Short-term impact of PM2.5 on contemporaneous asthma medication use: Behavior and the value of pollution reductions

Proc Natl Acad Sci U S A. 2019 Mar 19;116(12):5246-5253. doi: 10.1073/pnas.1805647115. Epub 2018 Nov 26.


Asthma ranks among the most costly of chronic diseases, accounting for over $50 billion annually in direct medical expenditures in the United States. At the same time, evidence has accumulated that fine particulate matter pollution can exacerbate asthma symptoms and generate substantial economic costs. To measure these costs, we use a unique nationwide panel dataset tracking asthmatic individuals' use of rescue medication and their exposure to PM2.5 (particulate matter with an aerodynamic diameter of <2.5 μm) concentration between 2012 and 2017, to estimate the causal relationship between pollution and inhaler use. Our sample consists of individuals using an asthma digital health platform, which relies on a wireless sensor to track the place and time of inhaler use events, as well as regular nonevent location and time indicators. These data provide an accurate measurement of inhaler use and allow spatially and temporally resolute assignment of pollution exposure. Using a high-frequency research design and individual fixed effects, we find that a 1 μg/m3 (12%) increase in weekly exposure to PM2.5 increases weekly inhaler use by 0.82%. We also show that there is seasonal, regional, and income-based heterogeneity in this response. Using our response prediction, and an estimate from the literature on the willingness to pay to avoid asthma symptoms, we show that a nationwide 1 μg/m3 reduction in particulate matter concentration would generate nearly $350 million annually in economic benefits.

Keywords: asthma; economic value; particulate matter; rescue inhaler.

MeSH terms

  • Air Pollutants / adverse effects*
  • Air Pollution / adverse effects*
  • Air Pollution / economics*
  • Asthma / economics*
  • Asthma / prevention & control*
  • Environmental Exposure / adverse effects
  • Environmental Exposure / economics
  • Health Care Costs / statistics & numerical data
  • Humans
  • Particulate Matter / adverse effects*
  • United States


  • Air Pollutants
  • Particulate Matter