Thunderstorm asthma in Melbourne: how to prepare

On the evening of 21 November 2016, a storm swept across Melbourne on a hot day with high grass pollen. Within hours, ambulance cases and emergency departments were overwhelmed. Victoria’s health department called it the world’s largest epidemic thunderstorm asthma event, and ten people died. Next month marks ten years since that night, and this year’s season has started early. On 1 October, Victoria’s Chief Health Officer said a warm, wet winter had brought an early start to pollen season, and the team behind the Melbourne Pollen count expects a more intense season than 2025.

Thunderstorm asthma can affect people who have never had an asthma attack. This guide covers who is at risk, what to do before and during storm days, and how your local pharmacy fits into your plan.

What thunderstorm asthma is

In Victoria, grass pollen season usually runs from 1 October to 31 December, with levels in Melbourne tending to peak from mid-October and fall away from late November. Rye grass is thought to be the main culprit.

When a particular type of storm arrives on a day with lots of grass pollen in the air, the pollen grains can burst into tiny particles. These gather in the strong wind gusts just before the rain and are small enough to be breathed deep into the lungs. That can trigger asthma symptoms quickly. When many people are affected at once, it is called epidemic thunderstorm asthma.

Who is at risk

According to the Victorian Department of Health and Asthma Australia, the people most at risk are those with:

current asthma, especially if it is not well controlled;
past asthma, even if you have not had symptoms for years;
undiagnosed asthma, such as wheezing or breathlessness you have never had checked;
spring hay fever, particularly if you are sensitive to grass pollen, with or without an asthma diagnosis.

Having both asthma and hay fever raises the risk further. If you sneeze your way through every spring and have ever had a wheeze, take this season seriously.

Preparing before storm season

The National Asthma Council Australia and Victoria’s health department recommend a few steps before peak pollen:

Book an asthma review with your GP. Check that you have a written asthma action plan and that it includes what to do on thunderstorm asthma days. Asthma guidelines have changed in recent years, with more emphasis on preventer and anti-inflammatory reliever treatment, so an older plan may need updating.
Take your preventer as prescribed. The aim is to have your asthma well controlled before the pollen peaks, not to start treatment on the day of a storm.
Treat your hay fever. A corticosteroid nasal spray used every day through pollen season is the standard approach. These sprays take one to two weeks to reach full effect, so start early. Antihistamine nasal sprays work faster, within 15 to 30 minutes.
Keep a reliever with you. Make sure it is in date, and carry a spacer.
Learn asthma first aid, and make sure the people you live or work with know it too.

Watching the forecast

Victoria’s health department publishes an epidemic thunderstorm asthma risk forecast every day from 1 October to 31 December. It covers three days, rates the risk as low, moderate or high, and is published on the VicEmergency app and website, updated around 12:30 pm. You can set a VicEmergency watch zone for your area to get notifications. The Melbourne Pollen app shows daily pollen counts.

On a high-risk day, especially as a storm approaches:

get inside before the wind gusts arrive, and stay in until the storm has passed;
close windows and doors;
switch off air conditioners that draw in outside air, and set your car’s air to recirculate;
keep your reliever and spacer within reach.

Asthma first aid

The National Asthma Council’s first aid steps for people aged 12 and over are:

Sit the person upright, stay calm and reassure them.
Give 4 separate puffs of a blue or grey reliever puffer through a spacer. Shake the puffer, give 1 puff into the spacer, and have the person take 4 breaths in and out. Repeat until 4 puffs have been given.
Wait 4 minutes. If breathing is still difficult, give 4 more puffs the same way.
If there is still no improvement, or breathing gets worse at any point, call triple zero (000) for an ambulance, and keep giving 4 puffs every 4 minutes until help arrives.

You can call 000 at any time if you are worried, and straight away if the breathing problem is severe. Check the full chart on the National Asthma Council website, which also covers children under 12.

How your pharmacy can help

Blue and grey reliever puffers are Pharmacist Only medicines in Australia. You can buy one without a prescription, but the pharmacist keeps it behind the counter and will usually ask a few questions about your asthma. Those questions are useful: if you are buying several relievers a year or do not have an asthma action plan, the pharmacist may suggest a GP review.

Before the season peaks, your local pharmacy can:

check your inhaler and spacer technique, since many people use their puffer in a way that delivers less medicine to the lungs (our guide to inhaler technique checks in Melbourne covers this in detail);
help you choose a spacer and show you how to clean it;
recommend a hay fever nasal spray and explain how to use it properly;
review whether you are using your preventer as prescribed.

Practical Example: A 34-year-old in Footscray has had hay fever every spring since her teens and a wheeze “now and then” that she never had checked. After reading the October pollen warning, she drops into a pharmacy listing an asthma management service. The pharmacist recommends a daily corticosteroid nasal spray for her hay fever, sells her a reliever and spacer with a quick technique demonstration, and suggests she book a GP appointment to check for asthma and get a written action plan before the November peak. She sets up a VicEmergency watch zone for her suburb the same afternoon.

Finding help near you

Use search for pharmacies to find one offering asthma management, asthma education or hay fever advice, or browse pharmacies in Melbourne and pharmacies in Victoria. On a storm night, check opening hours before you leave home, because late-night options are limited.

Official sources to check

Thunderstorm asthma is rare, but it moves fast. Getting your asthma or hay fever under control before the November peak, and knowing what to do when a storm is forecast, matters far more than anything you can do once the storm has arrived.