Attendance at chlorinated indoor pools and risk of asthma in adult recreational swimmers

Ferrari, Marcello; Schenk, Kai; Mantovani, William; Papadopoulou, Christina; Posenato, Chiara; Ferrari, Pietro; Poli, Albino; Tardivo, Stefano

doi:10.1016/j.jsams.2010.12.006

Cited by 24 publications

(24 citation statements)

References 27 publications

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“…The present findings support the previously advanced hypothesis7 13 19 21 that exposures to NCl 3 levels commonly occurring in indoor swimming-pool environments can cause acute airway and mucosal symptoms as well as changes in lung function and deterioration of asthma.…”

Section: Discussionsupporting

confidence: 92%

“…The fact that there was a tendency towards a decreasing risk of asthma in workers with longer work history may indicate a healthy worker effect due to the irritating properties of NCl 3 in pool environments. A recent study21 reported a higher prevalence (4.5%) of new-onset asthma among recreational swimmers with >320 h of cumulative pool attendance compared to 0.4% among swimmers with <320 h of pool attendance, thus supporting a role for exposure at chlorinated pools for development of asthma. In children engaged in recreational swimming, a statistically significant relationship was shown between cumulative attendance at indoor swimming-pools and the probability of developing asthma in those with increased total IgE in serum 13 19.…”

Section: Discussionmentioning

confidence: 94%

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Lung function in volunteers before and after exposure to trichloramine in indoor pool environments and asthma in a cohort of pool workers

et al. 2012

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ObjectivesExposure to trichloramine (NCl3) in indoor swimming-pool environments is known to cause mucous membrane irritation, but if it gives rise to changes in lung function or asthma in adults is not known. (1) We determined lung function in volunteers before and after exposure to indoor pool environments. (2) We studied the occurrence of respiratory symptoms and asthma in a cohort of pool workers.Design/methods/participants(1) We studied two groups of volunteers, 37 previously non-exposed healthy persons and 14 pool workers, who performed exercise for 2 h in an indoor pool environment. NCl3 in air was measured during pool exposures and in 10 other pool environments. Filtered air exposures were used as controls. Lung function and biomarkers of pulmonary epithelial integrity were measured before and after exposure. (2) We mailed a questionnaire to 1741 persons who indicated in the Swedish census 1990 that they worked at indoor swimming-pools.Results(1) In previously non-exposed volunteers, statistically significant decreases in FEV1 (forced expiratory volume) and FEV% (p=0.01 and 0.05, respectively) were found after exposure to pool air (0.23 mg/m3 of NCl3). In pool workers, a statistically significant decrease in FEV% (p=0.003) was seen (but no significant change of FEV1). In the 10 other pool environments the median NCl3 concentration was 0.18 mg/m3. (2) Our nested case/control study in pool workers found an OR for asthma of 2.31 (95% CI 0.79 to 6.74) among those with the highest exposure. Exposure-related acute mucous membrane and respiratory symptoms were also found.ConclusionsThis is the first study in adults showing statistically significant decreases in lung function after exposure to NCl3. An increased OR for asthma among highly exposed pool workers did not reach statistical significance, but the combined evidence supports the notion that current workroom exposures may contribute to asthma development. Further research on sensitive groups is warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Lung function in volunteers before and after exposure to trichloramine in indoor pool environments and asthma in a cohort of pool workers

et al. 2012

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“…These results are similar to those reported previously for swimmers and athletes. [8][9][10] Swimmers with rhinitis could have concomitant asthma; 8,12,20 therefore, indoor pool workers should also be checked for allergic disease of the inferior airway.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies of swimmers have been performed, but fewer studies have focused on pool workers. [8][9][10][11][12] In one study, swimmers had poorer nasal functions compared to runners, but only the post-nasal drip was significantly different between the two groups. The authors concluded that the results supported the existence of swimming-induced rhinitis independent of the atopic status of the athlete.…”

Section: Introductionmentioning

confidence: 96%

“…The most frequent symptoms are red eyes, a runny nose, loss of voice and cold-like symptoms. 12,13 These symptoms are due to irritation of the nasal mucosa and can be investigated using nasal cytology. Nasal smears can be assessed easily using light microscopy and can reveal relevant information about the predominant cell types infiltrating the nasal cavity.…”

