What is Thunderstorm Asthma?

As the name implies, “thunderstorm asthma” refers to asthma attacks that occur during or after a thunderstorm.^1,2 These attacks can be fatal if not managed. 

In regions with high numbers of thunderstorms, there can be increases of the attacks that put a strain on local hospitals. One example is the thunderstorm asthma attacks that occurred in Melbourne, Australia in 2016.^1,3,4 During this event, emergency hospital visits were up four times the regular amount due to acute respiratory distress.^1,5 

Causes of thunderstorm asthma 

While the exact defining factors and classifications of asthma are currently under review, asthma can be generalized as a respiratory condition that causes inflammation and irritation of the airways.^1,6  Asthma can be triggered by sensitivities to particles in one’s environment, genetic makeup, or lifestyle.¹ Asthma symptoms include coughing, breathlessness, and wheezing.¹ 

Allergies

A common cause of asthma attacks is seasonal allergies with pollen being a common triggering culprit. Thunderstorms can cause pollen grains to burst open and circulate in the air which is one reason behind the term “thunderstorm asthma”.¹ These pollen bits can travel into the lower airway and trigger asthma symptoms.¹ 

People with a pollen sensitivity may be at a greater risk for experiencing thunderstorm asthma (TA).² Oddly enough, people without a prior allergy can also have a TA attack. 

A review study looked at the relationship between pollen and thunderstorm asthma incidences.² Twenty study results showed higher levels of pollen in the air before a thunderstorm could contribute to higher incidences of TA.²

Researchers also noted that different types of pollen could contribute to thunderstorm asthma, including grass, wood, weed, and tree pollen.² 

Fungi

Studies examined environmental health at the time of thunderstorm asthma attacks and found that the presence of pollen didn’t explain the prevalence of TA.^2,7, What these researchers found was that another contributor may be fungi. Fungi release tiny particles in the air called spores. Certain fungi releasing spores when the air is damp —- like during a thunderstorm.² Some studies found unusually high amounts of fungi spores in the air before, during, and after thunderstorms.² 

However, another study didn’t find an association between fungi spores in the air and thunderstorm asthma.² These conflicting research results call for a need to study fungi as a cause specifically. 

More research is needed 

It’s essential to note that research into thunderstorm asthma is still limited. Other environmental health factors, such as temperature, could also impact pollen as a cause.² Understanding how pollen affects air quality could predict the high-risk times for thunderstorm asthma, helping to guide public health strategies to protect the vulnerable.²  

References

1. Dharmage, SC, Perret, JL, Custovic A. Epidemiology of asthma in children and adults. Frontiers in Pediatrics. 2019;7:246. https://www.frontiersin.org/articles/10.3389/fped.2019.00246/full. 
2. Idrose NS et al. A systemic review of the roles of grass pollen and fungi in thunderstorm asthma. Environmental Research. 2020;181:108911. doi:10.1016/j.envres.2019.108911. 
3. Elliot AJ. The impact of thunderstorm asthma on emergency department attendances across London during July 2013. Emerg Med J. 2014;31(8):675-8. doi: 10.1136/emermed-2013-203122. 
4. Davidson AC, Emberlin J, Cook AD, Venables KM. A major outbreak of asthma associated with a thunderstorm: experience of accident and emergency departments and patients’ characteristics. Thames Regions Accident and Emergency Trainees Association. BMJ. 1996;312(7031):601-4. https://doi.org/10.1136/bmj.312.7031.601. 
5. Andrew E. Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma. BMJ. 2017;359:j5636. https://doi.org/10.1136/bmj.j5636 .
6. Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med. 2006;355(21):2226–35. doi: 10.1056/NEJMra054308.
7. Anderson W, Prescott GJ, Packham S, Mullins J, Brookes M, Seaton A. Asthma admissions and thunderstorms: a study of pollen, fungal spores, rainfall, and ozone. QJM: Int. J. Med. 2001;94(8):429-433. doi: 10.1093/qjmed/94.8.429.
8. https://www.frontiersin.org/articles/10.3389/fped.2019.00246/full