Introduction: Air pollution in India is a significant public health issue. Air-health surveillance has been recently introduced in heavily polluted Indian cities, to inform relevant mitigation and health preparedness actions. The air-health surveillance tracks emergency room visits (ERV) for acute respiratory illnesses in select sentinel hospi- tals. Reporting from multiple facilities is necessary to get a representative picture, but expanding coverage poses challenges. In this context, pharmaceutical data can serve as an alternative data source to aid surveillance efforts. Methods: We examined the potential role of data on sales of respules (a combination of corticosteroid and bron- chodilator medicines, used in nebulizers) as an indicator in air-health surveillance. The association between daily respules sold at a trust-based hospital in Pune, India, and daily concentration of local ambient particulate matter (PM_2.5) was assessed using a time-stratified case-crossover design.

Results: A positive correlation, with a lag effect, was observed. A 10 µg/m³ increase in PM_2.5 level led to an 8 % and 6 %

increase in respules sales after a lag of 3 and 4 days, respectively. The number of respules sold correlated well with ERV. Discussion: The findings indicate that respules sold could serve as a reliable proxy for tracking health impacts from air pollution.

Conclusion: Our study provides a proof-of-concept analysis showing that pharmaceutical data can be used as a proxy measure to assess the short-term health impacts of air pollution. Further exploration is needed to evaluate its utility for air-health surveillance efforts in India.

Media articles and coverage

Key results of this study were communicated through the following articles in the digital and print media.

• धुरक्यात लपलेला राक्षस ओळखता येऊ शकेल? – विविध शहरांमध्ये श्वासंविकारांसाठी लागणाऱ्या औषधांची मागणी केव्हा , किती वाढते या निकषांचा वापर करून वाढती प्रसुषण पातळी मोजता येईल का? ; Lokmat , 29 December 2025 

• Breathless Pune | For every 10 µg/m3 increase in PM2.5 level, there was 6-8 % jump in medicine sales: Study; The Indian Express, 23 November 2025