RESEARCH ARTICLE Thunderstorm asthma outbreak, a rare phenomenon in southwest Iran: patients’ perspectives Shohreh Rabiee 1 & Hassan Mousavi 2 & Morteza Abdullatif Khafaie 3,4,5 Received: 9 April 2018 /Accepted: 16 October 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Previous studies that described thunderstorm asthma, which is a rare event, are not being well explained. This study was conducted, to describe the patient perspective on their asthma attack experience during Ahvaz post-rain phenomenon. We have interviewed patients present in the Naft clinic of Ahvaz, during 28th October and the first week of November 2015. Recruitment was continued as saturation ensued by 33 participants. An inductive content analysis was used to evaluate the interviews. The key finding indicated a climatic condition, direct or indirect contact with rain, history of allergy, and physical conditions are the main categories. The patient emphasized the importance of dust, humidity, first autumn rainfall, and environmental air pollution in occurrences of the event. When exposed to further rains (third rainfall onward), they were less likely to experience dyspnea or shortness of breath. However, being indoor or out at the time of rainfall reported not to be related to the onset of asthma exacerbation. This study yielded that patients’ asthma outbreak is a climate-related health impact and many individual factors triggering this issue. Patients concerns need future investigation and public health emergency planning and response arrangements. Keywords Thunderstorm asthma . Outbreak . Ahvaz . Rainfall . Qualitative study Introduction On 28 October 2015, immediately after the first rainfall, an acute outbreak of asthma occurred in the metropolitan city of Ahvaz, located in the southwest of Iran (Idani, Dastoorpoor, Goudarzi, & Khanjani, 2016). There was an abrupt rise in the number of patients presenting with asthma to the emergency departments. Similar phenomena were reported in the last few years, during the same period of time (almost November) which was called BAhvaz post-rain phenomenon^(Feli et al., 2015; Forouzan & Masoumi, 2014). An early observation is that thunderstorm asth- ma is not well understood, nor are the factors that enable asthma attack to be predicted. Industrialization and technological devel- opment brought various achievements to human life. However, unsustainable development often leads to an adverse impact on the ecosystem (Kozlov et al., 2017) and health (Khafaie et al., 2017a; Khafaie et al., 2017b). Air pollution also is mainly con- sequences of industrialization, which is related to urbanization and biofuel use. Over the last decade, changes in dust storms characteristics have been observed in different parts of the world. The chang- ing frequency of dust storms in the Khuzestan has led to a growing concern regarding the health of the nation (Maleki, Sorooshian, Goudarzi, Nikfal, & Baneshi, 2016; Mojadam et al., 2018). The world health organization recently recog- nized Ahvaz as one of the most polluted cities in the world in terms of PM 10 (Organization, 2016) The sources of Khuzestan’ s dust storms are located in Iraq and Saudi Arabia (Broomandi, Dabir, Bonakdarpour, & Rashidi, 2017). However, the main source of dust storms in the province is Hoor al-Azim Wetland, a transboundary lagoon between Iran Responsible editor: Philippe Garrigues * Morteza Abdullatif Khafaie khafaie-m@ajums.ac.ir 1 Coronary Care Unit of Naft Hospital, National Oil Company, Ahvaz, Iran 2 Deputy of Health and Occupation Medicine, National Oil Company, Ahvaz, Iran 3 Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 4 Department of Public Health, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 5 Deputy of Research and Development, Ahvaz Jundishapur University of Medical Sciences, Golestan, Ahvaz, Khuzestan, Iran Environmental Science and Pollution Research https://doi.org/10.1007/s11356-018-3478-9