Asthma affects many patients differently, particularly during the heat. Some patients may experience heightened symptoms during weather changes, such as during the transition from winter into spring and summer, temporary changes in temperature, for example when moving from a hot humid day outside and into a cool building, and allergy triggers. Viral illness may also contribute. Heat does not necessarily cause different symptoms to normal; however, it is important for asthma patients to understand what their triggers are 26.
Visit the National Asthma Council Australia website for information on asthma action plans, education programs, and videos on using asthma devices:
Thunderstorm asthma is the sudden onset of asthma in a large group of people during a thunderstorm, many who may have only experienced hay fever symptoms previously, not asthma.
While these events are infrequent, climate change may bring about increases in intensity of rainfall and thunderstorms, which may be associated with increases in related asthma events 27. They usually occur in Australia from October to December and are triggered by allergens from rye grass pollen and a certain type of thunderstorm. Victoria experienced the largest thunderstorm asthma event ever recorded on 21-22 November 2016, with a significant increase in emergency department presentations and nine excess deaths due to asthma between 21–30 November than would ordinarily be recorded during that period 28.
General practices are an essential part of the emergency response to thunderstorm asthma as they can help to prevent hospital admissions and unnecessary deaths. During the 2016 event in Victoria, GPs managed an additional 8,940 – 13,689 asthma-related cases and therefore prevented further strain on emergency departments 29.
While it is important that all patients are aware of the risks for thunderstorm asthma, there are some specific risk factors that increase the likelihood of thunderstorm asthma in patients:
- current asthma status, particularly patients who do not take preventer therapy or who do not control their asthma well
- past history of asthma
- experiencing seasonal allergic rhinitis (hay fever) (with or without known asthma)
- rye grass pollen sensitisation
- being a younger adult, particularly in their 20s and 30s 28
- Being an older adult, particularly if they have co-morbidities such as chronic asthma and COPD 30
- Following the 2016 event, it was found there may be an additional risk for patients from Southeast Asia or the Indian subcontinent (it is unclear whether this was due to genetic, environmental or cultural factors) 28.
The RACGP has published a fact sheet and media release on the risk factors for thunderstorm asthma. The RACGP’s gplearning platform also has an article on Identifying and managing risk factors for thunderstorm asthma, which includes information for GPs on preparing for and assessing risk factors for thunderstorm asthma, including:
- diagrams on how thunderstorm causes asthma epidemics
- a list of risk factors for thunderstorm asthma
- criteria for completing a thunderstorm asthma risk assessment
- management of thunderstorm asthma guidance
- patient education
- support for practice preparedness.
Preparing your practice
In the lead up to late spring and summer, your practice can prepare by:
- securing sufficient supply of in-date reliever medication and spacers on site
- ensuring that all staff, both clinical and non-clinical, are trained in asthma first-aid (further information can be found at the National Asthma Council website)
- ensuring clinical staff are up to date with acute asthma management
- monitoring local health department websites and the Bureau of Meteorology website for alerts and updates on whether there is a high risk for thunderstorm asthma
- considering how your practice would respond to a surge in patients 28
- identifying potential at-risk patients and communicating targeted messages to them (ie asthmatics, older people etc.)
- planning for staff absences, ensuring staff contact details are up-to-date and staff allergies and asthma status are recorded.