Impact of Landscape Fire Smoke Exposure on Patients With Asthma With or Without Laryngeal Hypersensitivity

Anne E Vertigan; Erin S Harvey; Tesfalidet Beyene; Joseph Van Buskirk; Elizabeth G Holliday; Sarah L Bone; Vanessa M McDonald; Jay C Horvat; Vanessa E Murphy; Megan E Jensen; Geoffrey G Morgan; Graeme R Zosky; Matthew Peters; Claude S Farah; Christine R Jenkins; Constance H Katelaris; John Harrington; David Langton; Philip Bardin; Gregory P Katsoulotos; John W Upham; Jimmy Chien; Jeffrey J Bowden; Janet Rimmer; Rose Bell; Peter G Gibson

doi:10.1016/j.jaip.2023.06.015

Impact of Landscape Fire Smoke Exposure on Patients With Asthma With or Without Laryngeal Hypersensitivity

J Allergy Clin Immunol Pract. 2023 Oct;11(10):3107-3115.e2. doi: 10.1016/j.jaip.2023.06.015. Epub 2023 Jun 15.

Authors

Anne E Vertigan¹, Erin S Harvey², Tesfalidet Beyene³, Joseph Van Buskirk⁴, Elizabeth G Holliday⁵, Sarah L Bone⁶, Vanessa M McDonald⁷, Jay C Horvat⁸, Vanessa E Murphy³, Megan E Jensen³, Geoffrey G Morgan⁴, Graeme R Zosky⁹, Matthew Peters¹⁰, Claude S Farah¹¹, Christine R Jenkins¹², Constance H Katelaris¹³, John Harrington¹⁴, David Langton¹⁵, Philip Bardin¹⁶, Gregory P Katsoulotos¹⁷, John W Upham¹⁸, Jimmy Chien¹⁹, Jeffrey J Bowden²⁰, Janet Rimmer²¹, Rose Bell²², Peter G Gibson²

Affiliations

¹ School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia. Electronic address: anne.vertigan@health.nsw.gov.au.
² School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
³ School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
⁴ Sydney School of Public Health and University Centre for Rural Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
⁶ Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia.
⁷ Asthma and Breathing Research Centre, Hunter Medical Research Institute, Newcastle, New South Wales, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia.
⁸ School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.
⁹ Tasmanian School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
¹⁰ Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia.
¹¹ Concord Clinical School, University of Sydney, Concord, New South Wales, Australia.
¹² Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia; Concord Clinical School, University of Sydney, Concord, New South Wales, Australia.
¹³ School of Medicine, Western Sydney University, and Campbelltown Hospital, Campbelltown, New South Wales, Australia.
¹⁴ Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
¹⁵ Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Melbourne, Victoria, Australia; Department of Thoracic Medicine, Frankston Hospital, Frankston, Melbourne, Victoria, Australia.
¹⁶ Lung and Sleep Medicine, Monash University and Medical Centre, Clayton, Melbourne, Victoria, Australia.
¹⁷ St George Specialist Centre, Kogarah, Southern Sydney, New South Wales, Australia; St George and Sutherland Clinical School, University of New South Wales, Kogarah, Southern Sydney, New South Wales, Australia; Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia.
¹⁸ Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, Queensland, Australia; University of Queensland Frazer Institute, Woolloongabba, Brisbane, Queensland, Australia.
¹⁹ Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; School of Medicine, University of Sydney, Sydney, New South Wales, Australia.
²⁰ Respiratory and Sleep Services, Flinders Medical Centre and Flinders University, Bedford Park, Adelaide, South Australia.
²¹ Woolcock Institute of Medical Research, Glebe, Sydney, New South Wales, Australia; St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia.
²² Asthma Australia, Melbourne, New South Wales, Australia.

PMID: 37329954
DOI: 10.1016/j.jaip.2023.06.015

Abstract

Background: Individuals with asthma experienced severe and prolonged symptoms after the Australian 2019 to 2020 landscape fire. Many of these symptoms, such as throat irritation, occur in the upper airway. This suggests that laryngeal hypersensitivity contributes to persistent symptoms after smoke exposure.

Objective: This study examined the relationship between laryngeal hypersensitivity and symptoms, asthma control, and health impacts on individuals exposed to landscape fire smoke.

Method: The study was a cross-sectional survey of 240 participants in asthma registries who were exposed to smoke during the 2019 to 2020 Australian fire. The survey, completed between March and May 2020, included questions about symptoms, asthma control, and health care use, as well as the Laryngeal Hypersensitivity Questionnaire. Daily concentration levels of particulate matter less than or equal to 2.5 μm in diameter were measured over the 152-day study period.

Results: The 49 participants with laryngeal hypersensitivity (20%) had significantly more asthma symptoms (96% vs 79%; P = .003), cough (78% vs 22%; P < .001), and throat irritation (71% vs 38%; P < .001) during the fire period compared with those without laryngeal hypersensitivity. Participants with laryngeal hypersensitivity had greater health care use (P ≤ .02), more time off work (P = .004), and a reduced capacity to participate in usual activities (P < .001) during the fire period, as well as poorer asthma control during the follow-up (P = .001).

Conclusions: Laryngeal hypersensitivity is associated with persistent symptoms, reports of lower asthma control, and increased health care use in adults with asthma who were exposed to landscape fire smoke. Management of laryngeal hypersensitivity before, during, or immediately after landscape fire smoke exposure might reduce the symptom burden and health impact.

Keywords: Asthma; Chronic cough; Inducible laryngeal obstruction; Landscape fire; Laryngeal hypersensitivity; Severe asthma; Vocal cord dysfunction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Asthma* / epidemiology
Australia / epidemiology
Cross-Sectional Studies
Humans
Hypersensitivity*
Larynx*
Respiration Disorders*