Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Environ Res. 2024 Dec 1;262(Pt 1):119827. doi: 10.1016/j.envres.2024.119827. Epub 2024 Aug 23.
Associations between exposure to per- and polyfluoroalkyl substances (PFAS) and pediatric asthma and reduced lung function in children are mixed and inconclusive. The study objective was to examine the extant research on exposure to PFAS and the diagnosis of asthma or decreased lung function in children <17 years of age to highlight what is known and to identify research gaps for future investigations.
The present review was registered on the PROSPER database (CRD42023407172). We systematically searched several bibliographic databases (Scopus, Embase, Web of Science (core Collection), Medline, and CINAHL) along with grey literature sources in January 2023 to find relevant studies before this date. The National Toxicology Program's Office of Health Assessment and Translation (NTP OHAT) tool was applied to assess the risk of bias (RoB) assessment. We used a random-effects meta-analysis to assess the associations. From 12 observational epidemiological studies (out of 513) explored for qualitative analyses, 4 studies were included in quantitative analyses.
The meta-analysis revealed a significant association between exposures to perfluorooctanoate (PFOA) with the prevalence of children's asthma [Odds Ratios (OR) = 1.162 (95% CI: 1.004-1.321)] whereas the association for perfluorooctane sulfonate (PFOS) was not statistically significant [OR = 1.03 (95%CI: 0.806-1.265]. The narrative synthesis results of the four included studies that examined the effects of PFAS exposure on lung function did not demonstrate significant associations between exposure to PFAS and decreased lung function. The RoB for most included studies was assessed as probably low without serious limitations. However, two studies were at high risk of biases.
Our findings suggest that children who are exposed to PFOA are at a higher risk of developing asthma as well as the association between exposure to PFOS with impaired lung function. Large longitudinal studies with homogeneous PFAS exposures and standardized outcome measures are needed to ascertain these outcomes with improved certainty as well as toxicological studies to investigate the underlying mechanisms.
全氟和多氟烷基物质（PFAS）暴露与儿童哮喘和肺功能下降之间的关联尚不确定。本研究旨在检查关于 PFAS 暴露与儿童（<17 岁）哮喘或肺功能下降诊断的现有研究，以突出已知内容并确定未来研究的差距。
本综述已在 PROSPER 数据库（CRD42023407172）中注册。我们于 2023 年 1 月系统地检索了几个文献数据库（Scopus、Embase、Web of Science（核心合集）、Medline 和 CINAHL）以及灰色文献来源，以查找该日期之前的相关研究。国家毒理学计划健康评估和转化办公室（NTP OHAT）工具用于评估偏倚风险（RoB）评估。我们使用随机效应荟萃分析来评估关联。在定性分析中，探讨了 12 项观察性流行病学研究（共 513 项），其中 4 项研究纳入了定量分析。
荟萃分析显示，全氟辛酸（PFOA）暴露与儿童哮喘患病率之间存在显著关联[比值比（OR）=1.162（95%CI：1.004-1.321）]，而全氟辛烷磺酸（PFOS）的关联无统计学意义[OR=1.03（95%CI：0.806-1.265）]。纳入的四项研究中，有四项研究检查了 PFAS 暴露对肺功能的影响，结果表明 PFAS 暴露与肺功能下降之间没有显著关联。大多数纳入研究的 RoB 评估为低风险，没有严重的局限性。然而，有两项研究存在高偏倚风险。
我们的研究结果表明，接触 PFOA 的儿童患哮喘的风险更高，接触 PFOS 与肺功能受损有关。需要进行大型纵向研究，这些研究具有同质的 PFAS 暴露和标准化的结局指标，以更确定地确定这些结果，并进行毒理学研究以探讨潜在机制。
