Indoor swimming pools, water chlorination and respiratory health

Nemery, Benoît; Hoet, Peter; Nowak, Dennis

doi:10.1183/09031936.02.00308602

Cited by 89 publications

(77 citation statements)

References 32 publications

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“…In the present study, we found significant improvement in In spite of recent evidence suggesting that chlorine exposure during swimming may be associated with an increase in the frequency of asthma attacks, 31,32 there is considerable evidence 1 that swimming in a heated indoor pool environment, which provides warm, moist air for inhalation, is still far less asthmogenic than other types of exercise, such as running or cycling. 2 The harmful effects of chlorine appear to be dependent on concentration and length of exposure, and still require further study.…”

Section: Allergy Skin Testingcontrasting

confidence: 45%

Avaliação espirométrica e da hiper-responsividade brônquica de crianças e adolescentes com asma atópica persistente moderada submetidos a natação

Wicher¹,

Ribeiro²,

Marmo³

et al. 2010

J. Pediatr. (Rio J.)

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Objective: To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma (MPAA). Methods:A randomized, prospective study of children and adolescents (age 7-18 years) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil. After a 1-month run-in period, 61 patients (34 female) were randomized into two groups, a swimming group (n = 30) and a control group (n = 31), and followed for 3 months. Both patient groups received inhaled fluticasone (dry powder, 250 mcg twice a day) and salbutamol as needed. The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions. Both groups underwent spirometric assessment and methacholine challenge test -provocative concentration of methacholine causing a 20% fall in FEV 1 (PC 20 ) -before and after the study period. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured only in the swimming group.

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Section: Allergy Skin Testingcontrasting

confidence: 45%

Avaliação espirométrica e da hiper-responsividade brônquica de crianças e adolescentes com asma atópica persistente moderada submetidos a natação

Wicher¹,

Ribeiro²,

Marmo³

et al. 2010

J. Pediatr. (Rio J.)

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“…Furthermore, a positive dose-effect relationship was found between pool attendance in adults and children and serum surfactant protein-A and -B, which are markers of lung epithelium hyperpermeability in a variety of acute or chronic lung disorders [8,9]. However, as swimming is often considered healthy for asthmatics, especially for children, asthma-related referral to improve their general condition might play a role in exacerbating their symptoms and the meaning of changes in biomarker levels is unclear [6]. The analysis made use of an ecological approach and thus might have led to artificial relationships between the studied end-points and pool attendance.…”

mentioning

confidence: 99%

“…This study showed that specific swimming pool-induced asthma might be an occupational risk. However, the study only involved three individuals and the mechanisms remain elusive [6].…”

mentioning

confidence: 99%

Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers

Jacobs¹,

Spaan²,

Rooy³

et al. 2007

European Respiratory Journal

180

139

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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.

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“…(17) The benefits of swimming for individuals with asthma are reinforced by studies that suggest a reduction in the symptoms, (18) improved endurance (19) and reduction in EIB intensity. (20) However, there are reports showing that the disinfection of the pools with chlorine-based products can cause airway irritation and alterations, (20)(21)(22) which are wellestablished in elite swimmers but unknown in amateur swimmers. These alterations have been thought to be associated with the intensity of the training and chronic exposure to chlorine.…”

Section: Resultsmentioning

confidence: 99%

“…(8) The procedure most commonly used for disinfection of the water in swimming pools is treatment with chlorine-based products. These are concentrated on the surface of the water (9) and can also cause undesirable effects on the respiratory system, as has been shown in studies involving elite swimmers. (10) There is evidence that these swimmers present a higher prevalence of bronchial hyperresponsiveness when compared to athletes participating in other sports.…”

Section: Questionnairementioning

confidence: 99%

Frequência de sintomas de asma e de redução da função pulmonar entre crianças e adolescentes nadadores amadores

Fiks

Santos

Antunes³

et al. 2009

J. bras. pneumol.

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Objective: To investigate the incidence of asthma symptoms in young amateur swimmers, and to describe the clinical treatment of the children with asthma in a private sports club in the city of São Paulo, Brazil. Methods: The study included 171 amateur swimmers, ranging from 6 to14 years of age. All of the participants or their legal guardians were asked to complete the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and 119 were submitted to pulmonary function testing at rest. Results: The overall incidence of asthma symptoms (ISAAC score ≥ 6) among the swimmers was 16.8%. Of the 119 swimmers submitted to spirometry, 39 (32.7%) presented spirometric alterations (FEV 1 /FVC < 0.75). Among those with an ISAAC score ≥ 6, there were 10 (31.2%) who stated that they were receiving no asthma treatment. Of those who reported receiving pharmacological treatment, 24% made use of bronchodilators but not of corticosteroids. Conclusions: The incidence of asthma symptoms and pulmonary function alterations among amateur swimmers within the 6-14 age bracket was high. In addition, a relevant proportion of these athletes were receiving no treatment.Keywords: Asthma/therapy; Asthma/diagnosis; Child; Swimming; Exercise. ResumoObjetivo: Investigar a frequência de sintomas de asma entre crianças e adolescentes nadadores amadores e descrever o tratamento clínico entre as crianças asmáticas em um clube esportivo privado na cidade de São Paulo. Métodos: Foram incluídos no estudo 171 nadadores amadores de 6 a 14 anos de idade. Todos os participantes ou seus responsáveis foram solicitados a responder o questionário International Study of Asthma and Allergies in Childhood (ISAAC), e 119 realizaram prova de função pulmonar em repouso. Resultados: A frequência geral de sintomas de asma (ISAAC ≥ 6 pontos) entre os nadadores foi de 16,8%. Entre os 119 nadadores que realizaram a espirometria, 39 (32,7%) apresentaram alterações espirométricas (VEF 1 /CVF < 0,75). Entre os sujeitos com escore ISAAC ≥ 6, 10 (31,2%) alegaram não realizar nenhum tipo de tratamento para a doença. Daqueles que afirmaram realizar tratamento medicamentoso, 24% faziam uso de broncodilatadores mas não de corticosteroides. Conclusões: A frequência de sintomas de asma e de alterações da função pulmonar em nadadores amadores de 6 a 14 anos foi elevada. Além disso, uma proporção considerável destes atletas não recebia tratamento.

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Indoor swimming pools, water chlorination and respiratory health

Cited by 89 publications

References 32 publications

Avaliação espirométrica e da hiper-responsividade brônquica de crianças e adolescentes com asma atópica persistente moderada submetidos a natação

Avaliação espirométrica e da hiper-responsividade brônquica de crianças e adolescentes com asma atópica persistente moderada submetidos a natação

Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers

Frequência de sintomas de asma e de redução da função pulmonar entre crianças e adolescentes nadadores amadores

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