Section: Introductionmentioning

confidence: 99%

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Effects of indoor swimming pools on the nasal cytology of pool workers

Erkul

Yaz²,

Cingi

et al. 2014

J. Laryngol. Otol.

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Objective: We aimed to evaluate the relationship between swimming pool pollutants and allergic rhinitis in swimming pool workers.Materials and methods: Twenty-seven indoor pool workers (group 1) and 49 control subjects (group 2) were enrolled in the study. A skin prick test was performed and a nasal smear was obtained from each subject to evaluate rhinitis.Results: When the groups were compared in terms of epithelial cells, group 1 had significantly more epithelial cells than group 2. When the groups were compared with regard to eosinophils, group 1 had significantly more eosinophils than group 2. The skin prick test results for both groups were not significantly different.Conclusion: Indoor pool workers showed severe symptoms of rhinitis and eosinophilic nasal cytology, likely due to chlorine. Nasal cytology is an easy-to-administer diagnostic test and can be used to follow up rhinitis in indoor pool workers, along with nasal endoscopy, a detailed clinical history and a skin prick test. IntroductionUnder optimal nasal breathing conditions, air passes over the nasal mucosa resulting in warming, humidification and cleansing. However, these conditions can be influenced by several factors. Indoor air quality may negatively affect the sinonasal mucosa and is associated with occupational and smoking irritants, which can cause chronic or allergic rhinitis. 1 To maintain proper nasal functions, the optimal indoor air temperature should be approximately 23°C with 50 per cent humidity. 2 Indoor air is often cleaned to limit the levels of pollutants by modifying temperature and humidity in houses and offices. 2 However, the improper maintenance, design and operating of air-conditioning systems in non-industrial indoor areas contributes to an increased prevalence of rhinitis. 3 In Turkey, smoking is prohibited indoors and in common social areas.Allergic rhinitis is a symptomatic disorder caused by immunoglobulin E-mediated inflammation of the nasal membranes, which is induced by exposure to an allergen or allergens. Allergic rhinitis frequently causes symptoms that include sneezing, nasal obstruction,

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Air Quality and Temperature Effects on Exercise‐Induced Bronchoconstriction

Rundell

Anderson

Sue‐Chu

et al. 2015

Comprehensive Physiology

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Exercise-induced bronchoconstriction (EIB) is exaggerated constriction of the airways usually soon after cessation of exercise. This is most often a response to airway dehydration in the presence of airway inflammation in a person with a responsive bronchial smooth muscle. Severity is related to water content of inspired air and level of ventilation achieved and sustained. Repetitive hyperpnea of dry air during training is associated with airway inflammatory changes and remodeling. A response during exercise that is related to pollution or allergen is considered EIB. Ozone and particulate matter are the most widespread pollutants of concern for the exercising population; chronic exposure can lead to new-onset asthma and EIB. Freshly generated emissions particulate matter less than 100 nm is most harmful. Evidence for acute and long-term effects from exercise while inhaling high levels of ozone and/or particulate matter exists. Much evidence supports a relationship between development of airway disorders and exercise in the chlorinated pool. Swimmers typically do not respond in the pool; however, a large percentage responds to a dry air exercise challenge. Studies support oxidative stress mediated pathology for pollutants and a more severe acute response occurs in the asthmatic. Winter sport athletes and swimmers have a higher prevalence of EIB, asthma and airway remodeling than other athletes and the general population. Because of fossil fuel powered ice resurfacers in ice rinks, ice rink athletes have shown high rates of EIB and asthma. For the athlete training in the urban environment, training during low traffic hours and in low traffic areas is suggested.

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Attendance at chlorinated indoor pools and risk of asthma in adult recreational swimmers

Cited by 24 publications

References 27 publications

Lung function in volunteers before and after exposure to trichloramine in indoor pool environments and asthma in a cohort of pool workers

Lung function in volunteers before and after exposure to trichloramine in indoor pool environments and asthma in a cohort of pool workers

Effects of indoor swimming pools on the nasal cytology of pool workers

Air Quality and Temperature Effects on Exercise‐Induced Bronchoconstriction

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