In the days before a major thunderstorm storms, emergency room visits for seniors suffering from asthma and chronic obstructive pulmonary disease (COPD) have increased significantly, according to a research letter published Monday in JAMA Internal Medicine.
Although the study used Medicare data for those 65 and older, the danger is just as real for younger people with serious respiratory illnesses, said study author Dr. Anupam Jena, an associate professor of health care policy at Harvard Medical School.
“It can certainly affect children and young adults with asthma,” Jena said. “We just needed to have the specific data that Medicare provides so that we can compare hospitalization rates with weather patterns in small areas.”
The study found that emergency visits peaked the day before the storm, with an average of 1.8 additional visits per million beneficiaries.
“The visits were not during the thunder when the rains came down,” Jena said. “And after the storm was over, we saw that the rates of visits to the ER fell.”
Thunder asthma
The phenomenon of “thunder asthma” was first recorded in Birmingham, England in 1983 and in Melbourne, Australia in 1987, where widespread waves of asthma attacks were found to be associated with severe thunderstorms during high pollen counts.
It happened again in 2016 in Melbourne, killing eight people and sending about 8,000 to the emergency room.
No one understood why this could happen, because rain typically washes pollen out of the air. In addition, the size of the rye pollen pores in the Melbourne area were too large to be easily inhaled and placed in the sinuses before they could reach the lungs.
So why would a rare storm with that kind of pollen cause such an extreme reaction?
“In our study, we found that pollen did not rise in the days before the outbreak, which makes it strange to then attribute the increase in hospitalizations to pollen, at least exclusively,” Jena said.
Still, levels of nitrogen dioxide, sulfur dioxide, carbon monoxide and ozone changed in the days leading up to a thunderstorm, Jena said. However, all levels fell after the storm ended.
“Preliminary studies suggest that rapid temperature rises may precipitate respiratory problems, and we observed changes in temperature in the days leading up to thunderstorms,” he added.
“The last thing to note is that this was a study of thousands of thunderstorms that occurred in the US, consistent with high frequency data on environmental parameters and hospitalizations, making these findings potentially more generalizable than previous studies on this topic,” said Jena.
Day before storm is more dangerous
The study analyzed Medicare insurance requirements for emergency room visits related to acute respiratory distress between January 1999 and December 2012, and compared the U.S. National Oceanic and Atmospheric Administration’s atmospheric and lightning data for each U.S. province.
“We found ER visits rose during the days leading up to the thunderstorm as temperature rises and the number of particles in the air begins to rise,” Jena said.
Particulate matter is a mixture of solid and liquid substance found in the air. Dust, dirt and smoke particles are larger, but there are also extremely small, indestructible particles that are not visible to the naked eye. These are called PM 2.5 because their size is generally 2.5 micrometers or less.
That’s really small – for comparison, an average human hair is 30 times larger than a PM 2.5 particle. Because they are so small, these particles can travel deep into the lungs and be destroyed with our lungs and bodily functions.
Rain, on the other hand, washes away the particles of dust.
Using census data, the study estimates that there are 37.7 million Americans who are 65 years or older. Using these figures, the study estimated an additional 52,000 visits to the emergency room over a period of 14 years due to respiratory distress in the three or more days due to major storms.
“If you know a thunderstorm is coming, think about it just as you would if pollen counts were high, and take a little extra care,” Jena advised.
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