Thunderstorm Asthma
Last updated: September 2024
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Although rare, thunderstorm asthma has been formally recorded since 1983 around the world.
Cold weather, pollution, hot, and even humid weather are all known seasonal triggers of asthma; however, a lesser-known trigger is thunderstorms.1,2 Yes, that is right, thunderstorms can trigger asthma in certain circumstances.1 Thunderstorm asthma is a term used to described an asthma attack that starts or worsens following a thunderstorm.3
Although rare, thunderstorm asthma has been formally recorded since 1983 around the world, notably; Birmingham and London in the United Kingdom, Naples in Italy, and events in Australia, with the largest recorded event occurring in Melbourne, Australia in November 2016.4-6
The thunderstorm event in Australia which occurred on 21st November 2016 saw a 73% increase in ambulance call outs for asthma symptoms, a 672% increase in people presenting with breathing issues, and an increase of 992% for asthma-related hospital admissions.4,6 10 deaths were also associated with the event.6 This highlights the potential threat that thunderstorm asthma has on public health.6
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Thunderstorm asthma is typically triggered by high pollen or other aeroallergens.5,7 Under normal weather conditions, pollen grains can penetrate the upper respiratory tract, however, when they are broken apart by thunderstorms into smaller fragments, they are able to penetrate further into the airways triggering asthma symptoms.5,7
It is theorised that the excess moisture in clouds split apart pollen grains and fungal spores by osmotic shock.4,7 This causes them to break into smaller, inhalable parts. The rain then brings these particles down to ground level where the micro-particles can be inhaled deep into the lungs.4 Inhalation of high concentrations of these allergens can induce asthmatic responses in sensitised individuals.4,5
Rainfall usually removes pollen from the air, but, during a thunderstorm, updrafts bring whole pollen into the cloud base where they split, and the cold downdrafts bring the fragments to ground level where strong winds disperse them.5
Symptoms of thunderstorm asthma are usually rapid-onset which makes it particularly risky for asthma sufferers.7
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It has been shown that 90-100% of those affected with acute breathing difficulties following thunderstorm events have a history of allergic rhinitis.7
People at risk from thunderstorm asthma include:
Other risk factors named by the Harvard Medical school include low scores on rapid exhalation tests, higher levels of ryegrass pollen-specific IgE, high eosinophils and high FeNO.3
Previous thunderstorm asthma events have also indicated that young adults (below 30) can be particularly affected.4
In the UK, approximately 1 in 12 adults and 1 in 11 children suffer with asthma, and allergic rhinitis affects between 10-15% of children and 26% of adults in the UK, which means that a large proportion of the UK population may be susceptible to thunderstorm asthma.8,9
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Fractional exhaled nitric oxide (FeNO) testing is a simple, non-invasive, and rapid point-of-care test to measure airway inflammation associated with Type 2 asthma.*
FeNO testing involves inhaling then exhaling through the device to measure a patient’s FeNO level and can be used on adults and children.**
FeNO testing is a quick and easy way to diagnose and manage asthma.*
Although rare, these events can have major impacts on public health, including overwhelming emergency departments.4 It is important to educate your patients on the importance of taking their asthma medication as prescribed, as these events can put patients whose asthma is not in control, at risk. 7,10
It is important that patients adhere to their preventer medications to reduce the risk associated with thunderstorm asthma.7,11 A FeNO (Fractional exhaled nitric oxide) test can monitor patient adherence to their inhaled corticosteroids (ICS), and help you titrate dosage to best control your patient’s asthma.12-14
Encourage patients to seek medical attention if their asthma symptoms get worse or if seasonal rhinitis sufferers develop asthma symptoms (wheeze, breathlessness, cough). 7
It is also important to adequately control seasonal rhinitis.9 Why not check out our tips for managing asthma during hay fever season?
Thunderstorm asthma is a rare phenomenon, however, as seen with the 2016 Melbourne event, it can pose a potential threat to public health.6 To find out more about asthma and FeNO, head to our FeNO learn app where you will also find our educational FeNO course.
* NIOX®. Data on File; MKT-DOF-007. 2024.
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