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Lee BA. Effect of exposure to disinfection by-products during swimming exercise on asthma-related immune responses. JOURNAL OF WATER AND HEALTH 2024; 22:735-745. [PMID: 38678426 DOI: 10.2166/wh.2024.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/13/2024] [Indexed: 04/30/2024]
Abstract
Swimming is a widely practiced exercise in modern society, where there is a heightened interest in health. The exceptional benefits of swimming are well-known, yet the issue of water quality management inevitably arises due to its nature as an aquatic exercise. Several studies reported that chlorine disinfectants commonly used in swimming pool water disinfection could degrade into toxic disinfection by-products (DBPs) and suggested that the DBPs might induce respiratory disorders, including asthma. Conversely, there were also reports that the DBPs had no significant effects on respiratory conditions. In this study, we investigated the influence of swimming exercise and DBPs on asthma. The decomposition products had little effect on the number of T cells in various immune organs. However, swimming exercise was found to increase the cell count in proportion to the exercise duration. Nevertheless, there were no significant changes in other immune cells and the secretion of asthma-related cytokines. These findings indicate that the effects of swimming pool DBPs on respiratory conditions during swimming exercise are either negligible or absent, and instead, the immunological benefits gained through consistent swimming exercise outweigh any potential drawbacks.
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Affiliation(s)
- Bo-Ae Lee
- Department of Sport Science, College of Liberal Arts, Dongguk University, 38066 Gyeongsangbuk-do, Gyeongju, South Korea E-mail:
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2
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Kawabata A, Motoyama Y, Takeuchi J, Kusunoki T. Swimming was associated with rhinitis and pollinosis in a duration-dependent manner. Pediatr Int 2024; 66:e15758. [PMID: 38780222 DOI: 10.1111/ped.15758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Previous studies have reported conflicting results regarding the effects of childhood swimming on respiratory allergic symptoms. We investigated the relationship between swimming and respiratory allergic symptoms in schoolchildren. METHODS A questionnaire regarding participation in sports club activities and respiratory allergic symptoms in schoolchildren was distributed to the parents of all 6853 public school students (aged 6-14 years) in Omihachiman City, Shiga, Japan. The relationships between participation in sports club activities and the prevalence of respiratory allergic symptoms were analyzed by multivariable logistic regression analyses. RESULTS Questionnaires were returned for 4991 schoolchildren (response rate: 72.8%). Logistic regression analysis revealed significant positive associations between swimming and rhinitis (42.9% vs. 38.9%; adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.44), and swimming and pollinosis (32.1% vs. 28.1%; adjusted odds ratio, 1.28; 95% confidence interval, 1.11-1.47). The duration of participation in swimming activities was also significantly positively associated with the prevalence of rhinitis and pollinosis. Those who had participated in swimming activities for 6 years or more showed significantly higher prevalences of rhinitis and pollinosis (46.3% and 36.4%, respectively) than those without swimming activities (38.9% and 28.1%, respectively) and those who had participated in swimming activities for 5 years or less (40.1% and 28.5%, respectively). CONCLUSIONS Swimming was associated with the prevalence of rhinitis and pollinosis in schoolchildren, especially among those who had participated in swimming activities for 6 years or more. Preventive measures and early interventions for rhinitis and pollinosis should be recommended to these children.
