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

Abstract

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.

Chronic exposure to emissions from photocopiers in copy shops causes oxidative stress and systematic inflammation among photocopier operators in India

“…CC-16 levels in serum increase when lung epithelium permeability is adversely affected by air pollutants or other lung toxicants. On the contrary, reduced levels of CC-16 in lung lavage fluid occur in several lung disorders, probably due to a decrease in the production of CC-16 as a consequence of a depletion of Clara cells [79]. In the present study, neither significant increase nor significant decrease was observed in the plasma levels of CC-16 of photocopier operators indicating insignificant effects of the PM on the lung epithelium which is surprising.…”

Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools

“…[21] Swimming pool workers have also experienced symptoms associated with the lower respiratory tract and an increased risk of asthma. [22] Trichloramine levels of 100 or 570 mg/m 3 have been associated with work-related asthma in personnel working at indoor swimming pools. [12] Trichloramine exposure and the occurrence of asthma among swimming pool employees have also been described by Rosenman, Millerick-May, and Reilly et al [23] At present, there is no OEL for trichloramine adopted in Sweden.…”

Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes

“…67,68 Healthy adults have also been shown to have decreases in lung function when exposed to pool air during exercise (0.8% FEV 1 decrease). 69 On biopsy, swimmers have similar inflammatory and remodeling changes as mild asthmatics and increased mucin levels. 70 Belgian researchers have found strong evidence of a relationship between chlorine exposure and asthma, or exercise-induced bronchospasm, in children (for children with high immunoglobulin E, OR 1.79 per 100-hour increase in lifetime pool attendance, CI 1.07-2.72), 71 (OR if children swam as infants 3.0, CI 1.3-7.4 ), 72 (adolescents with highest pool exposure have an OR 3.74, CI 1.40-9.93, population-attributable risk of asthma 63.5% ).…”