title: Association between respiratory prescribing, air pollution and deprivation, in primary health care.
abstract: BACKGROUND
  We investigated the association between respiratory prescribing, air quality and deprivation in primary health care. Most previous studies have used data from secondary and tertiary care to quantify air pollution effects on exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, these outcomes capture patients who suffer from relatively severe symptoms.
  
  
  METHODS
  This is a population-based ecological study. We analysed respiratory medication (salbutamol) prescribed monthly by 63 primary care practices, UK. Firstly, we captured the area-wide seasonal variation in prescribing. Then, using the area-wide variation in prescribing as an offset, we built a mixed-effects model to assess the remaining variation in relation to air quality and demographic variables.
  
  
  RESULTS
  An increase of 10 μg/m(3) in ambient PM10 was associated with an increase of 1% (95% CI: 0.1-2%) in salbutamol prescribing. An increase of 1 SD in income and employment deprivation was associated with an increase of 20.5% (95% CI: 8.8-33.4%) and 14.7% (95% CI: 4.3-26.2%) in salbutamol prescribing rate, respectively.
  
  
  CONCLUSIONS
  The study provides evidence that monthly respiratory prescribing in primary care is a useful indicator of the extent to which air pollution exacerbates asthma and COPD symptoms. Respiratory prescribing was higher on deprived populations.
authors.affiliation: Newcastle University, Institute of Health and Society, Baddiley-Clark Building, The Medical School, Newcastle upon Tyne NE2 4AX, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Sofianopoulou
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Rushton
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Diggle
authors.forename: Tanja
authors.initials: T
authors.lastname: Pless-Mulloli
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data; D000420:Albuterol / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D052638:Particulate Matter / Q000009:adverse effects; D011203:Poverty / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology; D012621:Seasons; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D052638:Particulate Matter; D000420:Albuterol
keywords: COPD; air pollution; asthma; deprivation; prescribing; primary health care