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Asthma Wheeze Follows Thunderstorms 7-11-08

Thunderstorms -- usually thought to clear the air -- are associated with about a 3% spike in emergency room visits for asthma, researchers here said.

In a study carried out in the 20-county Atlanta region, hospital data showed a significant increase in visits for asthma (P<0.001) the day after a thunderstorm, according to Andrew Grundstein, Ph.D., of the University of Georgia Atlanta, and colleagues.

Because asthma is prevalent in the region even such a small relative increase could have a "significant public health impact in the population," Dr. Grundstein and colleagues said in the July issue of Thorax.

The researchers noted that an association between thunderstorms and asthma has been reported previously, but this is the first study to look at the issue in the American south, where both asthma and thunderstorms are common.

Dr. Grundstein and colleagues collected data on emergency room visits for asthma over 12 years, from 1993 through 2004, from 41 of the 42 hospitals in the region.

Thunderstorm data were collected from an automated surface observing station at the Atlanta Hartsfield-Jackson airport, which recorded 564 thunderstorm days during the study period. That was 12.9% of 4,383 total days studied.

All told, the 41 emergency departments recorded a total of 215,832 asthma visits during the study period, of which 24,350 occurred on days following thunderstorms, the researchers found.

Overall, the hazard ratio for asthma the day after a thunderstorm was 1.035, which was significant at P<0.001, but the effect varied depending on what other weather phenomena were associated with the storm.

For example, there was no significant effect if the storm had no rainfall.

But rainfall of between zero and 0.28 centimeters was associated with a hazard ratio of 1.047, between 0.28 and 2.06 centimeters with a hazard ratio of 1.032, and greater than 2.06 centimeters with a hazard ratio of 1.045.

The hazard ratios were significant at P=0.009, P=0.016, and P=0.010, respectively.

Wind also played a role, the researchers found, in that the effect vanished for storms with winds of 9.4 meters per second or less. When winds were from 9.l4 through 14.3 meters per second, the hazard ratio was 1.049, which was significant at P<0.001.

For higher winds still, the hazard ratio was 1.039, but it did not reach statistical significance because of wide confidence intervals (P=0.061).

Exactly why thunderstorms might give rise to asthma attacks remains unclear, the researchers said, but "one prominent hypothesis" is that pollen grains break up by osmotic shock in rainwater, releasing allergens, which are then spread by the gusty winds of the storm.

These findings are preliminary evidence in support of that mechanism, Dr. Grundstein and colleagues said.

They noted that the study used meteorological data from only one weather station and the data may only represent events near the Atlanta airport.

Dr. Grundstein and colleagues said they plan to follow up with data from other local stations, radar data on thunderstorm characteristics, and spatial analysis of the asthma data to "conduct a more refined assessment."