Associations between serum per-and polyfluoroalkyl substances and asthma morbidity in the National Health and Nutrition Examination Survey (2003-2018)

By Allison J. Burbank, Rebecca C. Fry, and Corinne A. Keet
JACI
February 13, 2023
DOI: 10.1016/j.jacig.2023.100078

Background

Per- and polyfluoroalkyl substances, or PFAS, are a class of chemicals widely used in manufacturing and are highly resistant to degradation, accumulating in the environment. Serum concentrations of these “forever chemicals” were associated with impairment of innate and adaptive immune responses in humans and animals. The relationship between serum PFAS levels and asthma morbidity has not been studied.

Objective

The purpose of the study was to test the association between serum PFAS concentration and asthma exacerbations.

Methods

We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES, 2003-2018). We fit multivariable logistic regression models to estimate odds ratios and 95% confidence intervals for asthma exacerbation in the prior 12 months given serum concentrations of PFAS. Models were adjusted for relevant covariates.

Results

Of 1,101 participants with self-reported current asthma and available serum PFAS data, we observed that higher serum perfluorooctanoic and perfluorodecanoic acids were associated with greater odds of asthma attacks in the previous 12 months (aOR 1.16, 95% CI 1.01, 1.33 and aOR 1.21, 95% CI 1.03, 1.43, respectively). After stratification by age, the association between perfluorooctanoic acid and asthma attacks was significant in the 12–18-year-old group only (aOR 1.56, 95%CI 1.06, 2.31). No significant relationships were observed between PFAS and asthma-related emergency department visits. After correction for multiple comparison testing, none of the associations reached the threshold of significance.

Conclusion

The role of these bioaccumulative “forever chemicals” in susceptibility to asthma attacks warrants further examination in longitudinal studies.

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