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Affiliation(s)
- Ayu Kawabata
- Laboratory of Child Health and Nutrition, Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan
| | - Yuie Motoyama
- Laboratory of Child Health and Nutrition, Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Kusunoki
- Laboratory of Child Health and Nutrition, Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan
- Department of Pediatrics, Shiga Medical Center for Children, Shiga, Japan
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3
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Lee BA. Effects of disinfection by-products in swimming pool environments on the immunological mechanisms of respiratory diseases. JOURNAL OF WATER AND HEALTH 2023; 21:1600-1610. [PMID: 37902213 PMCID: wh_2023_335 DOI: 10.2166/wh.2023.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Swimming in pools is a popular and healthy recreational activity. However, potential adverse health effects from disinfection byproduct (DBP) exposure in pool water are concerning. This study evaluated how such DBP exposure affects the respiratory system. DBP exposure was simulated with an animal-specific pool environment model. Experimental animals were exposed to DBPs for a specified duration and frequency over 4 weeks. The wet and dry weights of murine lungs were measured, with no significant differences observed. There were no significant differences in interkeukin (IL)-2/4/10, and interferon-γ levels. However, IL-6 expression decreased in the experimental group. To investigate the effects of DBP exposure on immune cell response, various samples, such as bronchoalveolar lavage fluid, lymph nodes, spleen, and thymus, were collected for T-cell isolation and fluorescence-activated cell sorting. Asthma-related blood cell distribution was analyzed using a complete blood count test; no significant differences were found. Thus, DBP exposure through this model did not induce substantial lung tissue damage, major alterations in cytokine expression (besides IL-6), significant immune cell responses, or changes in asthma-associated blood cell distribution. However, considering earlier results, future studies should focus on specific types, intensity, and duration of exercise that could affect DBP exposure-related immune-inflammatory responses.
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Affiliation(s)
- Bo-Ae Lee
- Department of Sport Science, College of Liberal Arts, Dongguk University, 38066, Gyeongsangbuk-do, Gyeongju, South Korea E-mail:
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4
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O'Connor C, McCarthy S, Murphy M. Pooling the evidence: A review of swimming and atopic dermatitis. Pediatr Dermatol 2023; 40:407-412. [PMID: 37029288 PMCID: PMC10946598 DOI: 10.1111/pde.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
Swimming is an excellent form of aerobic exercise and is an essential life skill. Many children with atopic dermatitis (AD) are advised not to swim because of concerns about negative impacts on their skin disease, and some children with AD do not swim because they are self-conscious about the appearance of their skin. We aimed to perform a narrative review of the available literature on swimming and AD and scientifically analyze the potential impact of all components of swimming in AD-water, skin barrier, swimming gear, and exercise. Studies examined the impact of swimming on the skin barrier and the relative contraindications to swimming. Constituents of water which may affect AD include hardness, pH, temperature, antiseptics, and other chemicals. Potential interventions to reduce damage included emollient application, special swim gear, and showering post-submersion. The benefits of swimming as a form of exercise in AD included reduced sweating, cardiorespiratory fitness, and maintenance of healthy weight. Drawbacks of swimming as a form of exercise in AD included the limited benefit on bone mineral density. Future research should examine the impact of swimming on flares of AD using noninvasive biomarkers as well as clinical severity assessment and assess the role for different types of emollient as an intervention for optimal eczema control. This review highlights gaps in the scientific literature on swimming and AD and provides evidence-based guidance on interventions to minimize deleterious effects on skincare and maximize opportunities for children with AD to swim.
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Affiliation(s)
- Cathal O'Connor
- DermatologySouth Infirmary Victoria University HospitalCorkIreland
- Paediatrics and Child HealthCork University HospitalCorkIreland
- MedicineUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Siobhan McCarthy
- DermatologySouth Infirmary Victoria University HospitalCorkIreland
- MedicineUniversity College CorkCorkIreland
| | - Michelle Murphy
- DermatologySouth Infirmary Victoria University HospitalCorkIreland
- MedicineUniversity College CorkCorkIreland
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5
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Abilleira E, Goñi-Irigoyen F, Aurrekoetxea JJ, Cortés MA, Ayerdi M, Ibarluzea J. Swimming pool water disinfection by-products profiles and association patterns. Heliyon 2023; 9:e13673. [PMID: 36865475 PMCID: PMC9970905 DOI: 10.1016/j.heliyon.2023.e13673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
The aim of this work was to determine and study the concentration of different groups of disinfection by-products (DBPs): trihalomethanes, haloacetic acids, haloacetonitriles, haloacetones and combined chlorine (as an indicator of chloramine levels), in the water of 175 public swimming pools in Gipuzkoa (Basque Country, Spain). The study included chlorinated and brominated pools, indoor and outdoor, used for recreational and sports purposes, and filled with water from calcareous and siliceous soils. The most abundant were haloacetic acids, followed by trihalomethanes, with chlorinated or brominated forms predominating depending on whether the pools were disinfected by chlorination or bromination, respectively. All the 75th percentiles of DBPs were below the limits established by the European Chemical Agency (ECHA), although the maximum values of trihalomethanes exceeded them. The same was true for dichloroacetonitrile in chlorinated pools and dibromoacetonitrile in brominated pools. All families of DBPs showed positive associations with each other, all being significant except for combined chlorine. Their mean levels were higher in outdoor pools than in indoor pools, significantly so in all except combined chlorine. Recreational pools showed higher levels of haloacetic acids and combined chlorine than sports pools. The concentrations of the different groups of DBPs were higher in the pools than in the mains water that fed them. This increase, especially that of the haloacetonitriles, as well as the high concentrations of brominated forms in the pools disinfected by bromination, make it necessary to focus on their toxicological implication. The differences in the DBP profiles of the filling network water were not transferred to the pool water.
