Hid­den dan­gers of hay fever

The Australian Women's Weekly - - What's New -

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.

Caught un­awares

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.

His­tory re­peat­ing

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.

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