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This study demonstrates the association between greater odds of asthma attacks in the previous 12 months and higher concentrations of PFDA and PFOA in the serum, which was significant for individuals aged 12 to 18 years.

Per- and poly-fluoroalkyl substances (PFAS) are chemicals widely utilized in manufacturing and tend to be highly resistant to degradation; hence, they are referred to as forever chemicals. The current study conducted a secondary analysis of the available data to assess the association between asthma exacerbation and the concentration of PFAS in the serum. 

The study results indicated an association between higher serum concentrations of perfluorodecanoic (PFDA) and perfluorooctanoic acids (PFOA) and higher odds of asthma attacks in the study participants, with the association being significant only in individuals aged 12 to 18 years. The study results are published in the Journal of Allergy and Clinical Immunology, Global.

Baseline Characteristics of Study Participants

The study included 1101 participants with current asthma and the availability of serum PFAS information; however, perfluorooctane sulfonate (PFOS) and PFOA data were not available for 935 participants.

Association Between Asthma Attacks and Serum Concentrations of PFAS

Asthma attacks occurring within the past 12 months were positively associated with serum concentrations of PFAS. The association was strongest in PFDA and PFOA. Following stratification by age, there was a statistically significant association between PFDA and asthma attacks among study participants > 18 years of age. Based on stratification by sex, greater odds of asthma attacks were significantly associated with PFDA only in male participants. PFAS concentrations in the serum were not found to be significantly associated with urgent care or emergency department visits.

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Odds of Asthma Attacks and Doubling of PFAS Serum Concentrations

The data analysis demonstrated a positive association between asthma attacks and serum PFOA and PFDA concentrations in study participants ≥ 12 years of age after adjusting for covariates. The odds of asthma attacks demonstrated a 1.2-fold increase with a doubling of serum concentrations of PFDA, and a 1.6-fold increase with a doubling of serum concentrations of PFOA in adults and adolescents, respectively. However, these associations did not remain statistically significant following correction for multiple tests.

Study Limitations

The current study is an analysis of a data set from a survey. The study limitations that may limit the validity and credibility of the study results include the cross-sectional study design, potential recall bias, and the failure to control for certain covariates in the analysis of the survey data.

This study demonstrated the association between greater odds of asthma attacks in the previous 12 months and higher concentrations of PFDA and PFOA in the serum.


Burbank, A. J., Fry, R. C., & Keet, C. A. (2023). Associations between serum per- and polyfluoroalkyl substances and asthma morbidity in the National Health and Nutrition Examination Survey (2003-18). J Allergy Clin Immunol Glob., 2(2), 100078. https://doi.org/10.1016/j.jacig.2023.100078