Louisville Medicine Volume 66, Issue 2 | Page 25

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