Liu Yang ¹ Chen Xinting ² Zhang Aie ³ Xu Ruiqi ² Paulo Moreira ^4,5,6* Dou Mei ^2,7

• ¹ Shandong Provincial Chronic Disease Hospital, Qingdao, Human, China, Qingdao, China
• ² School of Public Health, Qingdao University, Qingdao, Shandong Province, China
• ³ Qilu Hospital, Shandong University, Jinan, Shandong Province, China
• ⁴ Shandong Provincial Qianfoshan Hospital, International Healthcare Management Research and Development Centre), Jinan, China
• ⁵ Henan Normal University, School of Social Affairs, Henan, China, Xinxiang, China
• ⁶ Atlantica Instituto Universitario, Gestao em Saude, Oeiras, Portugal
• ⁷ Qingdao University Archives, Qingdao, Human, China, Qingdao, China

Objective: To ascertain the prevalence of asthma attacks among archivists and identify the associated occupational factors in this understudied professional population. Methods: We conducted a cross-sectional, questionnaire-based study among 1002 archival workers. A multiple logistic regression was conducted to identify the association between asthma attacks and occupational exposures. The Strobe Protocol was applied. Results: 999 workers were included in the final analysis with the asthma prevalence of 33.3%. Main factors associated with asthma attacks (OR [95% CI]) were the presence of chemically irritating odors (2.152 [1.532-3.024]), mold odors (1.747 [1.148-2.658]), and insects (1.409[1.041-1.907]). A significant synergistic effect was observed between chemical irritants and mold, the odds ratio was 7.098 (95% CI:4.752 -10.603). Conclusions: There was a high prevalence of asthma attacks among archival workers, an under-studied population. Chemical irritants, molds and insects were associated with their asthma attacks. Notably, this study's data analysis has revealed a strong synergy (OR=7.098) between chemical odors and molds in the workplace. While the existing international literature on this specific interaction remains somewhat limited, previous studies have already demonstrated the potential for chemical irritants, such as sulfur dioxide and ozone, to synergistically interact with inhalable allergens, including fungi, molds and dust mites. Consequently, this interaction seems to exacerbate asthma symptoms and perpetuate untreated exposure. Furthermore, in damp and damaged buildings, the presence of microbial components, such as cellular debris or spores released during fungal growth can trigger an inflammatory response, potentially served as a shared pathway for the development of asthma among individuals exposed to these hazardous factors.