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Affiliation(s)
- Eunate Abilleira
- Ministry of Health of the Basque Government, Public Health Laboratory in Gipuzkoa, Av. Navarra, 4, 20013 Donostia-San Sebastián, Spain,Epidemiology of Chronic and Comunnicable Diseases Area, Biodonostia Health Research Institute, P° Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Spain,Corresponding author. Ministry of Health of the Basque Government, Public Health Laboratory in Gipuzkoa, Av. Navarra, 4, 20013, Donostia-San Sebastián, Spain.
| | - Fernando Goñi-Irigoyen
- Ministry of Health of the Basque Government, Public Health Laboratory in Gipuzkoa, Av. Navarra, 4, 20013 Donostia-San Sebastián, Spain,Epidemiology of Chronic and Comunnicable Diseases Area, Biodonostia Health Research Institute, P° Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Spain,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Juan J. Aurrekoetxea
- Environmental Epidemiology and Child Development, Biodonostia Health Research Institute, P° Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Spain
| | - María A. Cortés
- Ministry of Health of Basque Government, Public Health Subdirectorate of Gipuzkoa, Av. Navarra, 4, 20013, Donostia-San Sebastián, Spain
| | - Mikel Ayerdi
- Environmental Epidemiology and Child Development, Biodonostia Health Research Institute, P° Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Spain,Ministry of Health of Basque Government, Public Health Subdirectorate of Gipuzkoa, Av. Navarra, 4, 20013, Donostia-San Sebastián, Spain
| | - Jesús Ibarluzea
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain,Environmental Epidemiology and Child Development, Biodonostia Health Research Institute, P° Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Spain,Ministry of Health of Basque Government, Public Health Subdirectorate of Gipuzkoa, Av. Navarra, 4, 20013, Donostia-San Sebastián, Spain,Facultad de Psicología de la UPV-EHU, Campus Gipuzkoa, Av. Tolosa, 70, 20018, Donostia-San Sebastián, Spain
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6
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Pandian AMK, Rajamehala M, Singh MVP, Sarojini G, Rajamohan N. Potential risks and approaches to reduce the toxicity of disinfection by-product - A review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 822:153323. [PMID: 35066044 DOI: 10.1016/j.scitotenv.2022.153323] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/08/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
Water contamination through anthropogenic and industrial activities has led to the emergence and necessity of disinfection methods. Chlorine and bromine gases, often used to disinfect water, resulted in the by-product formation by reacting with organic matter. The Disinfectant by-products (DBP) led to the formation of Trihaloaceticacid (TAA), Trihalomethane (THM), and other minor components. The release of chemicals has also led to the outbreak of diseases like infertility, asthma, stillbirth, and types of cancer. There are new approaches that are found to be useful to compensate for the generation of toxic by-products and involve membrane technologies, namely reverse osmosis, ultrafiltration, and nanofiltration. This review mainly focuses on the toxicology effects of DBPs and various approaches to mitigate the same. The health hazards caused by different DBPs and the various treatment techniques available for the removal are discussed. In addition, a critical comparison of the different removal techniques was discussed.
