brisbane, QLD, Australia. 7. Monash Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia. 8. Bureau of Meteorology, Melbourne, VIC, Australia. 9. Monash Health, Melbourne, VIC, Australia. 10. The University of Melbourne, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia; Austin Health, Melbourne, VIC, Australia. 11. Alfred Health, Melbourne, VIC, Australia. 12. Northern Health, Melbourne, VIC, Australia. 13. St Vincent's Health, Melbourne, VIC, Australia. 14. Melbourne Health, Melbourne, VIC, Australia. 15. Eastern Health, Melbourne, VIC, Australia. 16. La Trobe University, Melbourne, VIC, Australia. 17. Western Health, Melbourne, VIC, Australia. 18. Royal Children's Hospital, Melbourne, VIC, Australia. 19. University of Technology Sydney, Sydney, NSW, Australia. 20. Austin Health, Melbourne, VIC, Australia. 21. Peninsula Health, Melbourne, VIC, Australia. 22. Barwon Health, Geelong, VIC, Australia. 23. The University of Melbourne, Melbourne, VIC, Australia; Austin Health, Melbourne, VIC, Australia. 24. The University of Melbourne, Melbourne, VIC, Australia. 25. Alfred Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, VIC, Australia. 26. Cabrini Health, Melbourne, VIC, Australia. 27. Deakin University, Melbourne, VIC, Australia. 28. Environmental Protection Authority Victoria, Melbourne, VIC, Australia. 29. Eastern Health, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia.
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.
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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