BACKGROUND There have been 26 epidemic thunderstorm asthma (ETSA) events worldwide, with Melbourne at the epicentre of ETSA with 7 recorded events, and in 2016 experienced the deadliest ETSA event ever recorded. Health services and emergency departments were overwhelmed with thousands requiring medical care for acute asthma and 10 people died. OBJECTIVES This multidisciplinary study was conducted across various health and science departments with the aim of improving our collective understanding of the mechanism behind ETSA. DESIGN This study involved time-resolved analysis of atmospheric sampling of the air for pollen and fungal spores, and intact and ruptured pollen compared with different weather parameters, pollution levels and clinical asthma presentations. METHODS Time-resolved pollen and fungal spore data collected by Deakin AirWATCH Burwood, underwent 3-h analysis, to better reflect the 'before', 'during' and 'after' ETSA time points, on the days leading up to and following the Melbourne 2016 event. Linear correlations were conducted with atmospheric pollution data provided by the Environment Protection Authority (EPA) of Victoria, weather data sourced from Bureau of Meteorology (BOM) and clinical asthma presentation data from the Victorian Agency for Health Information (VAHI) of Department of Health. RESULTS Counts of ruptured grass pollen grains increased 250% when the thunderstorm outflow reached Burwood. Increased PM10, high relative humidity, decreased temperature and low ozone concentrations observed in the storm outflow were correlated with increased levels of ruptured grass pollen. In particular, high ozone levels observed 6 h prior to this ETSA event may be a critical early indicator of impending ETSA event, since high ozone levels have been linked to increasing pollen allergen content and reducing pollen integrity, which may in turn contribute to enhanced pollen rupture. CONCLUSION The findings presented in this article highlight the importance of including ruptured pollen and time-resolved analysis to forecast ETSA events and thus save lives.

中文翻译：

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完美风暴：墨尔本全球最致命的流行性雷暴哮喘 (ETSA) 事件期间的空气时间分析。

背景 全球已发生 26 起流行性雷暴哮喘 (ETSA) 事件，其中墨尔本是 ETSA 的震中，有 7 起有记录的事件，2016 年经历了有记录以来最致命的 ETSA 事件。数千人因急性哮喘需要医疗护理，卫生服务和急诊部门不堪重负，造成 10 人死亡。目标 这项多学科研究是在各个健康和科学部门进行的，旨在提高我们对 ETSA 背后机制的集体理解。设计本研究涉及对空气中花粉和真菌孢子的大气采样以及完整和破裂花粉与不同天气参数、污染水平和临床哮喘表现进行比较的时间分辨分析。方法 Deakin AirWATCH Burwood 收集的时间分辨花粉和真菌孢子数据经过 3 小时分析，以更好地反映墨尔本事件前后几天的 ETSA 时间点“之前”、“期间”和“之后” 2016年活动。与维多利亚州环境保护局（EPA）提供的大气污染数据、气象局（BOM）提供的天气数据以及卫生部维多利亚健康信息局（VAHI）提供的临床哮喘报告数据进行线性相关。结果 当雷暴雨到达伯伍德时，破裂的草花粉粒数量增加了 250%。在风暴流出中观察到的 PM10 增加、相对湿度高、温度降低和臭氧浓度低与破裂草花粉水平增加相关。特别是，在此 ETSA 事件之前 6 小时观察到的高臭氧水平可能是即将发生 ETSA 事件的关键早期指标，因为高臭氧水平与花粉过敏原含量增加和花粉完整性降低有关，这反过来又可能导致花粉增多破裂。结论 本文提出的研究结果强调了将破裂花粉和时间分辨分析纳入预测 ETSA 事件从而拯救生命的重要性。