Background: There are few studies of occupational asthma among florists. In this study, we evaluated questionnaire-based prevalence and possible risk factors of occupational asthma among florists in Turkey. Methods: We collected data from 60 (71.4%) florist shops with 128 (86.5%) florists selected by a cluster sampling method and investigated occupational history, respiratory, ocular, dermal, and nasal symptoms based on a modified version of the American Thoracic Society questionnaire. We evaluated work-site pulmonary function tests and atopy by skin prick test for the most common allergens in the region (D. farinae, D. pteronyssinus, Mould mix) and flower mix (Aster chinensis, Chrysanthemum koreanum, Dahlia cultorum, Solidago virgaurea, Chrysanthemum leucanthemum). We calculated work intensity from total working years and weekly working hours. We measured humidity and temperature, and evaluated ventilation systems in shops. Florists who reported having anyone of the following symptoms: non-productive cough, dyspnea, chest tightness, or wheezing, were defined as having asthma, and, if those symptoms were related to work, we defined them as occupational asthma. Possible risk factors were analyzed by age- and gender-adjusted logistic models comparing symptomatic and asymptomatic florists. Smoking status had limited effect on the results, so we excluded smoking from the models. Results: The median age was 28.0 years. 85.9% were males, 63.3% were current smokers. The prevalence of occupational asthma was 14.1% (n=18). We observed work related excess risk factors among florists with a high work intensity (OR=7.3, 95% CI=1.1-51.8) and long work duration (OR=5.1, 95% CI=1.2-21.6). Florists with occupational asthma were 5.9 times more likely to have positive a11ergen skin test for flower mix (95% CI=1.4-24.3). We also observed an excess risk of a11ergic rhinitis (OR=13.2, 95% CI=3.1-56.4) and conjunctivitis (OR= 8.4 95% CI=2.4-29.24) among florists with occupational asthma. Conclusion: This study showed that most prominent risk factors of occupational asthma were work intensity, work duration, and specific atopy in florists. We believe that new studies from developing countries are needed to understand etiologic factors of occupational asthma.
National Institute for Occupational Safety and Health, Division of Respiratory Diseases Studies, Mail Stop H-2800, 1095 Willowdale Road, Morgantown, WV 26505