Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers

Abstract

The association between swimming pool characteristics and activities of employees and respiratory symptoms in employees was studied. Trichloramine levels were measured to evaluate relationships with pool characteristics and to estimate long-term exposure levels.Questionnaires were available from 624 pool workers and 38 swimming facilities. Chloramine levels were measured by area sampling over 2-h periods and analysed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyperresponsiveness were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modelled with regression analysis. This model was used to estimate long-term average chloramine levels for each pool studied.Employees with higher exposure reported upper respiratory symptoms with greater frequency. Upper respiratory symptoms were statistically significantly associated with cumulative chloramine levels (odds ratio (OR) .1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared with a Dutch population sample (OR ranged 1.4-7.2).An excess risk for respiratory symptoms indicative of asthma was observed in swimming pool employees. Aggravation of existing respiratory disease or interactions between irritants and allergen exposures are the most likely explanations for the observed associations.

Airway irritation among indoor swimming pool personnel: trichloramine exposure, exhaled NO and protein profiling of nasal lavage fluids

“…In general, the levels of trichloramine found in this study (about 0.2 mg/m 3 in the 9 facilities) are relative low compared to several other studies, which have shown levels about 0.5 mg/m 3 (Dang et al 2010;Jacobs et al 2007;Thickett et al 2002). Almost all of the facilities in this study had baths are believed to generate higher trichloramine levels .…”

“…However, people frequently being in the environment often experience airway, eye or dermatological problems (WHO 2006;Nemery et al 2002). Several studies have showed that personnel, like lifeguards and pool attendants, suffer from nasal and throat symptoms, often together with eye irritation (Massin et al 1998;Demange et al 2009;Dang et al 2010;Fantuzzi et al 2010;Jacobs et al 2007). There are also studies indicating that children frequently visiting indoor swimming pools have an increased risk to develop asthma and allergy (Bernard et al 2005;Bernard et al 2006), although the opposite has also been found (Font-Ribera et al 2011).…”

“…It is also predicted that crowded modern adventure bath with waterfalls, water slides and bubble pools could generate higher trichloramine levels in the air (Hery et al 1995;Richardson et al 2010). There are still gaps in the knowledge about the health effects of trichloramine, but many studies suggests it as the most important cause for airway symptoms among employees and visitors (Massin et al 1998;Jacobs et al 2007; Levesque et al 2006). In addition, trichloramine induced occupational asthma has been reported (Thickett et al 2002).…”

Swimming pool, respiratory health, and childhood asthma: Should we change our beliefs?

“…They showed that lifeguards of both sexes exposed to trichloramine were at risk of developing acute irritantrelated eye, nose, and throat symptoms, but they were unable to show a relationship between cumulative exposure to trichloramine and bronchial responsiveness to methacholine. 25 In a more recent study from the Netherlands, Jacobs et al 26 found an elevated prevalence of respiratory symptoms in swimming pool workers compared with the Dutch general population.…”

Potential negative effects of chlorinated swimming pool attendance on health of swimmers and associated staff

“…Recently, Jacobs et al [43] . A regression analysis of the data proved that the number of users in the water was significantly associated to the trichloramine level, in such a way that an increase of 50 additional swimmers meant a 0.40 mg/m 3 rise.…”