title: Feasibility of Deploying Inhaler Sensors to Identify the Impacts of Environmental Triggers and Built Environment Factors on Asthma Short-Acting Bronchodilator Use.
abstract: Epidemiological asthma research has relied upon self-reported symptoms or healthcare utilization data, and used the residential address as the primary location for exposure. These data sources can be temporally limited, spatially aggregated, subjective, and burdensome for the patient to collect.
  
  
  
  First, we aimed to test the feasibility of collecting rescue inhaler use data in space-time using electronic sensors. Second, we aimed to evaluate whether these data have the potential to identify environmental triggers and built environment factors associated with rescue inhaler use and to determine whether these findings would be consistent with the existing literature.
  
  
  
  We utilized zero-truncated negative binomial models to identify triggers associated with inhaler use, and implemented three sensitivity analyses to validate our findings.
  
  
  
  Electronic sensors fitted on metered dose inhalers tracked 5,660 rescue inhaler use events in space and time for 140 participants from 13 June 2012 to 28 February 2014. We found that the inhaler sensors were feasible in passively collecting objective rescue inhaler use data. We identified several environmental triggers with a positive and significant association with inhaler use, including: AQI, PM10, weed pollen, and mold. Conversely, the spatial distribution of tree cover demonstrated a negative and significant association with inhaler use.
  
  
  
  Utilizing a sensor to capture the signal of rescue inhaler use in space-time offered a passive and objective signal of asthma activity. This approach enabled detailed analyses to identify environmental triggers and built environment factors that are associated with asthma symptoms beyond the residential address. The application of these new technologies has the potential to improve our surveillance and understanding of asthma. Citation: Su JG, Barrett MA, Henderson K, Humblet O, Smith T, Sublett JW, Nesbitt L, Hogg C, Van Sickle D, Sublett JL. 2017. Feasibility of deploying inhaler sensors to identify the impacts of environmental triggers and built environment factors on asthma short-acting bronchodilator use. Environ Health Perspect 125:254-261; http://dx.doi.org/10.1289/EHP266.
authors.affiliation: Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Su
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Barrett
authors.forename: Kelly
authors.initials: K
authors.lastname: Henderson
authors.forename: Olivier
authors.initials: O
authors.lastname: Humblet
authors.forename: Ted
authors.initials: T
authors.lastname: Smith
authors.forename: James W
authors.initials: JW
authors.lastname: Sublett
authors.forename: LaQuandra
authors.initials: L
authors.lastname: Nesbitt
authors.forename: Chris
authors.initials: C
authors.lastname: Hogg
authors.forename: David
authors.initials: D
authors.lastname: Van Sickle
authors.forename: James L
authors.initials: JL
authors.lastname: Sublett
mesh_terms: D001249:Asthma / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004779:Environment Design; D004784:Environmental Monitoring / Q000379:methods; D006801:Humans; D019570:Inhalation Exposure / Q000706:statistics & numerical data*; D036501:Metered Dose Inhalers / Q000706:statistics & numerical data*
chemical_list: D001993:Bronchodilator Agents