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Emergency Medicine3 papers

Thunderstorm asthma

Last edited: 4/16/2026

Overview

Thunderstorm asthma refers to an acute exacerbation of asthma triggered by specific weather conditions associated with thunderstorms, often characterized by pollen grains being dispersed into smaller particles that penetrate deeper into the lungs 1. This phenomenon can lead to widespread respiratory distress and requires timely public health interventions 1.

Diagnosis

  • Symptoms include acute onset of wheezing, breathlessness, and coughing 1.
  • Spirometry often shows obstructive pattern with reduced FEV1/FVC ratio 1.
  • Peak expiratory flow variability is common 1.
  • Allergy testing may reveal pollen sensitization 1.

    • Management

  • First-line treatments: Short-acting beta-agonists (SABAs) for immediate relief (e.g., albuterol 2.5-5 mg via nebulizer) 1.
  • Systemic corticosteroids: Oral prednisolone 40-60 mg daily for 3-5 days 1.
  • Oxygen therapy: For hypoxemia, target SpO2 ≥92% 1.
  • Bronchodilators: Consider continuous nebulized albuterol if severe 1.
  • Monitoring: Frequent reassessment of respiratory status and oxygen saturation 1.

    • Special Populations

  • Pregnancy: Management focuses on SABAs and systemic corticosteroids with close monitoring; expert opinion suggests caution with prolonged use of systemic steroids (Evidence: Expert opinion) 1.
  • Pediatrics: Similar to adults but with emphasis on weight-appropriate dosing for SABAs and corticosteroids (Evidence: Expert opinion) 1.
  • Elderly: Increased vigilance for comorbidities like COPD; consider stepped care approach (Evidence: Expert opinion) 1.
  • Comorbidities: Patients with pre-existing asthma or allergic rhinitis require heightened vigilance and proactive management (Evidence: Expert opinion) 1.

    • Key Recommendations

  • Prepare emergency response plans well in advance of thunderstorm seasons to mitigate public health impacts (Evidence: Expert opinion) 1.
  • Implement public alerts and education campaigns to recognize and respond to thunderstorm asthma symptoms (Evidence: Expert opinion) 1.
  • Ensure availability of SABAs, systemic corticosteroids, and oxygen therapy in healthcare facilities and emergency settings (Evidence: Expert opinion) 1.

    • References

    1 Hurley A. Hurricane preparedness, response and recovery: Is everybody ready?. Journal of business continuity & emergency planning 2019. link

    Original source

    1. [1]
      Hurricane preparedness, response and recovery: Is everybody ready? — Hurley A Journal of business continuity & emergency planning (2019)
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