Asthma-related symptoms, E.R. visits and
hospitalizations all decreased, according to data from digital
inhaler sensors and local hospitals
After four Louisville, Kentucky, coal-fired power plants either
retired coal as their energy source or installed stricter emission
controls, local residents’ asthma symptoms and asthma-related
hospitalizations and emergency room visits dropped dramatically,
according to research published today in Nature Energy.
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The study was conducted by Columbia University Mailman School of
Public Health, Propeller Health, University of California Berkeley,
Harvard TH Chan School of Public Health, University of Texas
Austin, Colorado State University, Louisville Metro Department of
Public Health and Wellness, Louisville Metro Office of Civic
Innovation and Technology, the Christina Lee Brown Envirome
Institute and Family Allergy & Asthma.
Coal-fired power plants are known to emit pollutants associated
with adverse health effects, including increased asthma attacks,
asthma-related ED visits and hospitalizations.1-5 In 2014,
coal-fired power plants accounted for 63% of economy-wide emissions
of sulfur dioxide (SO2) in the U.S.6 Historically, Kentucky has
ranked among the top five states in the U.S. for emissions from
power generation.7
Starting with a pilot in 2012, the city of Louisville embarked
on a project called AIR Louisville, which aimed to use data from
Propeller Health’s digital inhaler sensors to gain insights into
the impact of local air quality on the burden of respiratory
disease in the community. The public-private collaboration equipped
more than 1,200 Louisville residents with asthma and COPD with
Propeller sensors, which attach to patients’ existing inhalers and
deliver insights on medication use, symptoms and environmental
factors to the Propeller app on their smartphone.
“AIR Louisville brought together local government, public and
private partners and residents for a common mission: to leverage
local data to make our city better and more breathable,” said
Louisville Mayor Greg Fischer. “We are still seeing the results of
AIR Louisville in this research, which demonstrates the public
health impact of retiring coal as an energy source or further
controlling coal-fired emissions.”
Between 2013 and 2016, one coal-fired power plant in the
Louisville area retired coal as an energy source, and three others
installed stricter emission controls to comply with regulations
from the U.S. Environmental Protection Agency. Researchers took
advantage of these circumstances to analyze the impact of the
coal-fired power plant energy transitions on residents’ respiratory
health, using data from Propeller and local hospitals to assess how
asthma-related symptoms, ED visits and hospitalizations changed
over time.
The study looked at the frequency of the total number of
asthma-related E.R. visits and hospitalizations per ZIP code in
Jefferson County, as well as the frequency of asthma rescue
medication use among 207 people. Data on rescue medication use for
asthma was used as a proxy for patients’ symptoms, as patients use
their rescue medication for acute relief from symptoms such as
coughing and shortness of breath.
“This study was unique in its ability to measure asthma
morbidity based on both hospitalizations and daily symptoms, and to
leverage an abrupt change in environmental exposure to more
directly attribute changes in asthma exacerbation to changes in
coal-fired power plant emissions,” said Joan Casey, PhD, lead
author of the paper and assistant professor of environmental health
sciences at Columbia University Mailman School of Public
Health.
The researchers found that energy transitions in the spring of
2015 resulted in three fewer hospitalizations and ED visits per ZIP
code per quarter in the following year, when comparing areas that
had high coal-fired power plant emission exposure prior to the
transition to those with lower levels. This translates into nearly
400 avoided hospitalizations and ED visits each year across
Jefferson County.
At the individual level, the Mill Creek SO2 scrubber installed
in June 2016 was associated with a 17 percent immediate reduction
in rescue medication use, which was maintained thereafter. The
study also found the odds of having high rescue use throughout a
month (on average more than four puffs per day) was reduced by 32
percent following the June 2016 energy transition.
“This is the first study to use digital inhaler sensors to
understand the health effects of reducing emissions from coal-fired
power plants,” said study author Meredith Barrett, PhD, head of
population health research for Propeller Health. “We hope this
evidence will encourage government officials to support stricter
standards when regulating coal-fired power plants and encourage us
towards cleaner power options, thereby protecting the health of the
people who live near these facilities.”
