When should we suspect ‘climate-amplified’ rhinitis/asthma versus poor control from other causes?

Before labeling rhinitis or asthma as “climate-amplified,” we must first exclude common causes of poor control: adherence issues, suboptimal controller dosing, inhaler technique, indoor allergen exposure, occupational triggers, and comorbidities (GERD, CRS, OSA, obesity). These remain far more common explanations.

I begin to suspect climate amplification when symptoms demonstrate a temporal shift or intensity mismatch:

• Earlier spring onset or prolonged fall symptoms compared to historical norms
• Exacerbations during “moderate” pollen counts
• Worsening during heat waves, wildfire smoke (PM2.5), high-ozone days, or post-thunderstorm events
• Concordance with local plant phenophases rather than regional pollen reports

In these cases, the issue i...