If you have asthma, you may already know the feeling: perfume in an elevator or an air freshener in a restroom, and your chest tightens. You’re far from alone. Here’s what the research shows about fragrance as an asthma trigger, and what you can ask for.
Evidence key Strong Moderate Weak How we grade
In US and Australian surveys, most people with asthma say scent makes them ill
In a national US survey, about two in three adults with asthma (64.3%) said fragranced products made them ill, compared with about one in four (23.8%) of people without asthma. Moderate evidence. Steinemann 2018
27.9% of US adults with asthma said fragranced products had triggered asthma attacks. Moderate evidence. Steinemann 2018
Australia looks much the same. In a national survey of 1,098 Australian adults, more than half of those with asthma or an asthma-like condition (55.6%) said fragranced products made them ill, against about a quarter (23.9%) of people without asthma. Moderate evidence. Steinemann 2018 About 1 in 4 Australian adults with asthma (24.0%) said a fragranced product had triggered an asthma attack; air fresheners were the most common trigger (14.1% of all asthmatics). Moderate evidence. Steinemann 2018
It has been seen in the clinic
In a 1986 clinic and hospital survey of 60 asthma patients, 72% said perfume or cologne worsened their asthma, and two asthma patients who could not smell at all still reacted to perfume worn by others nearby. Moderate evidence. Shim & Williams 1986
A small clinic study found that a real cologne challenge produced an objective, reproducible 18-58% drop in FEV1 (lung function) within minutes in asthma patients who already reported cologne sensitivity, blocked mostly by bronchodilators rather than cromolyn or blocking the sense of smell. Weak evidence. Shim & Williams 1986
Classic allergy tests don’t explain it. Standard allergy tests did not predict who reacted to fragrance; people with sensitive airways (including non-allergic asthma) were 2-4 times more likely to react, pointing to airway irritation rather than classic allergy. Moderate evidence. Elberling 2005
Asthma lab studies leave out the people who react most
Chamber studies of asthma exclude moderate and severe asthmatics by design, and the one study that directly compared severity bands found the excluded group had the largest airway response — so these studies likely underestimate how sensitive people with asthma really are. Strong evidence. Kleinbeck & Wolkoff 2024 Industry-funded
At work
Over 20 years (1993–2012), California's work-related asthma surveillance confirmed 270 cases linked to perfume or air fresheners at work, 3.8% of all confirmed cases; perfume was the 9th most common workplace asthma exposure. Moderate evidence. Weinberg 2017
94% of workers with fragrance-related work asthma in California were women, mostly in offices, health care and schools, and most cases came from perfume worn by others. Moderate evidence. Weinberg 2017
And half of them were still exposed at work. Workers with fragrance-related asthma were twice as likely as other work-asthma cases to still be exposed at work (50% vs 26%) and more often had workers' compensation claims denied (30% vs 21%), though ER visit and hospitalization rates were the same. Moderate evidence. Weinberg 2017
Children
In a national Canadian birth cohort (n=2,022), infants in homes with more frequent use of household cleaning products at 3–4 months of age had higher odds of recurrent wheeze (adjusted OR 1.35 per interquartile increase in use) and of an asthma diagnosis (adjusted OR 1.37) by age 3, but no higher odds of isolated allergic sensitization (skin-prick positivity). Strong evidence. Parks et al. 2020
Scented spray products — spray and plug-in air fresheners, dusting sprays — were among the specific product types most strongly associated with childhood wheeze and asthma risk in this Canadian birth cohort. Moderate evidence. Parks et al. 2020
Shut out of public places
41% of US adults with asthma reported health problems from air fresheners, and 36.7% said they can't use a public restroom that has one. Moderate evidence. Steinemann 2018
About 1 in 5 Australians with asthma (21.4%) said they can't or won't use public toilets that have air fresheners. Moderate evidence. Steinemann 2018
When it isn’t asthma
Not every scent reaction in the airways is asthma, and it matters for treatment. Scent-triggered throat and breathing reactions can mimic asthma but do not respond to asthma inhalers; almost two-thirds of these patients had been prescribed asthma medication anyway. Moderate evidence. Hoy 2010 If your inhaler doesn’t help with scent reactions, tell your doctor.
What people with asthma want
People with asthma back fragrance-free spaces by wide margins: 66.2% vs 16.1% for fragrance-free workplaces and 72.1% vs 14.8% for fragrance-free health care. Moderate evidence. Steinemann 2018
California’s public health department has already said what should change. The California Department of Public Health recommends enforced fragrance-free workplace policies, no air fresheners or fragranced cleaners, and better ventilation instead of odor masking. Moderate evidence. Weinberg 2017
What you can do
- At work, ask for an accommodation. Our workplace guide has a letter to copy and what to ask your doctor to write.
- For your child’s school or daycare, use our school letter.
- At home, take out air fresheners and switch to fragrance-free cleaners. Check them in EWG’s Guide to Healthy Cleaning.
- Put up a fragrance-free sign and hand out our fact sheet.
Every claim above shows its evidence grade and names its source, with a link wherever one exists. Fragrance can trigger asthma symptoms; we don’t claim it causes asthma. See the claims we won’t make. Information, not medical advice. Follow your asthma action plan and talk to your doctor.