Thunderstorm asthma and the role of the hospital pharmacist

On the evening of 21 November 2016, after a wild and windy thunderstorm, the city of Melbourne was plunged into a ‘thunderstorm asthma’ epidemic, triggering asthma attacks on a scale not seen before in Victoria and tragically claiming nine lives.

A complete surprise to most Melburnians, the phenomena of thunderstorm asthma is believed to occur when a windy thunderstorm enables pollen grains to absorb moisture and burst into smaller fragments which enter the lungs. Many of the thunderstorm asthma sufferers had not been diagnosed with asthma previously or had not experienced an asthma attack in many years.

Beginning in late afternoon and reaching a peak in the evening, the thunderstorm asthma surge occurred after community pharmacies had closed making it difficult for people to obtain over-the-counter medicine and spacer devices. Many late night pharmacies were quickly emptied of stock so people were referred onto major hospitals. This resulted in an inundation of emergency departments (EDs) that suddenly received hundreds of respiratory patients, estimated at 4000 across Melbourne and Geelong. Demand for ambulances and calls to emergency services were also unprecedented.

Hospital EDs are well trained to deal with a sudden swell of patients, with strong procedures ensuring medical and nursing staff availability and timely treatment for the most unwell patients. However, the thunderstorm asthma event was unique resulting in the need for many patients to quickly access a specific medicine to avoid escalation. Easier access to stocks of asthma medicines and spacer devices would have enabled some hospitals to more efficiently manage and treat patients, preventing subsequent capacity issues.

Many large EDs now have specialist pharmacists as part of their team whilst others have on-call pharmacists available after hours. Pharmacists working in EDs during the event reported an extremely high demand for their services as they reviewed patients, took medication histories, counselled patients on medication and technique, coordinated discharges to free inpatient beds and contacted wholesalers to request emergency deliveries.

Overall, Melbourne’s hospitals responded well to the unexpected epidemic of asthma. However SHPA’s submission to the Inspector-General for Emergency Management flagged key lessons for future emergencies:

• Clear processes for obtaining asthma medicines in an emergency, both for obtaining stock from within pharmacy sites in hospital and from wholesalers, are imperative. One major teaching hospital waited five hours before additional life-saving stock was delivered.
• A greater utilisation of the hospital pharmacy workforce in the ED at times of medicine-focused emergencies might provide increased support for medical and nursing staff and prevent excessive waiting times for patients.
• An activation to direct hospital pharmacists to return to work at time of emergencies could be useful to enable efficient discharge of inpatients when beds are required urgently.
• Extended after-hours services provided by hospital pharmacies can greatly assist an effective hospital emergency response.

The lessons of this thunderstorm asthma event will be instrumental for the development of future plans for responding to public health emergencies. As healthcare professionals with core expertise in medicines and their use, hospital pharmacists are already playing important roles alongside clinicians and allied health practitioners in multidisciplinary teams. At times of public health emergency, hospital pharmacists represent an additional resource currently untapped for hospital management looking for innovative and responsive models of patient care.

*Kristin Michaels is the Chief Executive Officer of The Society of Hospital Pharmacists of Australia, with a keen interest and experience in health system design. She is a seasoned Board Director in primary, acute and aged-care sectors. Kristin holds qualifications in Arts, Organisational Leadership, Governance and Health Service Management. She is a Fellow of the Australian Institute of Company Directors and is accredited as an International Partnership Broker.

Image credit: ©iStockphoto.com/Allen Johnson