by Abir Mukherjee

D’Amato and colleagues discuss the idea that thunderstorms in pollen season can induce severe asthma attacks in susceptible pollinosis patients.
The scientific background to this observation is that that storms can concentrate pollen grains at ground level, which may then release allergenic particles of respirable size in the atmosphere after their imbibition of water and rupture by osmotic shock. During the first 20-30 minutes of a thunderstorm, a large amount of pollen is dispersed into the atmosphere as a bioaerosol of allergenic particles, which can induce asthmatic reactions, often severe. Subjects without asthma symptoms, but affected by seasonal rhinitis can also experience an asthma attack
A key message for susceptible patients is increasing awareness of being outdoors during a thunderstorm in the pollen season could trigger an asthma attack.
Davies et al in the BMJ (2018) also discuss the phenomenon of epidemic thunderstorm asthma. They suggest proactive measures to identify and pre-emptively protect susceptible people are critical to mitigating the effects of thunderstorm asthma. Whilst known previous asthma seems to be an inadequate predictor of risk, seasonal allergic rhinitis (hay fever) from grass pollen allergy, and degree of sensitisation, appears to be a universal risk factor among affected patients.

References

How Do Storms Affect Asthma?
Author(s) D’Amato G; Annesi-Maesano I; Vaghi A; Cecchi L; D’Amato M
Source Current Allergy and Asthma Reports; Mar 2018; vol. 18 (no. 4); p. 24

Thunderstorm asthma: controlling (deadly) grass pollen allergy
Author(s) Davies, J.M., Thien, F. and Hew, M., 2018.
Source BMJ: British Medical Journal (Online), 360.5

A post from our Clinical Librarian, Abir Mukherjee @ClinicalLibUCLH 

Some basic patient information on asthma as a condition and management can be found at the following sites:

• Patient Info provides a printable overview of asthma as well as how to manage it and what things may act as triggers. https://patient.info/health/asthma-leaflet
• NHS Choices also discusses causes, triggers and complications in simple language. https://www.nhs.uk/conditions/asthma/
• The British Lung Foundation provides a range of information on causes, symptoms , management and has a specific section for asthma in children. https://www.blf.org.uk/support-for-you/asthma
• The AAIR Charity (Asthma, Allergy & Inflammation Research) focusses on effective treatments and cures for allergic diseases, notable research has included the identification of an asthma gene. It has some basic background information for patients on its website. http://www.aaircharity.org/

A post from our Clinical Librarian, Abir Mukherjee  @ClinicalLibUCLH

Here are five recent articles on asthma treatment from 2018:

• Akhbari, M., Kneale, D., Harris, K.M. and Pike, K.C., 2018. G460 (P) Interventions for autumn exacerbations of asthma in children: a systematic review. Cochrane Reviews
• Chang, Y.S., 2018. Non-pharmacologic Therapies for Severe Asthma. In Severe Asthma (pp. 123-129). Springer, Singapore.
• Larsson, K., Ställberg, B., Lisspers, K., Telg, G., Johansson, G., Thuresson, M. and Janson, C., 2018. Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR). Respiratory research, 19(1), p.12.
• Licari, A., Castagnoli, R., Brambilla, I., Marseglia, A., Tosca, M.A., Marseglia, G.L. and Ciprandi, G., 2018. New approaches for identifying and testing potential new anti-asthma agents. Expert opinion on drug discovery, 13(1), pp.51-63.
• Sobieraj, D.M., Weeda, E.R., Nguyen, E., Coleman, C.I., White, C.M., Lazarus, S.C., Blake, K.V., Lang, J.E. and Baker, W.L., 2018. Association of Inhaled Corticosteroids and Long-Acting β-Agonists as Controller and Quick Relief Therapy With Exacerbations and Symptom Control in Persistent Asthma: A Systematic Review and Meta-analysis. JAMA, 319(14), pp.1485-1496.

Chang (2018) identifies inhaler technique and adherence as the the key factors of successful management in severe asthma. He discusses factors to aid self-management such as patient education to maintain regular medications; a written action plan and awareness of environmental triggers such as inhalant allergens, smoking, air pollution, respiratory infections, and obesity.

Licari et al (2018) in their review provide a comprehensive and updated overview of the currently available, new and developing approaches for identifying and testing potential treatment options for asthma management. They discuss future therapeutic strategies for asthma needing the identification of reliable biomarkers that can help with diagnosis and endotyping, in order to determine the most effective drug for the right patient phenotype. Furthermore they conclude that a better understanding of the mechanisms of airway remodeling will likely optimize asthma targeted treatment.

Pike et al (2018) in their Cochrane systematic review found that seasonal omalizumab treatment from four to six weeks before school return may reduce autumn asthma exacerbations. Negative associations included injection site pain and treatment costs.

Sobierj and colleagues (2018) in a systematic review and meta-analysis discuss combined use of inhaled corticosteroids and long-acting beta-agonists (LABAs) as the controller and the quick relief therapy termed single maintenance and reliever therapy (SMART) which could be a potential therapeutic regimen for the management of persistent asthma.

A Swedish study by Larsson found that patients with severe asthma had few regular contacts with both primary and specialist care, and more than half of them experienced poor asthma control.

Please contact Hearing Library staff if you have any trouble accessing or finding these articles (or others!).