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Affiliation(s)
- A Muthu Kumara Pandian
- Department of Biotechnology, Vivekanandha College of Engineering for Women (Autonomous), Tiruchengode, Namakkal 637205, India.
| | - M Rajamehala
- Department of Biotechnology, Vivekanandha College of Engineering for Women (Autonomous), Tiruchengode, Namakkal 637205, India
| | - M Vijay Pradhap Singh
- Department of Biotechnology, Vivekanandha College of Engineering for Women (Autonomous), Tiruchengode, Namakkal 637205, India
| | - G Sarojini
- Department of Petrochemical Engineering, SVS College of Engineering, Coimbatore, India
| | - N Rajamohan
- Chemical Engineering Section, Sohar University, Sohar, Oman
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7
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Ahmadpour E, Halle S, Valois I, Ryan PE, Haddad S, Rodriguez M, El Aroussi B, Simard S, Delpla I, Proulx F, Tardif R, Debia M. Temporal and spatial variations in the levels of prominent airborne disinfection by-products at four indoor swimming pools. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:185-196. [PMID: 35119975 DOI: 10.1080/15459624.2022.2035741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Exposure to airborne disinfection by-products, especially trichloramine and trichloromethane, may cause various adverse health effects for the workers and users of indoor swimming pools. This study aims to evaluate the spatial and temporal variations in trichloramine and trichloromethane concentrations within and between swimming pools. Workplace measurements were carried out at four indoor swimming pools in Quebec (Canada) during the cold season. To fully represent daily operating conditions, sampling started 2 hr before the swimming pool opened and continued until 2 hr after closing. To quantify trichloramine and trichloromethane concentrations, 304 air samples have been collected. Temperature, humidity, and CO2 were measured-simultaneously every 2 hr. The results showed that both trichloramine and trichloromethane concentrations varied significantly in time. The observed daily variations in trichloramine and trichloromethane concentrations suggest that the common practice of collecting a single 2-hr air sample does not represent daily pool trichloramine and trichloromethane contamination levels and, consequently, does not represent the true exposure and health risks for workers that are present for a full 8-hr shift. This study recommends a new 8-hr sampling strategy or a full-shift strategy using a cassette with three impregnated filters as a valid and cost-effective solution for comparing time-weighted average (TWA) concentrations to permissible trichloramine exposure limits.
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Affiliation(s)
- Elham Ahmadpour
- Department of Environmental and Occupational Health, School of Public Health, Le Centre de recherche en santé publique (CReSP), Université de Montréal, Montreal, Quebec, Canada
| | - Stephan Halle
- Department of Mechanical Engineering, École de Technologie Supérieure (ETS), Montreal, Quebec, Canada
| | - Isabelle Valois
- Department of Environmental and Occupational Health, School of Public Health, Le Centre de recherche en santé publique (CReSP), Université de Montréal, Montreal, Quebec, Canada
| | - Patrick Eddy Ryan
- Department of Environmental and Occupational Health, School of Public Health, Le Centre de recherche en santé publique (CReSP), Université de Montréal, Montreal, Quebec, Canada
| | - Sami Haddad
- Department of Environmental and Occupational Health, School of Public Health, Le Centre de recherche en santé publique (CReSP), Université de Montréal, Montreal, Quebec, Canada
| | - Manuel Rodriguez
- École supérieure d'aménagement du territoire et de développement régional (ESAD), Université Laval, Québec City, Quebec, Canada
| | - Badr El Aroussi
- Department of Environmental and Occupational Health, School of Public Health, Le Centre de recherche en santé publique (CReSP), Université de Montréal, Montreal, Quebec, Canada
| | - Sabrina Simard
- École supérieure d'aménagement du territoire et de développement régional (ESAD), Université Laval, Québec City, Quebec, Canada
| | - Ianis Delpla
- École supérieure d'aménagement du territoire et de développement régional (ESAD), Université Laval, Québec City, Quebec, Canada
| | - François Proulx
- École supérieure d'aménagement du territoire et de développement régional (ESAD), Université Laval, Québec City, Quebec, Canada
| | - Robert Tardif
- Department of Mechanical Engineering, École de Technologie Supérieure (ETS), Montreal, Quebec, Canada
| | - Maximilien Debia
- Department of Environmental and Occupational Health, School of Public Health, Le Centre de recherche en santé publique (CReSP), Université de Montréal, Montreal, Quebec, Canada
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8
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Couto M, Bernard A, Delgado L, Drobnic F, Kurowski M, Moreira A, Rodrigues‐Alves R, Rukhadze M, Seys S, Wiszniewska M, Quirce S. Health effects of exposure to chlorination by-products in swimming pools. Allergy 2021; 76:3257-3275. [PMID: 34289125 DOI: 10.1111/all.15014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/14/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.
