The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission
The 2016 Melbourne thunderstorm asthma epidemic: Risk factors for severe attacks requiring hospital admission
复制标题
2016年墨尔本雷暴哮喘流行：需要住院治疗的严重发作的风险因素
DOI：
10.1111/all.13609
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发表时间：
2019-01-01
期刊：
影响因子：
12.4
通讯作者：
Thien, Francis
中科院分区：
文献类型：
--
作者：
Hew, Mark;Lee, Joy;Thien, Francis
2016年11月21日，世界上最具灾难性和致命性的雷暴哮喘疫情袭击了澳大利亚墨尔本。目的探讨雷暴致急症患者入院的危险因素。方法从墨尔本8家主要卫生服务机构的急诊记录中确定雷暴患者，并进行电话访谈。分析住院的危险因素。结果共访问了1435/2248例（64%）雷暴患者，其中164例（11.4%）需要住院治疗。总的来说，87%的人患有鼻炎，28%的人患有哮喘。住院的几率随着年龄的增加而增加（优势比1.010,95% CI 1.002, 1.019），并且在患有哮喘的个体中（校正优势比[aOR] 1.87, 95% CI 1.26, 2.78）。在过去12个月内因哮喘住院进一步增加了住院的几率（aOR 3.16, 95% CI 1.63, 6.12）。在亚裔患者中，住院的几率低于非亚裔患者（aOR 0.59, 95% CI 0.38, 0.94），但在澳大利亚出生的患者住院的几率更高（OR = 5.42, 95% CI 1.56, 18.83）。结论在到急诊室就诊的流行性雷暴哮喘患者中，已知哮喘患者的住院率因近期哮喘入院而进一步放大，突出了疾病控制不佳所带来的易感性。与非亚洲患者相比，在海外出生的亚洲患者入院的几率较低，但在本地出生的亚洲患者入院的几率较高；这些观察结果表明，对严重雷暴哮喘的易感性可能因基因与环境的相互作用而增强。
BackgroundThe world's most catastrophic and deadly thunderstorm asthma epidemic struck Melbourne, Australia, on November 21, 2016.ObjectiveAmong thunderstorm-affected patients presenting to emergency rooms (ERs), we investigated risk factors predicting severe attacks requiring admission to hospital.MethodsThunderstorm-affected patients were identified from ER records at the eight major Melbourne health services and interviewed by telephone. Risk factors for hospital admission were analyzed.ResultsWe interviewed 1435/2248 (64%) of thunderstorm-affected patients, of whom 164 (11.4%) required hospital admission. Overall, rhinitis was present in 87%, and current asthma was present in 28%. Odds for hospital admission were higher with increasing age (odds ratio 1.010, 95% CI 1.002, 1.019) and among individuals with current asthma (adjusted odds ratio [aOR] 1.87, 95% CI 1.26, 2.78). Prior hospitalization for asthma in the previous 12 months further increased the odds for hospital admission (aOR 3.16, 95% CI 1.63, 6.12). Among patients of Asian ethnicity, the odds for hospital admission were lower than for non-Asian patients (aOR 0.59, 95% CI 0.38, 0.94), but higher if born in Australia (OR = 5.42, 95% CI 1.56, 18.83).ConclusionsIn epidemic thunderstorm asthma patients who presented to the ER, higher odds for hospital admission among patients with known asthma were further amplified by recent asthma admission, highlighting the vulnerability conferred by suboptimal disease control. Odds for hospital admission were lower in Asian patients born overseas, but higher in Asian patients born locally, than in non-Asian patients; these observations suggest susceptibility to severe thunderstorm asthma may be enhanced by gene-environment interactions.