Could Night Shifts Raise Asthma Risk?


TUESDAY, Nov. 17, 2020 (HealthDay News)

Night-shift workers are about one-third more likely to develop moderate to severe asthma compared to folks working daylight hours, a new study finds.

Researchers in Britain explained that working a night shift can play havoc with the body’s internal clock, and has been tied to an increased risk for various metabolic disorders, cardiovascular disease and cancer. So, in the new study, they collected data on nearly 287,000 people listed in the U.K. Biobank between 2007 and 2010.

Compared with people who worked regular office hours, shift workers were more likely to be men, smokers, and live in urban areas and poorer neighborhoods. They also drank less alcohol, slept fewer hours and worked longer hours.

About 5% of all the participants had asthma and nearly 2% had symptoms that were moderate to severe, said researchers led by Dr. Hannah Durrington of the University of Manchester, in England.

After accounting for age, sex and a range of other risk factors, night-shift workers had a 36% rise in the odds of having moderate to severe asthma, compared with those working normal office hours, the researchers found.

Also, the odds of “wheeze” or airway whistling were 11% to 18% higher among night-shift workers, and the odds of poorer lung function were about 20% higher in people working permanent night shifts.

Durrington’s group stressed that the study can’t establish cause and effect, and only points to an association.

“However, it is plausible that circadian misalignment leads to asthma development,” the authors theorized. “The public health implications of our findings are potentially far-reaching, since both shift work and asthma are common in the industrialized world.”

The report was published online Nov. 16 in the journal Thorax.

About one in five people in the developed world work either permanent or rotating night shifts, most often in service industries or factories, the study authors noted in a journal news release.

Dr. Len Horovitz is a pulmonary specialist at Lenox Hill Hospital in New York City. He wasn’t involved in the study, but said its findings were “confounded by the fact that there were many smokers in this group,” and smoking can greatly raise the risk for asthma.

 

More information

For more on asthma, head to the U.S. National Heart, Lung, and Blood Institute.

SOURCE: BMJ, news release, Nov. 16, 2020

Steven Reinberg

MedicalNews
Copyright © 2020 HealthDay. All rights reserved.





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Record grass pollen in Canberra to blame for hay fever, thunderstorm asthma warnings


Coronavirus has brought months of lockdowns, isolation and staying at home, but for some, the need to shut up the house and isolate due to an invisible health threat isn’t new.

Thunderstorm asthma warnings issued for the ACT yesterday and today have seen many take extra precautions and stay inside.

For Eloise Robertson, who suffers from asthma triggered by pollen, it’s not the first time she’s had to bunker down in her house, and it probably won’t be the last.

“My whole world basically stops,” she said.

“When there’s thunderstorm warnings I will just stay in the house, pretty much stay in my bedroom.

Once, Eloise could manage her allergy symptoms to avoid triggering an asthma flare-up. But after this year’s horror hay fever season in the ACT, her doctor has had to prescribe her a stronger medication.

And she’s not alone.

ACT Pharmacy Guild president Simon Blacker said he had seen a lot more Canberrans with prescriptions for hay fever relief this year.

“Given the seriousness of their symptoms this year, they are looking for the best treatment they can get,” he said.

ANU points finger at grass pollen

Spring in Canberra has brought the highest rates of pollen recorded by the Australian National University’s pollen monitoring program in over five years.

Experts say Canberra is recording high levels of grass pollen.(ABC News: Greg Nelson)

Professor Simon Haberle, from the ANU’s pollen monitoring program, said a wetter than average spring was prolonging the problem.

Imported oaks, birches and other introduced trees in older suburbs that produce large pollen loads wear a lot of the blame for the city’s particularly bad hay fever seasons.

But Mr Haberle said Canberra’s hay fever seasons were made worse because of the region’s grass types, which many people are allergic to.

“We have quite a lot of grass, particularly to the north-west and north and east of us, and people are quite allergic to those different grass types, particularly rye grass, which is the strongest allergy grass we’ve got in our region.”

And while peaks of pollen loads in September were due to introduced trees, Paterson’s Curse and grasses are more likely to be the pollen culprits at this time of year.

High levels of pollen are expected for the rest of the week.



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Storm activity, high pollen levels spark fears of thunderstorm asthma in Victoria


The Bureau of Meteorology says there is a “high risk” of thunderstorm asthma across parts of Victoria today, where a combination of high pollen levels, gusty winds, rain and thunderstorms are forecast.

The areas most at risk are in western Victoria. They include the Mallee, Wimmera, Northern Country and South West forecast districts.

The risk is moderate in the Central area, which includes Melbourne, and in the North Central, West and South Gippsland weather districts.

Bureau of Meteorology (BOM) forecaster Richard Russell said anyone with hay fever could attest pollen levels were currently very high.

They usually peak for a six-week period beginning in November.