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Affiliation(s)
- Mariana Couto
- Centro de Alergia Hospital CUF Descobertas Lisboa Portugal
| | - Alfred Bernard
- Louvain Centre for Toxicology and Applied Pharmacology Institute of Experimental and Clinical Research (IREC) Catholic University of Louvain Brussels Belgium
| | - Luís Delgado
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de ImunoalergologiaCentro Hospitalar de São João E.P.E. Porto Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
| | | | - Marcin Kurowski
- Department of Immunology and Allergy Medical University of Łódź Łódź Poland
| | - André Moreira
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de ImunoalergologiaCentro Hospitalar de São João E.P.E. Porto Portugal
- Epidemiology Research Unit‐ Instituto de Saúde Pública Universidade do Porto Porto Portugal
| | | | - Maia Rukhadze
- Center of Allergy & Immunology Teaching University Geomedi LLC Tbilisi Georgia
| | - Sven Seys
- Laboratory of Clinical Immunology Department of Clinical Immunology KU Leuven Leuven Belgium
| | - Marta Wiszniewska
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland
| | - Santiago Quirce
- Department of Allergy La Paz University HospitalIdiPAZ, and Universidad Autónoma de Madrid Madrid Spain
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9
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Sun Y, Xia PF, Xie J, Mustieles V, Zhang Y, Wang YX, Messerlian C. Association of blood trihalomethane concentrations with asthma in U.S. adolescents: nationally representative cross-sectional study. Eur Respir J 2021; 59:13993003.01440-2021. [PMID: 34625481 PMCID: PMC9133491 DOI: 10.1183/13993003.01440-2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
Background Population studies show that the use of swimming pools is associated with the risk of asthma and allergic diseases among children. Our objective was to explore the associations between blood trihalomethane (THM) concentrations and asthma among US adolescents, and assess to what extent the association is modified by active tobacco smoke exposure. Methods We included 2359 adolescents aged 12–19 years with measured blood concentrations of chloroform (trichloromethane (TCM)), bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform (tribromomethane (TBM)) from the National Health and Nutrition Examination Survey 2005–2012. Logistic regression models were fitted to assess the odds ratios for the association of blood THM concentrations (three or four categories) with the risk of self-reported current and ever (lifetime) asthma. Results Blood DBCM concentrations were associated with a higher risk of ever asthma among all adolescents (OR 1.54 (95% CI 1.07–2.21), comparing the extreme exposure categories). The relationship was stronger among adolescents exposed to tobacco smoke (OR 3.96 (95% CI 1.89–8.30), comparing the extreme exposure categories). We also found positive relationships between blood brominated THM concentrations (sum of BDCM, DBCM and TBM) and risk of ever asthma and between blood DBCM and brominated THM concentrations and risk of current asthma among adolescents with tobacco smoke exposure. The relative excess risk of ever asthma due to the interaction between high blood DBCM and brominated THM concentrations and tobacco smoke exposure was 1.87 (95% CI 0.30–3.43) and 0.78 (95% CI 0.07–1.49), respectively. Conclusions Exposure to THMs is associated with a higher risk of asthma in adolescents, particularly among those exposed to tobacco smoke. Among a representative sample of 2359 US adolescents, we found that exposure to THMs was associated with a greater risk of asthma, particularly among those who were co-exposed to tobacco smokehttps://bit.ly/3mpHxgq
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Affiliation(s)
- Yang Sun
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peng-Fei Xia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Xie
- Department of Gastroenterology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Vicente Mustieles
- University of Granada, Center for Biomedical Research (CIBM), Granada, Spain.,Instituto de Investigación Biosanitaria Ibs GRANADA, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yi-Xin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Päivinen M, Keskinen K, Putus T, Kujala UM, Kalliokoski P, Tikkanen HO. Asthma, allergies and respiratory symptoms in different activity groups of swimmers exercising in swimming halls. BMC Sports Sci Med Rehabil 2021; 13:119. [PMID: 34607605 PMCID: PMC8491406 DOI: 10.1186/s13102-021-00349-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 09/22/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Respiratory symptoms are common in competitive swimmers. However, among these and in swimmers at other activity levels the swimming distance, the total spent time in swimming halls and their medical background varies. Our objectives were, first, to assess their medical histories and the associations with respiratory