Wastewater-based epidemiological evaluation of the effect of air pollution on short-acting beta-agonist consumption for acute asthma treatment.
Asthma, one of the most common chronic diseases in the world and a leading cause of hospitalization among children, has been associated with outdoor air pollution. We applied the wastewater-based epidemiology (WBE) approach to study the association between the use of salbutamol, a short-acting beta-agonist used to treat acute bronchospasm, and air pollution in the population of Milan, Italy. Composite 24-h samples of untreated wastewater were collected daily and analyzed for human metabolic residues of salbutamol by liquid chromatography tandem mass spectrometry. Corresponding daily outdoor concentrations of particular matter up to 10µm (PM10) and 2.5µm (PM2.5) in aerodynamic diameter, nitrogen dioxide, ozone, sulfur dioxide, and benzene were collected from the public air monitoring network. Associations at different lag times (0-10 days) were assessed by a log-linear Poisson regression model. We found significant direct associations between defined daily doses (DDD) of salbutamol and mean daily concentrations of PM10 and PM2.5 up to nine days of lag time. The highest rate ratio, and 95% confidence interval (CI), of DDD of salbutamol was 1.06 (95% CI: 1.02-1.10) and 1.07 (95% CI: 1.02-1.12) at seven days of lag time and for an increase of 10 μg/m(3) of PM10 and PM2.5, respectively. Reducing the mean daily PM10 concentration in Milan from 50 to 30μg/m(3) means that 852 (95% CI: 483-1504) daily doses of salbutamol per day would not be used. These results confirm the association between asthma and outdoor PM10 and PM2.5 and prove the potential of the WBE approach to quantitatively estimate the relation between environmental exposures and diseases.
Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: elena.fattore@marionegri.it.
Elena
E
Fattore
Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: enrico.davoli@marionegri.it.
Enrico
E
Davoli
Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: sara.castiglioni@marionegri.it.
Sara
S
Castiglioni
Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: cristina.bosetti@marionegri.it.
Cristina
C
Bosetti
Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: andrea.redepaolini@marionegri.it.
Andrea
A
Re Depaolini
Department of Cardiovascular Research, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: irene.marzona@marionegri.it.
Irene
I
Marzona
Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: ettore.zuccato@marionegri.it.
Ettore
E
Zuccato
Department of Environmental Health Science, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", via Giuseppe La Masa 19, 20156 Milan, Italy. Electronic address: roberto.fanelli@marionegri.it.
Roberto
R
Fanelli
D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000393:Air Pollutants / Q000032:analysis*; D000420:Albuterol / Q000032:analysis*; D001249:Asthma / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004784:Environmental Monitoring; D006801:Humans; D007558:Italy / Q000453:epidemiology; D052638:Particulate Matter / Q000032:analysis; D010865:Pilot Projects; D062065:Wastewater / Q000032:analysis*; D014874:Water Pollutants, Chemical / Q000032:analysis*
D058666:Adrenergic beta-2 Receptor Agonists; D000393:Air Pollutants; D000420:Albuterol; D001993:Bronchodilator Agents; D052638:Particulate Matter; D062065:Wastewater; D014874:Water Pollutants, Chemical
Asthma; PM(10); PM(2.5); Salbutamol; Wastewaters