Mr Russell said the current high pollen levels, combined with potential thunderstorm activity in the west of the state, later moving east into central areas, could create a “low-end” severe weather event.

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The worst thunderstorm asthma event occurred in Melbourne in 2016, when more than 3,500 people presented at hospital emergency departments with symptoms of asthma.

Ten people died and the majority of those affected were young people.

In another event earlier this month, emergency departments in southern New South Wales saw a surge in cases, with more than a dozen people seen at emergency departments in the Riverina.

Not every storm triggers asthma

A severe thunderstorm warning is in place for north-western parts of Victoria as a slow-moving pressure trough crosses the state.

With that there could be damaging winds and heavy rainfall, the BOM warns.

A severe weather warning for damaging winds is also in place for elevated parts of the Central district into Gippsland and the North East forecast districts.

“The trough that is driving this is slowly moving eastwards and will reach central parts of the state in the late afternoon, including Melbourne in the early evening,” Mr Russell said.

“The biggest risk in Melbourne will be early this evening, but it’s an outside chance from afternoon through to early hours of the morning.”

Mr Russell said not every storm on a high-pollen day triggered thunderstorm asthma because every storm was different.

“The behaviour and interaction between an area of high pollen, the way it reacts with the gustiness of thunderstorms, you need to concentrate that pollen into the outflow from the thunderstorm,” he said.

“The concern with thunderstorm asthma is you really need the right combination of high or extreme pollen levels across a broad area of the state and also gusty thunderstorms — or any really good mechanism to concentrate that pollen into a small area at any one time — so that you really are exposed to a really high dose of the pollens, as thunderstorms typically do.”



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Nathan Reynolds inquest hears prison nurse didn’t hear inmates tell her he was having an asthma attack


A nurse has been grilled over her decision to administer a drug commonly used to treat an overdose to an inmate who died from an asthma attack in a Sydney jail.

A coronial inquiry is investigating the death in custody of Indigenous man Nathan Reynolds at the John Moroney Correctional Complex in September 2018.

He died after having a “severe” asthma attack, just a week before his family expected him to be released from custody.

Warning: This story contains an image of an Indigenous person who has died.

Earlier this week, inmates claimed a nurse “slapped” and “shook” Mr Reynolds when she arrived at the scene.

Inmate Jeremy Preo said he had Mr Reynolds on his side and breathing, but was asked to move away.

“I was very distressed and distraught, because I know that when she came in, he was still alive,” Mr Preo said.

In her evidence, nurse Kasey Wright denied ever slapping Mr Reynolds, but said she did firmly shake him on the shoulder, to try and rouse him.

“I wanted him to respond to me,” Ms Wright said.

A nurse admitted firmly shaking Mr Reynolds on the shoulder to rouse him.(Supplied: Makayla Reynolds)

She said her actions had been part of her initial assessment of the 39-year-old, and that she couldn’t find a pulse, a heartbeat, and didn’t hear him breathing.

Ms Wright also defended her decision to administer Mr Reynolds with the overdose drug, Naloxone.

Counsel for the Reynolds family, Joshua Brock asked Ms Wright: “You could understand the perception … that the administration of Naloxone might reflect a prejudice … that the inmate has used drugs.”

Ms Wright rejected that, saying it was “best practice” to use the treatment when someone presented like Mr Reynolds.

“You’re not causing any harm … I would do that as best practice,” she said.

“If he had taken anything, hopefully it would have helped, and hopefully his heart would have started beating, and hopefully he would have started breathing,” she said.

Ms Wright said she did not hear inmates telling her it was an asthma attack.

She also said a defibrillator was missing from the “crash cart” she had scooped up from the jail’s health clinic, because it was kept elsewhere during the night shift.

When asked why an ambulance wasn’t called sooner, she said the prison officer who called her had “no urgency in his voice”.

“They should have called an ambulance straight away,” she said.

‘You don’t run in an emergency’

The inquiry earlier heard from a range of corrections officers — many of them unable to recall important details of the night.

John Phali, an officer of 34 years, gave conflicting accounts about when an ambulance was called, and who made the triple-0 call.

Mr Phali was also shown prison CCTV footage, which revealed him escorting Ms Wright to where Mr Reynolds was “unresponsive” on the floor.

When asked about his casual pace, he explained: “I said we need to hurry, but she [Ms Wright] said: ‘We don’t run’.”

Ms Wright also told the coroner: “You don’t run in an emergency.”

The inquest was played a recording of the triple-0 call made from the jail.

It was dialled by a separate officer, Sham Dhanju, who was manning the front gate.

“Is he conscious?” the operator asked, to which Mr Dhanju replied: “No.”

The inquiry heard that about a minute later, Mr Reynolds had stopped breathing, but no condition update was relayed to Mr Dhanju from fellow officers.

