Thunderstorm asthma outbreak of November 2016: a natural disaster requiring planning

Steven J Lindstrom, Jeremy D Silver, Michael F Sutherland, Andrew BA Treloar, Ed Newbigin, Christine F McDonald and Jo A Douglass
Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00285
Published online: 18 September 2017

Learning from a tragedy to increase public awareness and improve responses in future thunderstorm asthma events

Thunderstorm asthma is the occurrence of acute asthma either during or immediately after a thunderstorm and it is often characterised by a surge in emergency asthma presentations. The epidemic of thunderstorm asthma in Melbourne, Australia, on 21 November 2016 was the most extreme such event ever worldwide, with nine fatalities currently the subject of a coronial inquiry.1,2 Hospitals and ambulance services were placed under record pressure, and supplies of reliever medications were exhausted at some health services.1 Key tasks for the future are to predict the thunderstorms most likely to lead to asthma outbreaks and to define how best to respond. Further research to better anticipate these outbreaks is crucial and planning for the inevitable recurrence must occur at patient, institutional and state-wide levels.

  • 1 Austin Health, Melbourne, VIC
  • 2 University of Melbourne, Melbourne, VIC
  • 3 NSW Regional Office, Australian Bureau of Meteorology, Sydney, NSW
  • 4 Royal Melbourne Hospital, Melbourne, VIC


We thank Edwin Lampugnani (University of Melbourne) for kindly supplying the image in . Jeremy Silver's work was funded by the MacKenzie Postdoctoral Fellowship scheme at the University of Melbourne.

Competing interests:

In the past 5 years, Jo Douglass has received honoraria for educational presentations from AstraZeneca, GlaxoSmithKline, Stallergenes Greer, Novartis, Alphapharm, Shire, Mundipharma and Seqirus; has sat on advisory boards for Novartis, GlaxoSmithKline, Astra-Zeneca, Pieris, Stallergenes Greer and Seqirus; and has undertaken contracted and investigator-initiated research for GlaxoSmithKline, Novartis, AstraZeneca and Sanofi-Aventis. Jeremy Silver and Ed Newbigin are investigators on the National Medical and Health Research Council PBH grant 1116107, which partners with Stallergenes Greer. Christine McDonald has received honoraria for education presentations or advisory board participation from GlaxoSmithKline, Novartis and Pfizer.

  • 1. Inspector-General for Emergency Management. Review of response to the thunderstorm asthma event of 21–22 November 2016: final report. Melbourne: State of Victoria; 2017. (accessed June 2017).
  • 2. Victorian Department of Health and Human Services. The November 2016 Victorian epidemic thunderstorm asthma event: an assessment of the health impacts. The Chief Health Officer’s report, 27 April 2017. Melbourne: State of Victoria, 2017. (accessed June 2017).
  • 3. Queensland University of Technology. Final report: literature review on thunderstorm asthma and its implications for public health advice. (accessed June 2017).
  • 4. Marks GB, Colquhoun JR, Girgis ST, et al. Thunderstorm outflows preceding epidemics of asthma during spring and summer. Thorax 2001; 56: 468-471.
  • 5. Girgis ST, Marks GB, Downs SH, et al. Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk? Eur Respir J 2000; 16: 3-8.
  • 6. Adams RJ, Fuhlbrigge AL, Finkelstein JA, Weiss ST. Intranasal steroids and the risk of emergency department visits for asthma. J Allergy Clin Immunol 2002; 109: 636-642.
  • 7. Erbas B, Akram M, Dharmage SC, et al. The role of seasonal grass pollen on childhood asthma emergency department presentations. Clin Exp Allergy 2012; 42: 799-805.
  • 8. Egan P. Weather or not. Med J Aust 1985; 142: 330-330.
  • 9. Bellomo R, Gigliotti P, Treloar A, et al. Two consecutive thunderstorm associated epidemics of asthma in the city of Melbourne. The possible role of rye grass pollen. Med J Aust 1992; 156: 834-837.
  • 10. Howden ML, McDonald CF, Sutherland MF. Thunderstorm asthma — a timely reminder. Med J Aust 2011; 195: 512-513. <MJA full text>
  • 11. Eifan AO, Durham SR. Pathogenesis of rhinitis. Clin Exp Allergy 2016; 46: 1139-1151.
  • 12. Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines — 2016 revision. J Allergy Clin Immunol 2017; doi: 10.1016/j.jaci.2017.03.050 [Epub ahead of print].
  • 13. Peat JK, Tovey E, Mellis CM, et al. Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clin Exp Allergy 1993; 23: 812-820.
  • 14. Pulimood TB, Corden JM, Bryden C, et al. Epidemic asthma and the role of the fungal mold Alternaria alternata. J Allergy Clin Immunol 2007; 120: 610-617.
  • 15. Suissa S, Ernst P, Benayoun S, et al. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000: 343: 332-336.
  • 16. National Asthma Council Australia [website]. Australian asthma handbook; version 1.2. Melbourne: National Asthma Council Australia, 2016. (accessed Mar 2017).
  • 17. Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev 2010; 8: CD001186.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.