Do thunderstorms worsen asthma and COPD symptoms? – . Health Blog

Anyone familiar with hay fever knows that weather affects respiratory symptoms. However, many of the effects of weather on respiratory function remain unclear. An unanswered question is to what extent storms affect people with chronic lung disease, especially the way air moves in and out of the lungs. These "obstructive pulmonary diseases" are characterized by problems with narrowing the airways. The most common obstructive pulmonary diseases are asthma and chronic obstructive pulmonary disease (COPD). The two main types of COPD are chronic bronchitis and emphysema.

Obstructive pulmonary disease affects approximately 10% of the US population and accounts for an overwhelming proportion of hospital stays and deaths. In fact, COPD is the fourth leading cause of adult death in the United States.

The study looked at the relationship between thunderstorms and COPD, asthma symptoms

In a recent article published in JAMA Internal Medicine, researchers analyzed Medicare data from 1999 to 2012 to investigate whether storms led to an increase in emergency room visits for respiratory disease in patients with obstructive pulmonary disease. The study included 46,581,214 patients over the age of 65 who had 22,118,934 emergency rooms due to respiratory disease. Obstructive lung disease was a diagnosis in 43.6% of patients and included asthma (10.5%), COPD (26.5%), and combined asthma and COPD (6.6%).

The researchers used meteorological data from the U.S. National Oceanic and Atmospheric Administration (NOAA) to identify the dates on which thunderstorms occurred. The NOAA database covers the continental United States and contains data related specifically to storms: wind speed, lightning, precipitation and temperature. It also contains information about pollen and common air pollutants, including small particles (less than 10 millimeters in diameter), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide.

The analysis found that emergency rooms for people with obstructive pulmonary disease were more common around the time of thunderstorms, especially the day before a storm. Interestingly, there were no differences between the different types of obstructive pulmonary disease. Compared to the usual number of emergency rooms, people with asthma had a 1.1% increase, while patients with COPD and combined COPD and asthma the day before the storm had a 1.2% increase. The researchers calculated that for every million Medicare beneficiaries in the three days before and after the storm, there were between 22 and 34 additional emergency rooms for patients with obstructive pulmonary disease. This resulted in an additional 52,000 emergency rooms.

Why can symptoms get worse in stormy weather?

The authors looked for possible reasons why symptoms worsened in stormy weather. They found that higher levels of particulate matter before storms correlated with increased visits to the emergency room. Pollen and other air pollutant levels did not change until after the storms ended, so it was less likely that these factors were responsible for increased respiratory symptoms.

These findings differ from other reports examining the effects of storms on asthma and COPD. It found that the effects of wind and rain on pollen can exacerbate symptoms in patients whose lung disease is affected by allergies (mostly asthmatics). Still other studies have identified changes in sulfur dioxide as a significant factor in increased COPD symptoms during storms. At this point, it remains unclear which of these possible factors has the greatest influence on increased respiratory problems.

This makes it very difficult to know how, or even when, patients might avoid problems with their lung disease during storms. Given that the authors have found increases in all patient populations with obstructive pulmonary disease, it is reasonable for people with COPD, asthma, or COPD and asthma to be aware that their symptoms can flare up during storms.

The study methods had advantages and disadvantages

Using the large Medicare database enabled these researchers to identify small but potentially clinically important effects that would be overlooked in smaller patient populations. The Medicare database also made it possible to access real patient data.

However, this study had important limitations. The patients were all over 65 years of age and may not be representative of most asthma patients, who are typically much younger. Using diagnoses identified by hospital bills did not allow researchers to study a uniform group of patients with a narrowly defined diagnosis. Very different patients in the same diagnostic group would make it more difficult to clearly correlate certain factors with increased symptoms. In addition, this study did not investigate whether patients with non-obstructive pulmonary diseases such as idiopathic pulmonary fibrosis and hypersensitivity pneumonitis were similarly affected by storms.

Climate change may indicate more flare-ups in people with asthma and COPD

One of the effects of climate change is an increase in the number and severity of storms. As the climate changes, patients with lung disease are likely to have more and more severe symptoms that require a visit to the emergency room. This would both increase the burden of disease in these patients and increase the burden on our health system.