Thunderstorm associated asthma: a detailed analysis of environmental factors

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Abstract
Objectives: To seek associations between meteorological factors, concentrations of air pollutants or pollen, and an asthma epidemic which occurred in London on 24 and 25 June 1994 after a thunderstorm. Design: Retrospective study of patients' accident and emergency department records, with bivariate and multivariate analysis of environmental factors and data collection for the two months surrounding the epidemic. Setting: The accident and emergency department of St Mary's Hospital in west central London. Subjects: 148 patients presenting with asthma between 1 June and 31 July 1994, of whom 40 presented in the 24 hours after the storm. Results: The asthma epidemic was significantly associated with a drop in air temperature six hours previously and a high grass pollen concentration nine hours previously. Non-epidemic asthma was significantly associated with lightning strikes, increase in humidity or sulphur dioxide concentration, a drop in temperature or high rainfall the previous day, and a decrease in maximum air pressure or changes in grass pollen counts over the previous two days. Conclusions: New episodes of asthma during the epidemic on 24 and 25 June 1994 were associated with a fall in air temperature and a rise in grass pollen concentration. Non-epidemic asthma was significantly associated with a greater number of environmental changes. This may indicate that the patients with thunderstorm associated asthma were a separate population, sensitive to different environmental stimuli. Key messages Non-epidemic asthma during June and July 1994 was significantly associated with lightning strikes, increase in humidity or sulphur dioxide concentration, a fall in temperature or high rainfall the previous day, and a decrease in maximum air pressure or changes in grass pollen concentration over the previous two days Patients with asthma associated with thunderstorms may be a separate population from other patients with asthma, sensitive to different environmental stimuli