Geospatial-temporal analysis of the impact of ozone on asthma rescue inhaler use

Environ Int. 2020 Mar:136:105331. doi: 10.1016/j.envint.2019.105331. Epub 2019 Dec 10.


Rationale: Asthma is one of the most common chronic respiratory diseases in the United States. Several outdoor air pollutants have been associated with asthma morbidity. Previous studies of the effects of short-term air pollution exposure have been limited by potential exposure misclassification and limited spatial and temporal resolution of asthma outcome measures.

Objectives: We aimed to assess the association of short-term air pollutant exposure with the use of short-acting beta-2 agonists (SABA) for asthma by monitoring the time and place of occurrence with electronic medication monitors.

Methods: In a cohort of adults and children with asthma (n = 287; 60% female), we deployed electronic medication monitors fitted to metered-dose inhalers to monitor SABA use, capturing the date, time and location of use. We assigned pollutant exposures based on each actuation's time and location (4-h mean measures for ozone and particulate matter of 2.5 µm or smaller (PM2.5)), assessed associations using generalized linear models and explored age-specific effects.

Measurements and main results: Ambient ozone exposure was positively associated with SABA use (p = 0.01). Age-specific associations were identified (interaction p = 0.01), with a larger increase in SABA use for children (11.3%; 95% CI: 7.0%-18.2%) than adults (8.4%; 95% CI: 6.4%-11.0%) per IQR increase of ozone (16.8 ppb).

Conclusions: These findings support existing evidence that short-term exposure to ozone can cause morbidity in individuals with asthma, and suggest that ozone exposures below the current U.S. EPA standard may be associated with increased SABA use.

Keywords: Air pollution; Asthma; Mhealth; Ozone; Patient monitoring.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air Pollutants*
  • Air Pollution*
  • Asthma* / etiology
  • Asthma* / therapy
  • Child
  • Environmental Exposure
  • Female
  • Humans
  • Male
  • Nebulizers and Vaporizers
  • Ozone* / toxicity
  • Particulate Matter
  • United States


  • Air Pollutants
  • Particulate Matter
  • Ozone