FEATURE
THUNDERSTORM Asthma
Natalie Miller, MD
I
was on my rotation in the pediatric ER as
an intern at St. Louis Children’s Hospital/
Washington University in St. Louis. It had
been a beautiful May day in St. Louis, and
the city parks were full of children and
adults enjoying the weather. Much like Lou-
isville, St. Louis weather can be unpredictable,
and a thunderstorm had rolled through that
evening. My night shift started uneventfully, but soon we were in-
undated with patients. However, unlike most nights with a myriad
of diseases and injuries to treat, the vast majority of patients were
suffering from asthma exacerbations, some for the very first time.
After the tenth continuous albuterol nebulizer treatment was start-
ed, my attending said, “Thunderstorms bring in the asthmatics in
droves.” This surprised me and during a quiet period later that night,
I read about “thunderstorm asthma.” This night started my path to
the Allergy/Immunology specialty, and my love for all things allergy.
The CDC estimates that almost 26 million people in the United
States (including 7.1 million children) have been diagnosed with
asthma 1 . The Behavioral Risk Factor Surveillance Survey estimates
370,000 Kentucky adults and 106,400 children have asthma. Prev-
alence among adults has increased from 13.3 percent in 2005 to 15
percent in 2012. In children, that percentage has increased from 9.3
percent in 2006 to 10.2 percent in 2012 (1). The Allergy and Asthma
Foundation of America (AAFA) recently ranked Louisville as the
fifth most challenging place to live with asthma. This rating compares
asthma outcomes, including asthma prevalence, asthma-related
emergency department visits and asthma-related mortality. AAFA
also notes that Louisville has the highest prevalence of asthma in the
county (2). In 2012, Kentucky reported over 5,000 hospitalizations
with asthma as the primary diagnosis. Asthma was the third most
common cause of hospitalization in patients under the age of 18,
with the highest hospitalization rate for those under five years of age.
The AIR Louisville (airlouisville.com) project was a collaborative
partnership of various entities in Louisville, the Louisville Metro
government and a nonprofit institute and a technology company.
The thought was that by tracking asthma episodes in patients with
the use of electronic sensors to report wher e and how often they
were using their medication, we could better direct public policy
in designing programs to reduce pollution. In addition, the “digital
health platform” provided patients with feedback that reduced their
use of rescue inhalers, over 12 months by 82 percent and increased
by half their symptom-free days. Additionally, the authors felt that
this model could be replicated for other communities to reduce
asthma morbidity and pollution. (3, 6)
It should come as no surprise that this study’s greatest con-
centration of asthma patients lived in the West End, especially its
southern part, with a wedge going out past the airport and another
long wedge lining the river southwards towards Rubbertown. (4)
(continued on page 24)
JULY 2018
23