Thunderstorm-Associated Asthma in Shenzhen, China: A Retrospective Case-Control Study of Risk Factors, Clinical Characteristics, and Management Approaches

Objective: To identify risk factors, clinical characteristics, and management approaches associated with thunderstorm-associated asthma (TA) in Shenzhen, China, comparing it with general asthma (GA). Methods: A retrospective case-control study was conducted, including 42 patients with TA who presented with asthma exacerbations following thunderstorms and 361 patients with GA. Demographic variables and inflammatory biomarkers, including absolute eosinophil count (AEC), absolute neutrophil count, and C-reactive protein were evaluated. Logistic regression and receiver operating characteristic analyses were applied to determine discriminative factors. Results: Patients with TA were younger than those with GA (median 49 vs 57 years, p = 0.003) and demonstrated a higher prevalence of allergic rhinitis (73.8% vs 41.0%, p < 0.001). Eosinophil counts were significantly elevated among patients with TA (0.74× 10 9 /L vs 0.42× 10 9 /L, p < 0.001). An AEC ≥ 0.71× 10 9 /L effectively differentiated TA from GA (area under the curve [AUC] = 0.843). The combined model incorporating age, allergic rhinitis history, and AEC yielded improved diagnostic performance (AUC = 0.880). Hospitalization rates were lower in the TA group (16.7% vs 68.4%, p = 0.041), although all individuals received oxygen therapy. Conclusion: TA in Shenzhen affects younger atopic individuals with eosinophilic inflammation. AEC ≥ 0.71× 10 9 /L may aid screening during meteorological alerts, guiding acute management with oxygen, bronchodilators, and corticosteroids while avoiding unnecessary antibiotics. Keywords: absolute eosinophil count, allergic rhinitis, biomarker diagnosis, emergency management, eosinophilic inflammation, risk factors, retrospective case-control study, Shenzhen, thunderstorm asthma, united airway disease