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a Institute of
Respiratory Medicine, University of Sydney, NSW 2050, Australia, b NSW Regional Office, Bureau of
Meteorology, Sydney, NSW, Australia, c School of Biomedical Sciences, Charles
Sturt University, Wagga Wagga, NSW, Australia
Correspondence to: Dr G B Marks g.marks{at}unsw.edu.au
Received 6 October 2000; Returned to authors 5 January 2001; Revised version received 22 January 2001; Accepted for publication 26 February 2001
BACKGROUND
A study was
undertaken to assess the importance of thunderstorms as a cause of
epidemics of asthma exacerbations and to investigate the underlying mechanism.
METHODSA case control
study was performed in six towns in south eastern Australia. Epidemic
case days (n = 48) and a random sample of control days (n = 191) were
identified by reference to the difference between the observed and
expected number of emergency department attendances for asthma. The
occurrence of thunderstorms, their associated outflows and cold fronts
were ascertained, blind to case status, for each of these days. In
addition, the relation of hourly pollen counts to automatic weather
station data was examined in detail for the period around one severe
epidemic of asthma exacerbations. The main outcome measure was the
number of epidemics of asthma exacerbations.
RESULTSThunderstorm
outflows were detected on 33% of epidemic days and only 3% of control
days (odds ratio 15.0, 95% confidence interval 6.0 to 37.6). The
association was strongest in late spring and summer. Detailed
examination of one severe epidemic showed that its onset coincided with
the arrival of the thunderstorm outflow and a 4-12 fold increase in
the ambient concentration of grass pollen grains.
CONCLUSIONSThese
findings are consistent with the hypothesis that some epidemics of
exacerbations of asthma are caused by high concentrations of allergenic
particles produced by an outflow of colder air, associated with the
downdraught from a thunderstorm, sweeping up pollen grains and
particles and then concentrating them in a shallow band of air at
ground level. This is a common cause of exacerbations of asthma during
the pollen season.
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