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The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors
Open accessAbstract
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: ). 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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“On the 21st of November 2016, Melbourne, Australia, experienced a thunderstorm asthma health emergency (106, 107) that exceeded all previously reported thunderstorm asthma events [mainly in the UK and Australia (135, 136)].”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [106]
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““Thunderstorm asthma” (106, 107) is the outcome of a complex interaction between multiple factors but not necessarily any one of them individually.”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [106]
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Metadata
- Authors
- Thien, F., Beggs, P. J., Csutoros, D., Darvall, J., Hew, M., Davies, J. M., Bardin, P. G., Bannister, T., Barnes, S., Bellomo, R., Byrne, T., Casamento, A., Conron, M., Cross, A., Crosswell, A., Douglass, J. A., Durie, M., Dyett, J., Ebert, E., Erbas, B., French, C., Gelbart, B., Gillman, A., Harun, N.-S., Huete, A., Irving, L., Karalapillai, D., Ku, D., Lachapelle, P., Langton, D., Lee, J., Looker, C., MacIsaac, C., McCaffrey, J., McDonald, C. F., McGain, F., Newbigin, E., O'Hehir, R., Pilcher, D., Prasad, S., Rangamuwa, K., Ruane, L., Sarode, V., Silver, J. D., Southcott, A. M., Subramaniam, A., Suphioglu, C., Susanto, N. H., Sutherland, M. F., Taori, G., Taylor, P., Torre, P., Vetro, J., Wigmore, G., Young, A. C., & Guest, C.
- Affiliations
- Eastern Health (AU)
- Macquarie University (AU)
- Department of Health and Human Services (AU)
- The University of Melbourne (AU)
- The Alfred Hospital (AU)
- Queensland University of Technology (AU)
- Monash Health (AU)
- Bureau of Meteorology (AU)
- Alfred Health (AU)
- Northern Health (AU)
- St Vincent's Health (AU)
- Melbourne Health (AU)
- La Trobe University (AU)
- Western Health (AU)
- Royal Children's Hospital (AU)
- University of Technology Sydney (AU)
- Austin Health (AU)
- Peninsula Health (AU)
- Barwon Health (AU)
- Cabrini Hospital (AU)
- Deakin University (AU)
- Environment Protection Authority Victoria (AU)
- Corresponding author
- Thien, Francis
- ORCID
- Thien, Francis
- Beggs, Paul J
- Darvall, Jai
- Hew, Mark
- Davies, Janet M
- Bardin, Philip G
- Bannister, Tony
- Bellomo, Rinaldo
- Casamento, Andrew
- Conron, Matthew
- Cross, Anthony
- Durie, Matthew
- Dyett, John
- Ebert, Elizabeth
- Erbas, Bircan
- French, Craig
- Gelbart, Ben
- Harun, Nur-Shirin
- Huete, Alfredo
- Karalapillai, Dharshi
- Lachapelle, Philippe
- Langton, David
- Lee, Joy
- MacIsaac, Christopher
- McDonald, Christine F
- McGain, Forbes
- Pilcher, David
- Prasad, Shivonne
- Rangamuwa, Kanishka
- Ruane, Laurence
- Sarode, Vineet
- Silver, Jeremy D
- Subramaniam, Ashwin
- Suphioglu, Cenk
- Susanto, Nugroho Harry
- Torre, Paul
- Wigmore, Geoffrey
- Young, Alan C
- Venue
- The Lancet Planetary Health
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 2
- Issue
- 6
- Pages
- e255-e263
- ISSN
- 2542-5196 (ISSN-L)
- OpenAlex
- W2806469930
- Cited by
- 279
- References
- 36
- Citations by year
- 2026: 30 · 2025: 28 · 2024: 24 · 2023: 34 · 2022: 50 · 2021: 32 · 2020: 41 · 2019: 25 · 2018: 13
- FWCI
- 19.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Planetary Health (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by-nc-nd)
- Monash University Research Portal (Monash University) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Deakin Research Online (Deakin University) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by-nc-nd)
- La Trobe University
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Keywords
- environmental triggers, pollen, particulate matter, humidity, temperature, emergency department presentation, hospitalization, asthma, ethnic disparities, intensive care unit admission, mortality, preventive strategies, patient risk factors
- MeSH terms
- Adolescent, Adult, Allergens, Asthma, Australia, Emergency Service, Hospital, Female, Humans, Male, Middle Aged, Pollen, Surveys and Questionnaires, Risk Factors, Weather, Young Adult, Epidemics
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