Ambulance NSW also sought more information about Mr Reynolds’s condition by attempting to call Mr Dhanju back on phone numbers he provided.

The inquest heard one attempt went through to a fax machine, and the other, to voicemail.

During his evidence, another officer, John Fifita, was asked if he would do anything differently.

“I wish I was not there. Take a sickie,” he replied.



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Thunderstorm asthma strikes early in Riverina, emergency department on alert


Emergency departments in southern New South Wales are preparing for an increase in people needing treatment for thunderstorm asthma, with dangerous conditions expected over the weekend.

Murrumbidgee Local Health District (MLHD) saw a surge in cases last weekend, with more than a dozen presentations of thunderstorm asthma at emergency departments across the Riverina.

Thunderstorm asthma can be deadly, with nine people dying after an event in Melbourne in 2016.

MLHD respiratory clinical nurse consultant Robyn Paton said another thunderstorm asthma alert had been issued for Friday, Saturday and Sunday.

“It’s the sort of asthma that comes on very quickly,” she said.

“We’ve got lots of pollens in the air at the moment because we’re having a really good season and lots of intermittent rain.

Ms Paton said last weekend’s thunderstorm asthma alert came a week earlier than normal. And with increased rain, she expected the danger period would go beyond the usual four-week period.

She said their predicted timeline for the most dangerous period in the Riverina was usually the two weeks before and after the Melbourne Cup on the first Tuesday of November.

“Sometimes we need to extend [the timeline] if the pollen in the air is still ripening and we’re still getting thunderstorms in late spring,” Ms Paton said.

Ms Paton said thunderstorm asthma could affect people who hadn’t had asthma before, and it was common among those people with hayfever who often breathed through their mouths.

She encouraged Riverina residents with asthma to stay indoors this weekend, carry an asthma puffer and wear a mask when going outside.

“If your medication doesn’t hold you, please don’t hesitate to call an ambulance or get someone to drive you to the emergency department,” Ms Paton said.

“I think what’s happened since COVID, people are a little loath to come to the emergency department or even to go to their GPs because they’re concerned about the COVID presentations.”

Asthma sufferers already on alert

Asthma sufferer Craig Giles has started exercising indoors to avoid getting sick.(Supplied: Craig Giles)

Temora resident Craig Giles, who suffers from asthma and hayfever, said he had started exercising inside.

Mr Giles said he would increase his medication and exercise over the coming months to manage the increased risk.

“This last month the weather has been really unpredictable,” he said.

“Normally we don’t start this sort of business until early November, but it started four to six weeks ago and the season is ahead of itself for sure.”



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Nathan Reynolds died from an asthma attack in prison but nurse treated him for overdose, coronial inquest hears


A nurse assumed a prison inmate dying from a severe asthma attack had overdosed on drugs, a coronial inquest has heard.

Nathan Reynolds died in John Moroney Correctional Centre in September 2018 just a week before he was expected to be released.

The 39-year-old Indigenous man had notified staff he urgently needed help, but was pronounced dead just over an hour later.

Warning: This story contains an image of an Indigenous person who has died.

An inquest into his death today heard emotional evidence from an inmate who tried to save Mr Reynolds.

Jeremy Preo, who gave evidence via video link from jail, told Deputy Coroner Elizabeth Ryan when he came to see what was going on in his wing Mr Reynolds was sitting up, breathing, and using an asthma puffer on a couch.

But as Mr Reynolds was being moved to a wheelchair, he went stiff and took in three sharp breaths.

“That’s when Nathan more or less took his last breaths,” Preo said, as he broke down in tears.

“One of the other inmates beside me said he was blue in the face.”

Nathan Reynolds died in custody from an asthma attack in 2018.(Supplied: Makayla Reynolds)

Preo said he “intervened” by putting Mr Reynolds into a recovery position on his side and clearing his airways of fluid.

“I would say to him, ‘mate, take a breath for me’, and he would do that every time,” he said.

“He would take a deep breath in and one out.

“And that’s how I knew he was still alive at that point in time.”

The inmate said the incident took a turn for the worse when a “young nurse” arrived and rolled Mr Reynolds from his side, on to his back.

“The next thing I remember is her bent over the top of Nathan, slapping him, and shaking him and telling him to wake up,” he said.

Preo told the inquest the nurse then said Mr Reynolds was experiencing a drug overdose which prompted a corrections officer to ask the other inmates if he had taken any substances.

“How can you say that? … you’ve just watched him have an asthma attack,” Preo said he replied.

“I was very distressed and distraught, because I know that when she [the nurse] came in, he was still alive.

“I believe that she just thought he overdosed on drugs, because he was a criminal, he was in jail, he was a junkie.”

Nathan given opioid blocker by nurse

Lawyers for Mr Reynolds’s family said an autopsy found he was given a drug usually administered to people experiencing an opioid overdose.