The main funding for the project was provided by the Robert Wood
Johnson Foundation. Support was also provided by the Foundation for
a Healthy Kentucky, Norton Healthcare Foundation, Owsley Brown
Charitable Foundation, the American Lung Association, the National
Institute of Environmental Health Sciences and the U.S.
Environmental Protection Agency. The contents of the research and
related materials are solely the responsibility of the grantee and
do not necessarily represent the official views of the USEPA or the
Robert Wood Johnson Foundation. Lead author Joan Casey, PhD,
declares no financial interest in Propeller Health.
- Zheng, X.-y. et al. Association between air pollutants and
asthma emergency room visits and hospital admissions in time series
studies: a systematic review and meta-analysis. PLoS One 10,
e0138146 (2015).
- Orellano, P., Quaranta, N., Reynoso, J., Balbi, B. &
Vasquez, J. Effect of outdoor air pollution on asthma exacerbations
in children and adults: Systematic review and multilevel
meta-analysis. PLoS One 12, e0174050 (2017).
- Williams, A. M., Phaneuf, D. J., Barrett, M. A. & Su, J. G.
Short-term impact of PM2.5 on contemporaneous asthma medication
use: Behavior and the value of pollution reductions. Proc. Natl.
Acad. Sci. USA 116, 5246-5253 (2019).
- U.S. Environmental Protection Agency. Integrated Science
Assessment for Oxides of Nitrogen-Health Criteria,
<http://ofmpub.epa.gov/eims/eimscomm.getfile?p_download_id=526855>
(2016).
- U.S. Environmental Protection Agency. Integrated Review Plan
for the Primary National Ambient Air Quality Standard for Sulfur
Dioxide. EPA-452/R-14-007,
<https://www3.epa.gov/ttn/naaqs/standards/so2/data/20141028so2reviewplan.pdf>
(2014).
- Massetti, E. et al. Environmental Quality and the US Power
Sector: Air Quality, Water Quality, Land Use and Environmental
Justice. Prepared by: Oak Ridge National Laboratory for the U.S.
Department of Energy,
<https://www.energy.gov/sites/prod/files/2017/01/f34/Environment%20Baseline%20Vol.%202--Environmental%20Quality%20and%20the%20U.S.%20Power%20Sector--Air%20Quality%2C%20Water%20Quality%2C%20Land%20Use%2C%20and%20Environmental%20Justice.pdf>
(2017).
- U.S. Environmental Protection Agency. National Emissions
Inventory,
<https://www.epa.gov/air-emissions-inventories/2011-national-emissions-inventory-nei-data>
(2011).
About Propeller Health
Propeller Health is a leading digital health company dedicated
to making life better for every person with chronic respiratory
disease. Propeller creates products to more effectively treat
chronic respiratory disease and improve clinical outcomes for
patients through connectivity, analytics, and companion digital
experiences. The Propeller platform is used by patients, physicians
and healthcare organizations in the United States, Europe and Asia.
Propeller Health is a wholly owned subsidiary of ResMed (NYSE: RMD,
ASX: RMD). For more information, visit www.propellerhealth.com.
About Columbia University Mailman School of Public
Health
Founded in 1922, the Columbia University Mailman School of
Public Health pursues an agenda of research, education, and service
to address the critical and complex public health issues affecting
New Yorkers, the nation and the world. The Columbia Mailman School
is the seventh largest recipient of NIH grants among schools of
public health. Its nearly 300 multi-disciplinary faculty members
work in more than 100 countries around the world, addressing such
issues as preventing infectious and chronic diseases, environmental
health, maternal and child health, health policy, climate change
and health, and public health preparedness. It is a leader in
public health education with more than 1,300 graduate students from
55 nations pursuing a variety of master's and doctoral degree
programs. The Columbia Mailman School is also home to numerous
world-renowned research centers, including ICAP and the Center for
Infection and Immunity. For more information, please visit
http://www.mailman.columbia.edu.
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For media: Columbia University Mailman School of Public
Health Tim Paul + 917.743.8004 tp2111@cumc.columbia.edu
Propeller Health Rachel Fields +1 630.901.8265
rachel.fields@propellerhealth.com
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