FEATURE
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Symptoms of asthma include a persistent or worsening cough,
shortness of breath, chest tightness and wheezing. Triggers are var-
ied and include allergen exposure, tobacco smoke or other irritants
(i.e. strong odor, air pollution), cold temperatures, sudden weather
changes, reflux, sleep disorders, infections and even stress. In my
practice, we see asthma flares year round, but more often during
peaks of pollen seasons and virus/influenza season. The lush beauty
of Kentucky brings us long pollen seasons. Tree pollen is typically
present in the air from Valentine’s Day through Mother’s Day. Grass
pollen starts appearing around Mother’s Day lasting until the July
4 th holiday. Weed pollen begins in August (when schools start)
and lasts until the first freeze, usually around Halloween. Sited in
a river valley, Louisville also has a high level of mold spores in the
air, which we find in our aeroallergen counts year round.
Thunderstorm-related asthma epidemics are interesting phe-
nomena.
These epidemics, defined as an increased number of ER visits
for asthma related to thunderstorms, are uncommon. However,
they have been documented in cities across the world. The worst
epidemic described was in Melbourne, Australia in 2016. Over 8,500
ER visits for asthma were documented (many in patients without
diagnosed asthma, and many patients with severe symptoms), and
nine deaths. For each of these described epidemics, thunderstorms
coincided with high pollen counts in the spring. During these
events, pollen grains are carried at ground level. Due to the wet
conditions, the pollen grains can rupture and release their contents
into the air. These contents include respirable components, which
can reach the lower airways. Patients who are sensitized to these
pollens are at a high risk of having an asthma attack, sometimes
for the very first time (5).
Treatment for asthma is multi-tiered, and includes avoidance
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LOUISVILLE MEDICINE
of triggers and medications. Trigger avoidance can be difficult, but
knowing your allergic sensitivities can help guide avoidance mea-
sures. For instance, dust mite proof encasements on mattresses and
pillows can limit exposure to dust mites, which is a common trigger
for asthma. High quality air filters can limit the amount of pollen
and other outdoor aeroallergens that enter the home. Allergen im-
munotherapy desensitizes the immune system to pollens and other
inhaled aeroallergens, which leads to a decrease in symptoms and
reliance on medications.
Short-acting beta-agonists (i.e. albuterol) are a mainstay for
quick-relief of symptoms. However, improvement is temporary.
When these medications are needed often for frequent symptoms,
prevention becomes imperative. Long-acting controller medica-
tions (such as inhaled corticosteroids, leukotriene antagonists, and
long-acting beta-agonists) can help prevent symptoms and reduce
the frequency and severity of exacerbations. There are also newer,
injectable monoclonal antibodies that treat moderate to severe asth-
ma at a humoral level. The promise of a biologic adjuvant treatment
regimen is an exciting proposition for providers and patients alike.
Asthma is a chronic, sometimes life-threatening disease that cre-
ates a significant burden for our patients in Kentucky. As allergists,
we are happy to serve as a resource for primary care physicians in
the diagnosis and treatment of asthma. Improved asthma control
can significantly improve a patient’s productivity, health and overall
quality of life.
Dr. Miller practices Allergy and Immunology with Family Allergy and
Asthma.
1. Kentucky Asthma Surveillance Report 2008-2012. Kentucky
Asthma Management Program
2. http://www.aafa.org/page/asthma-capitals.aspx Accessed
5/6/2018.
3. Barrett M, Combs V, Su JG, Henderson K, Tuffli M; AIR Lou-
isville Collaborative; AIR Louisville Collaborative. AIR Lou-
isville: Addressing Asthma With Technology, Crowdsourcing,
Cross-Sector Collaboration, And Policy. Health Aff (Millwood).
2018 Apr;37(4):525-534. PubMed PMID: 29608361.
4. Barrett MA, Humblet O, Marcus JE, Henderson K, Smith T, Eid N,
Sublett JW, Renda A, Nesbitt L, Van Sickle D, Stempel D, Sublett
JL. Effect of a mobile health, sensor-driven asthma management
platform on asthma control. Ann Allergy Asthma Immunol. 2017
Nov;119(5):415-421.e1. PubMed PMID: 29150069.
5. D’Amato, et al. Thunderstorm-related asthma attacks. Journal of
Allergy and Clinical Immunology. 2017; 139: 1786-7.
6. www.airlouisville.com