FUKUSHIMA Lives on the Line

176Am J Respir Crit Care Med. 2012;186(12)1309-10Impacts of the 3/11 Disaster in Fukushima on Asthma ControlFukuhara A, Sato S, Uematsu M, Misa K, Nikaido T, Inokoshi Y, Fukuhara N,Wang X, Kanazawa K, Tanino Y, Ishida T, Munakata M.To the Editor:The Great East Japan Earthquake and tsunami on March 11, 2011, resulted in the Fukushima nuclear power plant accident, which consequently led to a massive emission of radioactive substances. We investigated the effect of this complex disaster on individuals with asthma, who have been treated and followed up regularly in the outpatient clinic of Fukushima Medical University Hospital, located 57 km away from the Fukushima Daiichi nuclear power plant. An interview by their attending doctors was performed to evaluate changes of dwelling, changes in lifestyle, and availability of antiasthmatic drugs. Psychological and asthma control status of the patients were evaluated using a visual analog scale (VAS) (1).Seventy patients with asthma (28 mild persistent, 24 moderate persistent, 12 severe persistent, and 6 the most severe) were enrolled. All the patients were treated with inhaled corticosteroids (ICS) before the disaster. All of them experienced the earthquake stronger than 6+ by Japan Meteorological Agency seismic intensity scale. They were evaluated 3 to 12 weeks after the disaster with regard to physical damage, status of evacuation, and availability of antiasthmatic drugs. In addition, asthmatic symptoms, asthma control, and anxieties about the disaster and their asthma were evaluated by the VAS analysis. They were asked to evaluate their situation by a −10 cm to +10 cm scale (−10 cm = worst or the most anxious; 0 cm = no change; +10 cm = improved significantly or no anxiety). Although physical damage was not reported, 6 subjects (8.6%) had lost their homes and were living in a shelter. In 6 patients (8.6%), ICS became unavailable and was discontinued. The deterioration rate of asthma was significantly higher in the ICS-discontinued group compared with the ICS-continued group (66.7% and 15.6%, P < 0.0001, respectively). VAS analysis of 64 ICS-continued patients revealed that 46 (71.8%) experienced anxiety about the disaster. The anxiety rate was significantly higher among females and those who required evacuation (P < 0.05). The deterioration rate of asthma was also significantly higher in the patients with anxiety regarding the disaster (P < 0.05) (Figure 1). The patients’ location did not affect their asthma control.In Japan, the effects of earthquakes on asthma exacerbation have been reported, but the results were inconsistent (2–4). In this study, it is clarified that the continuous use of ICS is the important factor for asthma control during the disaster. Although the severity of asthma was relatively high, only two patients experienced severe asthma attacks requiring emergency room visit. This also suggests the importance of reestablishing the drug supply system after the large disaster. In this disaster, the Japanese government allowed pharmacists to supply drugs without prescription if they could confirm the drugs that the patients regularly used. This emergent change in policy worked very well, and a majority of the patients suffering from chronic diseases could get their drugs. In this study, only 10% of the subjects had trouble getting antiasthmatic drugs.However, deterioration of asthma control was also observed in patients who could continue their ICS. Regarding this, VAS analyses revealed that deterioration is significantly related to emotional stress such as anxiety about the disaster and their having asthma. Fagan and colleagues also reported the importance of psychological stress on asthma during the September 11, 2001, terrorist attacks in the New York City metropolitan area (5). It is also known that central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma (6).Our study has some limitations. Due to the disaster, it was not possible to evaluate the parameters such as airway responsiveness, bronchial reversibility, and induced sputum analysis. The number of participants was