Abstract

Background:

Studies of thunderstorm asthma to understand risk factors using high-resolution climate data and asthma outcomes on a large scale are scarce. Moreover, thunderstorm asthma is not well studied in the United States.

Objectives:

We examined whether climate parameters involved in thunderstorms are associated with emergency department (ED) visits for acute asthma attacks in the United States.

Methods:

We analyzed 63,789 asthma-related, daily ED visits for all age groups, and thunderstorm-associated climate data in Louisiana during 2010 through 2012. We performed time-series analyses using quasi-Poisson regression models with natural cubic splines of date, parish, holiday, day of week, season, daily maximum concentrations of ozone (${\mathrm{O}}_3$) and fine particulate matter [PM $\le 2.5\mathrm{\mu }\mathrm{m}$ in aerodynamic diameter (${\mathrm{PM}}_{2.5}$)], and daily mean pressure, precipitation, and temperature. Because of a significant interaction effect between temperature and lightning days on asthma-related visits, we performed stratified analyses by days with/without lightning or thunderstorm (defined by any lightning and precipitation).

Results:

On thunderstorm days, higher asthma-related ED visits were associated with higher daily mean precipitation [$\text{relative risk\hspace{0.17em}}\left(\text{RR}\right)=1.145\text{\hspace{0.17em}per\hspace{0.17em}}1{\mathrm{g}/\mathrm{m}}^2/\mathrm{s}$ (95% CI: 1.009, 1.300)] and lower daily mean temperature [$\text{RR}=1.011$ per 1°C change (1.000–1.021)] without carry-over effect to the next non-thunderstorm day. These higher risks were found mainly among children and adults $<65\text{\hspace{0.17em}years}$ of age. We observed similar results on lightning days. However, we did not find similar associations for non-thunderstorm or non-lightning days. Daily maximum ${\mathrm{O}}_3$ and ${\mathrm{PM}}_{2.5}$ levels were not significantly associated with asthma ED visits on thunderstorm days.

Discussion:

Higher precipitation and lower temperature on thunderstorm days appear to contribute to asthma attacks among people with asthma, suggesting they should consider taking precautions during thunderstorms. EDs should consider preparing for a potential increase of asthma-related visits and ensuring sufficient stock of emergency medication and supplies for forecasted severe thunderstorm days. https://doi.org/10.1289/EHP10440

中文翻译：

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雷暴日哮喘急诊就诊与降水和温度的关联：2010-2012 年美国路易斯安那州数据的时间序列分析

摘要

背景：

使用高分辨率气候数据和大规模哮喘结果来了解雷暴哮喘风险因素的研究很少。此外，雷暴哮喘在美国没有得到很好的研究。

目标：

我们检查了雷暴中涉及的气候参数是否与美国急性哮喘发作的急诊 (ED) 就诊有关。

方法：

我们分析了 2010 年至 2012 年间路易斯安那州所有年龄组的 63,789 次哮喘相关的每日 ED 就诊以及雷暴相关的气候数据。我们使用准泊松回归模型和日期、教区、假日的自然三次样条进行时间序列分析, 星期几, 季节, 每日最大臭氧浓度 (${\mathrm{○}}_3$) 和细颗粒物 [PM$\le 2.5\mathrm{\mu }\mathrm{米}$气动直径 (${\mathrm{下午}}_{2.5}$)]，以及日平均压力、降水量和温度。由于温度和闪电天数对哮喘相关就诊有显着的交互作用，我们按有/无闪电或雷暴的天数（由任何闪电和降水定义）进行了分层分析。

结果：

在雷雨天，与哮喘相关的 ED 就诊次数增加与日平均降水量增加有关 [$\text{相对风险\hspace{0.17em}}\left(\text{RR}\right)=1.145\text{\hspace{0.17em}每\hspace{0.17em}}1{\mathrm{G}/\mathrm{米}}^2/\mathrm{s}$(95% CI: 1.009, 1.300)] 和更低的日平均温度 [$\text{RR}=1.011$每 1°C 变化 (1.000–1.021)] 不会影响到下一个非雷暴日。这些较高的风险主要发生在儿童和成人中$<65\text{\hspace{0.17em}年}$年龄。我们在闪电日观察到了类似的结果。但是，我们没有发现非雷暴或非闪电天的类似关联。每日最大值${\mathrm{○}}_3$和${\mathrm{下午}}_{2.5}$水平与雷暴日哮喘急诊就诊没有显着相关性。

讨论：

雷暴日降水量增加和气温较低似乎会导致哮喘患者发生哮喘发作，这表明他们应该考虑在雷暴期间采取预防措施。急诊科应考虑为可能增加的哮喘相关就诊做好准备，并确保为预测的严重雷暴天数提供足够的紧急药物和用品库存。https://doi.org/10.1289/EHP10440