symptoms among swimmers in different activity groups and then second, to study the pulmonary function findings and related medications in competitive swimmers who exercise in swimming hall environments the most. METHODS First, 1118 participants consisting of 133 competitive-, 734 fitness- and 251 occasional swimmers answered questionnaires concerning their medical background, their respiratory symptoms in connection to swimming distance and their amount of time spent in swimming halls. Secondly, in 130 competitive swimmers, pulmonary function was tested by spirometry and a specific questionnaire was used to assess respiratory symptoms, medical histories and prescribed medication. RESULTS Respiratory symptoms were reported by 18% of the studied swimmers. Competitive swimmers had significantly more symptoms than fitness- and occasional swimmers. Naturally competitive swimmers swum more than 2000 m and stayed by the pool more than 90 min, longer than the other activity groups of swimmers. Spirometry testing showed airway obstruction in 15 swimmers, which was 12% of the 130 competitive swimmers. 21 of them, had physician-diagnosed asthma and 16 of these individuals had prescribed medication for it. CONCLUSIONS Competitive swimmers had the highest swimming hall exposure and reported significantly more respiratory symptoms. A high prevalence of airway obstruction findings in competitive swimmers with asthma and allergies suggests a need for future recommendations for regular testing and special medical care for competitive swimmers.
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Affiliation(s)
- Marja Päivinen
- Department of Occupational Medicine, Faculty of Medicine, University of Turku, Turku, Finland.
- Institute of Clinical Medicine, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Kari Keskinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuula Putus
- Department of Occupational Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Pentti Kalliokoski
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Heikki O Tikkanen
- School of Medicine, Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
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11
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Denny SA, Quan L, Gilchrist J, McCallin T, Shenoi R, Yusuf S, Weiss J, Hoffman B. Prevention of Drowning. Pediatrics 2021; 148:peds.2021-052227. [PMID: 34253571 DOI: 10.1542/peds.2021-052227] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Drowning is a leading cause of injury-related death in children. In 2018, almost 900 US children younger than 20 years died of drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in prevention of drowning.
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Affiliation(s)
- Sarah A Denny
- Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio;
| | - Linda Quan
- Pediatric Emergency Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | | | - Tracy McCallin
- Children's Hospital of San Antonio, San Antonio, Texas.,Baylor College of Medicine, Houston, Texas
| | - Rohit Shenoi
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Shabana Yusuf
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jeffrey Weiss
- Phoenix Children's Hospital Medicine, Phoenix Children's Hospital, Phoenix, Arizona.,University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; and
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LORENSIA AMELIA, MUNTU CYNTHIAMARISCA, SURYADINATA RIVANVIRLANDO, SEPTIANI ROSLIN. Effect of lung function disorders and physical activity on smoking and non-smoking students. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E89-E96. [PMID: 34322622 PMCID: PMC8283647 DOI: 10.15167/2421-4248/jpmh2021.62.1.1763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
Background The number of young smokers is increasing, and hence their risk of respiratory problems. This risk is exacerbated by their low level of physical activity, which also reduces lung function. This study aimed to determine differences in lung function and levels of physical activity between smokers and non-smokers. Method This research was conducted from October 2019 to January 2020. The research design was cross-sectional, and a purposive sampling method was used. Pulmonary function was measured by means of spirometry, while physical activity was measured through a modified International Physical Activity Questionnaire (IPAQ). Results We enrolled 124 university students: 62 smokers and 62 non-smokers. A significant difference in lung function values (< 70 vs ≥ 70) was observed between smokers and non-smokers (p = 0.00). No difference (p = 0.907) in the level of physical activity was seen between smokers and non-smokers, with most subjects in both groups displaying moderate levels. Conclusions Students who smoked had more respiratory problems than those who did not. Although the level of physical activity did not correlate with respiratory problems, these problems were more common in the vigorous catgory.
