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The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission
Author(s) -
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 NurShirin,
Lachapelle Philippe,
Douglass Jo A.,
Irving Louis,
Langton David,
Mann Jennifer,
Erbas Bircan,
Thien Francis
Publication year - 2019
Publication title -
allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.363
H-Index - 173
eISSN - 1398-9995
pISSN - 0105-4538
DOI - 10.1111/all.13609
Subject(s) - asthma , medicine , odds ratio , odds , pediatrics , epidemiology , emergency medicine , logistic regression
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 ( ER s), 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.