What difficulties do people with asthma report with fragranced products?

Fragranced products are not limited to those we choose to use ourselves. They also occur in places where exposure can be difficult to avoid, such as cleaning products at work, air fresheners in public facilities, or products worn by people nearby. What difficulties do people with asthma report in these settings?

Anne Steinemann examined this issue through a US online survey in a paper appearing in a 2018 journal volume. Here, the group described as having asthma also included respondents who said that a health professional had told them they had an asthma-like condition. Recognizing that this differs from a patient study verified against medical records is the starting point for interpreting the results.

Focusing on 305 respondents within a survey of 1,137 people

The survey was conducted in June 2016 among 1,137 US adults aged 18–65. Participants were recruited from an online survey company’s panel to reflect the US population’s distribution of age, gender, and region.

Of these, 305 said that a health professional had told them they had asthma or an asthma-like condition. The study combined these respondents into one group and compared them with the remaining 832. Below, the former is called the self-reported asthma/asthma-like-condition group.

Questions covered frequency of fragranced-product use and exposure from others, health problems respondents associated with the products, difficulties in public places and at work, and preferences for fragrance-free environments. This study analyzed responses from a previously published general-population survey in greater detail according to reported asthma-related status.

The products included not only perfume but also air fresheners, deodorizers, detergents, fabric softeners, cleaning supplies, soaps, and shampoos. It was not an experiment testing one perfume or an individual synthetic fragrance ingredient.

The proportion reporting health problems differed between groups

In the self-reported asthma/asthma-like-condition group, 64.3% said they experienced at least one health problem from fragranced products. The corresponding proportion in the other group was 23.8%, lower than in the first group.

Using all 305 respondents in the self-reported asthma/asthma-like-condition group as the denominator, 43.3% reported respiratory problems, 28.2% migraine headaches, and 27.9% asthma attacks. Respondents could report more than one symptom, so these percentages cannot be added to obtain a percentage of people affected.

These figures describe experiences respondents perceived and reported as associated with the products. They are not proportions established by researchers observing attacks or measuring lung function. Nor did the study investigate the probability of developing new asthma after using fragranced products.

Difficulties can arise even without personal use

In the self-reported asthma/asthma-like-condition group, 99.3% reported exposure to fragranced products through their own use or others’ use at least once a week.

For particular settings, 41.0% reported health problems associated with air fresheners or deodorizers, 42.3% with being in a room after it had been cleaned with fragranced products, and 46.2% with being near someone wearing a fragranced product. For the scent of fragranced laundry products from a dryer vent, the figure was 28.9%.

These percentages also use the entire self-reported asthma/asthma-like-condition group as their denominator. They do not measure how much people actually inhaled in each setting or identify which compounds they reacted to. Some respondents reported difficulties in several settings, so these are not mutually exclusive groups of people.

Effects on access to places and work, not only symptoms

A distinctive feature of this study was its attention to disruptions in everyday life, not just symptom types. In the self-reported asthma/asthma-like-condition group, 36.7% said that air fresheners or similar products could prevent them from using public restrooms. A further question found that 43.9% reported places they could not go because fragranced products would make them ill.

In addition, the paper’s Results report that 35.4% of the self-reported asthma/asthma-like-condition group had become ill, missed work, or lost a job because of fragranced products at work in the 12 months preceding the survey. However, the question displayed in Supplementary Table CC does not explicitly state this time period. This was a combined item covering three outcomes. It does not mean that 35.4% lost a job, or that all of them missed work.

Among the 196 people who reported health problems, 62.8% said those problems substantially limited major daily activities such as breathing, concentrating, or working. This percentage is not based on all 305 people, nor is it the proportion with a legally certified disability.

The author emphasized that exposures people do not readily choose for themselves can restrict opportunities to work or use public facilities. The questionnaire sought to make visible everyday difficulties that cannot be understood solely as liking or disliking a scent.

Preferences for fragrance-free environments were also examined

In the self-reported asthma/asthma-like-condition group, 66.2% supported a fragrance-free workplace policy and 16.1% did not. The proportion preferring fragrance-free healthcare facilities and healthcare professionals was 72.1%.

These figures describe the environments respondents wanted. They do not measure reductions in attacks or absence from work before and after a policy was actually introduced.

What the survey shows and what remains unanswered

The author proposed reducing opportunities for exposure to fragranced products, particularly in workplaces and healthcare settings, as a potentially practical way to lessen burdens on health and participation in society. She also called for research into which ingredients or combinations of ingredients are associated with which symptoms.

However, this was a self-report survey at one point in time. Recall bias, judgments attributing symptoms to products, and characteristics of people who participate in surveys may influence the results. Even an online sample matched on age, gender, and region does not necessarily capture every American’s experience. Children and people aged 66 or older were outside its scope.

Because the study did not directly measure product emissions or exposure levels, it cannot by itself identify causative substances or mechanisms of illness. These limitations of self-report do not, in turn, justify denying the reported ill health or disruptions to daily life.

Conclusion

In this US survey, people who said that a health professional had told them they had asthma or an asthma-like condition more often reported symptoms and everyday difficulties they associated with fragranced products. These included public places and workplaces, where exposure is not easily controlled through personal choice alone.

Although the study did not establish causes experimentally, it provides information about who experiences difficulties and where. It points to the need to consider environments with reduced exposure, while separately testing their effects and mechanisms, and to address both symptoms and the conditions that hinder participation in society.

References

Steinemann, A. (2018). Fragranced consumer products: effects on asthmatics. Air Quality, Atmosphere & Health, 11, 3–9. DOI: 10.1007/s11869-017-0536-2 / Full text. Original article license: CC BY 4.0. (Published online in 2017; volume year 2018)