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Affiliation(s)
- AMELIA LORENSIA
- Department of Clinical-Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya (UBAYA), Indonesia
- Correspondence: Amelia Lorensia, Fakultas Farmasi Universitas Surabaya (UBAYA), Jl. Raya Kalirungkut Surabaya 60293, Indonesia - E-mail: -
| | - CYNTHIA MARISCA MUNTU
- Department of Pharmaceutical, Faculty of Pharmacy, Universitas Surabaya (UBAYA), Indonesia
| | | | - ROSLIN SEPTIANI
- Bachelor Student of Faculty of Pharmacy, Faculty of Pharmacy, Universitas Surabaya (UBAYA), Indonesia
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13
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Ramachandran HJ, Jiang Y, Shan CH, Tam WWS, Wang W. A systematic review and meta-analysis on the effectiveness of swimming on lung function and asthma control in children with asthma. Int J Nurs Stud 2021; 120:103953. [PMID: 34051586 DOI: 10.1016/j.ijnurstu.2021.103953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Swimming has been considered the most appropriate activity for children with asthma for its lower asthmogenicity compared to land-based activities. However, the benefits of swimming have been hampered by reports of increased asthma risks, airway inflammation and bronchial hyper-responsiveness from exposure to chlorine by-products in swimming pools. Thus, the role of swimming for children with asthma remains unclear. OBJECTIVES To determine the effectiveness of swimming as an intervention on lung function and asthma control in children below the age of 18 years. Any adverse effects from swimming on asthma were also examined. METHODS Searches were performed across six databases systematically (PubMed, CINAHL, Embase, CENTRAL, Scopus, and PsycINFO). Randomized controlled trials (RCTs), quasi-experimental studies and interventional studies with at least one control/comparator group that were published in English were included. All eligible studies were screened with risk of bias examined by two independent reviewers. Meta-analyses were conducted using Review Manager 5.4 software while narrative syntheses were performed where meta-analysis was inappropriate and heterogeneity was present. RESULTS 1710 records were retrieved from the search. A total of 9 studies with 387 participants were included in this review after screening. Swimming was found to have favourable effects on forced expiratory volume in one second (L) and forced vital capacity (%), but not for forced expiratory volume in one second (%) and peak expiratory flow (%). Narrative synthesis on asthma control and adverse effects were in favour of the swimming group. CONCLUSION Future studies that are adequately powered, involve swimming interventions of sufficient intensity, frequency and duration, examine cumulative exposures to chlorine by-products and take into account potential cofounders are warranted.
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Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Coral Hui Shan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
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14
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Oviedo L, Lopera L, Lara PA, Castrillón F, Peñuela GA. Monitoring of chlorine decay in public swimming pools in Medellín (Colombia). ENVIRONMENTAL MONITORING AND ASSESSMENT 2020; 193:10. [PMID: 33319333 DOI: 10.1007/s10661-020-08779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
The present work shows the evaluation of the decay of free residual chlorine in several public swimming pools in the city of Medellín, observing that a decrease in residual chlorine does occur. Some factors accelerate the decrease in the concentration of free residual chlorine in recreational water, such as the number of bathers in the pool, the pH, and the temperature of the water. For this reason, the concentration of the disinfectant rapidly decreases to an extent that the health of swimmers could be put at risk. The Authority of Health of Medellín carries out inspection, surveillance and quality control activities of water for recreational use. These purposes of these include guaranteeing the reduction of risk factors to the health of the users of said pools.
