LAUSR

Thunderstorm Asthma Last November, thunderstorm asthma killed at least eight people in Australia. Hundreds were rushed to hospitals in Victoria with breathing problems during and soon after the storm. In one 4-h period, Ambulance Victoria got more than 1900 calls and deployed an extra 60 ambulances. In a survey by the University of Melbourne, of 2588 respondents, 74% said they experienced an asthma attack tied to the storm, and 32% said it was their first bout of asthma. Among the dead were an 18-yr-old man described as ‘‘the fittest’’ among his gym class and a 35-yr-old woman who died in the arms of family after waiting more than 40 min for an ambulance (7). Thunderstorm asthma is a ‘‘freak illness’’ from a rare combination of weather and pollen. The pollen can be from grass, trees, or fungal spores. The Victoria ‘‘epidemic’’ of asthma was from rye grass pollen. Normally, rye pollen is trapped by nasal hairs and does not enter the lungs. But with the rare convergence of high pollen count, high heat and humidity, and a thunderstorm, rye grains absorb water and explode into many tiny pieces that are swept up and held close to the ground by downdraft and outflow winds. This ‘‘perfect storm’’ triggers asthma as allergic subjects inhale tiny rye allergens deep into their lungs (8). Risk factors for severe thunderstorm asthma include: 1) allergy to grass pollen, 2) history of hay fever, 3) poor control of baseline asthma, and 4) being outdoors (or indoors with open windows) during the storm (6). In August 2001, Rashidi Wheeler, aged 22 yr, who had asthma, and was a senior safety football player at Northwestern University, collapsed and soon died from asthma, trying to complete a grueling ‘‘voluntary’’ drill of 28 conditioning sprints (4). A torrential rainstorm occurred the night before. I have seen football players and runners struggle more than usual with their asthma when training hard soon after thunderstorms. Team physicians and athletic trainers should be alert to the possibility of thunderstorm asthma. In some cases, it may be the athlete’s first-ever attack of asthma. For athletes with known asthma or hay fever, an intense conditioning drill outdoors soon after a thunderstorm is a bad idea. Depending in part on baseline control of their asthma, some athletes should shelter indoors during the thunderstorm and maybe avoid any workout soon thereafter (2).