Hidden dangers of hay fever
An epidemic of storm asthma hit Melbourne with a vengeance last year. As the spring pollen season tightens its grip, Genevieve Gannon reports on the lessons learnt.
Emma Hart had experienced hay fever before, but never quite like this. Around 6pm on the night of a huge thunderstorm in Melbourne, she started feeling wheezy. She made herself a cup of tea because the heat and steam usually make her feel better, but on this occasion, it didn’t work. “The wheezing kept going. It got stronger and then I started coughing. The coughing exacerbated the wheezing,” she says.
Her husband, Wayne, is asthmatic, but she had never had an asthma attack. Recognising the signs, she started searching the house for his Ventolin inhaler. When she couldn’t find it, she called him. “I said, ‘Can you come home? I think I’m having an asthma attack.’ ” Noting the stress in her breathing, he told her to call an ambulance.
Emma called 000. The operator advised her to unlock her door in case she passed out before help arrived. An epidemic was sweeping across the city, so it was 40 minutes before the ambulance arrived. During that time, her wheezing got worse. “It felt like your chest just gets tighter and tighter and tighter,” she says.
When the paramedics came, they were dripping with sweat. “After you, we’ve got about 150 people waiting,” they told her.
Emma was one of thousands of Victorians who fell victim to thunderstorm asthma when an intense storm front rolled across Melbourne on November 21. Nine people died from asthma attacks triggered by microscopic allergens carried by the storm. The sick mobbed hospital emergency departments city-wide. More than
8500 people sought urgent medical aid. The Emergency Services Telecommunications Authority (ESTA) experienced a surge in demand nearly four times that which occurred on the day of the Black Saturday bushfires in February 2009.
“The scale of this epidemic was unprecedented,” the Victorian government review of emergency responses to the November 2016 thunderstorm asthma report said. “Never before have ESTA, Ambulance Victoria or Victorian hospitals experienced this level of demand in such a condensed time period and dispersed over such a large geographical area.”
The death toll was especially shocking – until that night, there had only been one known death from thunderstorm-associated asthma in the world, in the UK in 2002.
Professor Peter Gibson, the immediate past President of the Thoracic Society of Australia and New Zealand, says the catastrophe was a wake-up call for Australia, particularly Victoria, as it prepares for the next pollen season. Those most seriously affected, he says, were people unaware they were at risk of asthma, so had no medication to hand. “Many more people than previously thought are at risk of sudden, unforeseen asthma attack,” Professor Gibson says.
I feel incredibly lucky I got an ambulance. It was a massive wake-up call for me. Emma Hart, asthma attack survivor.
The reality is that hay fever can turn nasty in an instant. Researchers Dr Vikas Wadhwa and Dr Daniel Clayton-Chubb from Victoria’s Eastern Health conducted a study of 500 healthcare workers and found that, on the night of the storm, 37 per cent of those who had no prior history of asthma reported symptoms such as hay fever, shortness of breath, coughing, chest tightness and wheezing. “There are a lot of people who may not be aware that they are at risk of asthma,” says Dr Wadhwa. “Asthma is very unpredictable, in that it can strike very suddenly and very abruptly.”
Anyone with a history of hay fever should be on alert because it is one of the greatest risk factors, says Dr Clayton-Chubb. “The key message from our work is that anyone with hay fever should ensure that they have ready access to quick-acting asthma treatments at all times, but particularly in pollen season or if severe thunderstorms are predicted.”
Those people with a history of sensitivity to environmental aeroallergens, such as rye grass or mould, were far more likely to report symptoms than those with no history of allergies, or allergies to dust mites and cats, the study found.
November 2, 2016, wasn’t the first time Melbourne recorded a thunderstorm asthma event – there were others in
1987, 1989 and 2010. All took place in November and the last two events were preceded by very wet Septembers. There was also a severe one in Wagga Wagga, NSW, in 1997. Authorities have identified allergens released by rye grass pollen as the cause of the problem. The pollen particles rupture when they come into contact with moisture, releasing smaller allergen particles that can be inhaled into the airways.
After the 2016 epidemic, Asthma Australia surveyed 3000 people and found far more were susceptible to asthma than previously thought. “Because a significant proportion of people did not have an asthma diagnosis, they did not know what was happening or what to do,” says Asthma Australia’s CEO, Michele Goldman. Her view was supported by the doctors on the ground, according to the Director of Respiratory & Sleep Medicine at Austin Health, Professor Christine McDonald. “The people who have asthma and use regular medication, we didn’t see them. They were fine,” she says. “They were on their preventer. They were on their medication.” Many people whom she saw in the aftermath did, in fact, have sub-clinical asthma, but were not aware of it.
Since her attack, Emma Hart says she always carries Ventolin in her bag. “I feel incredibly lucky I even got an ambulance,” she says. “People who knew I had an asthma attack were calling me, saying, ‘Did you realise people died?’ That was a massive wake-up call for me.”
There are a lot of people who may not be aware that they are at risk of asthma. Dr Vikas Wadhwa, Director of General Medicine at Maroondah Hospital.
Tip of the iceberg
Professor McDonald urges people to be prepared for the months ahead. “For someone who’s had an episode before and wheezes, it’s not unreasonable to have a low-dose reliever at the beginning of the pollen season,” she says. “It’s the unpredictability of this that makes it more troublesome.”
Dr Wadhwa fears we haven’t seen the end of thunderstorm asthma. “As climate change affects more and more parts of the world, one has to really question whether this is the tip of the iceberg and we will end up seeing a lot more of this in the future.”
ABOVE: Emma Hart had never had an asthma attack before the storm. “It was such an odd sensation ... exacerbated by the fact the air was so thick.”
Rye grass pollen and how it reacts with wet weather in Melbourne (top) was a major trigger for the storm asthma.