Thunderstorm Asthma

“Why did you start?” Thunderstorm asthma is a previously described environmental phenomenon. The patient group most vulnerable to this phenomenon is unknown, and designing trials to identify them and optimal management is challenging as they are unpredictable events. “What did you try to do?” Within a period of thunderstorm asthma, we wanted to further investigate which patient groups were vulnerable to exacerbations and if there were any identifiable features of them and their management. “What did you do? We conducted a retrospective observational study during thunderstorms from 9th to 18th June 2023 of asthma presentations to Gloucestershire Emergency Departments and compared this to the same period in 2022. We analysed differences in age, deprivation level, atmospheric pollen, presence of eosinophilia (>0.30 x109/L) and pre-presentation medications. “What did you find?” In the thunderstorm period, presentations increased 272% and the cohort appeared to be younger in age compared to 2022 (79 from 29). There were no significant changes in patient deprivation levels, or measured pollen levels. The thunderstorm cohort were significantly more eosinophilic E>0.3 at presentation (42 to 3) (P<0.001). Pre-presentation medications were much less likely to include an inhaled corticosteroid in the thunderstorm group (12/79). “What does it mean?” Currently all guidance emphasises symptom orientated optimisation of asthma control and avoidance of triggers, but our data identified patients requiring hospitalisation during thunderstorms on minimal asthma medications. A greater focus on starting patients on inhaled steroids may be needed to prevent these types of exacerbations and this could be focussed on patients with known eosinophilia.