“[The nurse] arrived and gave Nathan Naloxone — a drug given to patients to counteract the effects of an overdose,” Karly Warner from the Aboriginal Legal Service said.

A girl addresses the media outside the Coroners Court.
Nathan’s sister Makayla Reynolds says her brother died too young and she wants justice.(ABC News: Jonathan Hair)

To mark the start of the inquest, a Welcome to Country ceremony took place at the front of the NSW Coroners Court which included song and dance.

“Anyone that met him, he just lit up the room, he was a jokester … all the kids loved Nathan,” his sister Taleah Reynolds said.

“Nathan would take all the kids out, his nieces, and nephews, stuff like that, he had a heart of gold.

“He should be here,” she said.

Ms Reynolds said she wanted someone held accountable for the death.

The inquest is expected to examine a range of topics and hear from more inmates, nurses, corrections officers and a respiratory specialist.

Counsel Assisting Chris McGory said Mr Reynolds’s condition was “already severe and life threatening” when he called for help.

He also said that immediate specialist medical intervention was needed to save his life.

The inquest is expected to run until mid-next week.



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Telling someone with a mental illness that they rely too much on their medication is like telling someone with asthma they rely too much on their inhaler : mentalhealth


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Asthma patient told to leave Canberra Hospital during bushfires because of poor air quality


Inside the Canberra Hospital’s intensive care unit, asthma patient Ryan Harris could smell and see bushfire smoke as he struggled to breathe.

The father of two spent weeks in hospital during the summer bushfire season before going home on the advice of his specialist, because air quality inside the wards was so poor.

“Having the smoke coming out of the air vents and seeing the fire outside, it was a bit nerve-racking,” Mr Harris said.

He said now when his two young children see smoke or fire, they think he is going back to hospital.

“It’s a trauma for them,” he said.

Air conditioning won’t be replaced for next bushfire season

Air quality inside the hospital was about half as polluted as outdoors on the days measured — though still unhealthy.(Supplied: James Dyer)

Government documents have shown almost every part of the hospital recorded “unhealthy” levels of smoke during the worst of the bushfire haze.

And on the January 2, a worker inside an ACT Health facility was sent home after having an asthma attack on site.

Canberra Health Services maintains that the smoke inside the hospital, while uncomfortable, did not pose a health risk to staff or patients.

No patients were discharged by staff from the hospital due to air quality.

But while filters have been replaced since the bushfire season, ACT Health has indicated it has no plans to replace the hospital’s air conditioning system, which failed to filter out the smoke.

It has previously told the ABC it has a stock of portable air purifiers to deploy if necessary.

As this summer approaches, Mr Harris is worried others could find themselves in the same situation he did.

A young man looks forlornly out of his living room window.
Mr Harris said a better air quality monitoring and reporting system needs to be in place for future bushfires.(ABC News: Ian Cutmore)

He said being safer in his own home than his local hospital was disappointing, but it was not the only problem.

While his family have educated themselves on the risks and monitor emergency warnings, he said there needed to be better air quality monitoring to give people the best chance.

“We’re pretty savvy and up to date with all the apps and the air quality monitoring throughout the area, but unfortunately there’s not enough,” he said.

Inquiry recommends improved air monitoring system

Orange haze obscures Parliament House.
Just after New Year, the worst of the heavy haze descended on the national capital.(AAP: Lukas Coch)

The New South Wales bushfire inquiry recommended an air quality community education campaign be launched as soon as possible, along with better air quality monitoring and alerts.

Asthma Australia is pushing for something similar to the successful SunSmart campaign, called AirSmart.

It surveyed more than 12,000 Australians over the course of the Black Summer bushfire season and found current public health advice for avoiding risks of bushfire smoke “did not appear to help people with asthma minimise the impacts of unhealthy air”.

“We’re calling on governments this asthma week to support an AirSmart campaign to help people better understand the dangers of unhealthy air,” Asthma Australia chief executive Michele Goldman said.

Mr Harris said during the smoke haze, friends reached out to him on social media seeking advice when they felt affected by the smoke.

Apart from suggesting they go to their GP, he felt there was little he could do.

“There is definitely a need for an awareness campaign, especially for those that aren’t as savvy on the internet or on the apps,” he said.

ACT Health Minister Rachel Stephen-Smith said part of the problem was the language used to communicate air quality.

“One of the things that has been part of a national conversation is how we measure air quality in a way that people will understand, and then communicate to people how they should respond to that,” she said.

Ms Stephen-Smith said the Government was considering a simpler system with indicator levels, rather than the current one that gave a parts per million number to indicate pollution levels.

“That number doesn’t actually mean much because it is a cumulative impact over the last 24 hours,” she said.

“So how do we say to people ‘this is level one, level two, level three smoke, and this is how you should respond’.”



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