An Overview of Thunderstorm-Associated Asthma Outbreak in Southwest of Iran

The aim of this study was to report the characteristics and treatment strategies of all patients with acute bronchospasm who were presented to the emergency departments of Ahvaz, Iran, following the occurrence of a thunderstorm on November 2, 2013. A total of 2000 patients presenting with asthma attacks triggered by thunderstorm were interviewed and an initial questionnaire was completed for each individual. After twenty days, patients were asked to complete a supplementary questionnaire, but only 800 of them accepted to do so. The majority of subjects was aged 20–40 years (60.5%) and had no history of asthma in most cases (60.0%). The symptoms had started outdoors for 60.0% of the participants. In most patients, the onset of the condition was on November 2. Short-acting β2-agonist (salbutamol) and aminophylline were the most commonly prescribed medications in the emergency department. Upon the second interview, 85.3% of the patients were still symptomatic. Overall, 63.6% did not have a follow-up visit after hospital discharge, although all of them were referred to the specialist. The findings of the present study suggest that thunderstorm-associated asthma could affect young adults with no gender priority, with or without asthma history, which put a strain on emergency medical services. 1. Introduction Thunderstorm-associated asthma refers to a sudden surge in the number of acute bronchospasm cases following the occurrence of thunderstorms [1–3]. It is not a formal or definite diagnosis of asthma, but it describes patients suffering from respiratory diseases after thunderstorms. Several observational studies have provided evidences for a relationship between thunderstorms and asthma [4–6]. Although the mechanism of this relationship is not clear yet, different climate changes, that is, temperature drop, higher humidity, thunder and lightning, and increased wind can raise the concentration of allergen particulates whose inhalation, particularly during seasons with high levels of allergens, intensifies asthma attacks [7, 8]. Since not all types of storms cause asthma, meteorological and aeroallergens seem to be simultaneously involved in the development of the condition [9, 10]. Thunderstorm asthma epidemics have been reported in various countries including Australia (Melbourne), England (Birmingham and London), Saudi Arabia, Italy, the U.S., and Canada. The patient characteristics, hospital admission, inadequacy of medical resources to deal with the condition, and the annual cycles of asthma epidemics in various geographic regions have been described