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Affiliation(s)
- Lía Oviedo
- Pollution Diagnostics and Control Group (GDCON), School of the Environment, Faculty of Engineering, University Research Campus (SIU), University of Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia
| | - Laura Lopera
- Pollution Diagnostics and Control Group (GDCON), School of the Environment, Faculty of Engineering, University Research Campus (SIU), University of Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia
| | - Paula A Lara
- Pollution Diagnostics and Control Group (GDCON), School of the Environment, Faculty of Engineering, University Research Campus (SIU), University of Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia
| | | | - Gustavo A Peñuela
- Pollution Diagnostics and Control Group (GDCON), School of the Environment, Faculty of Engineering, University Research Campus (SIU), University of Antioquia (UdeA), Calle 70 No. 52-21, Medellín, Colombia.
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15
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Wastensson G, Eriksson K. Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting. Crit Rev Toxicol 2020; 50:219-271. [PMID: 32484073 DOI: 10.1080/10408444.2020.1744514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inorganic chloramines are not commercially available, but monochloramine is produced in situ for disinfection or for use in chemical synthesis. Inorganic chloramines are also formed when free chlorine reacts with nitrogen containing substances, e.g. ammonia and urea, present in chlorinated water sources. Occupational exposure may, therefore, occur in e.g. swimming pool facilities and the food processing industry. Monochloramine is soluble and stable in water and the dominating inorganic chloramine in chlorinated water sources. No clinical effects were seen in healthy volunteers given monochloramine in drinking water during 4 or 12 weeks in doses of 0.043 or 0.034 mg/kg bw/day, respectively. Limited data indicate that monochloramine is weakly mutagenic in vitro but not genotoxic in vivo. One drinking water study indicated equivocal evidence of carcinogenicity in female rats but not in male rats and mice. No reproductive or developmental effects were shown in rodents in the few studies located. Dichloramine is soluble but unstable in water. In the only study located, mild histological effects in kidneys, thyroid and gastric cardia were observed in rats administered dichloramine in drinking water for 13 weeks. Trichloramine is immiscible with water and evaporates easily from water into air. Therefore, the primary exposure route of concern in the occupational setting is inhalation. Occupational exposure to trichloramine has been demonstrated in indoor swimming pool facilities and in the food processing industry where chlorinated water is used for disinfection. Exposure-response relationships between airborne levels and self-reported ocular and upper airway irritation have been shown in several studies. Exposure to trichloramine may aggravate asthma symptoms in individuals with existing asthma. The risk of developing asthma following long-term exposure to trichloramine cannot be evaluated at present. No data on genotoxic, carcinogenic, reproductive or developmental effects were located. The toxicological data for mono- and dichloramine are insufficient to recommend health-based occupational exposure limits (OELs).As regard trichloramine, the critical effect is judged to be irritation observed in several studies on pool workers, starting at approximately 0.4 mg/m3 (stationary sampling). Based on these data, a health-based OEL of 0.1 mg/m3 (8-h time-weighted average) is recommended. This corresponds to 0.2 mg/m3 for stationary measurements in swimming pool facilities. No short-term exposure limit (STEL) is recommended.
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Affiliation(s)
- Gunilla Wastensson
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kåre Eriksson
- Department of Sustainable Health, Umeå University, Umeå, Sweden
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16
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Irahara M, Yamamoto-Hanada K, Yang L, Saito-Abe M, Sato M, Inuzuka Y, Toyokuni K, Nishimura K, Ishikawa F, Miyaji Y, Fukuie T, Narita M, Ohya Y. Impact of swimming school attendance in 3-year-old children with wheeze and rhinitis at age 5 years: A prospective birth cohort study in Tokyo. PLoS One 2020; 15:e0234161. [PMID: 32516323 PMCID: PMC7282662 DOI: 10.1371/journal.pone.0234161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background In Japan, swimming school attendance is promoted as a form of therapy or as a prophylactic measure against asthma in young children. However, the putative beneficial effects have not been sufficiently verified. Objective The aim of the present study was to clarify whether or not swimming school attendance at age 3 years affects the onset and/or improvement of wheeze and rhinitis at age 5 years. Methods This study was a single-center, prospective, general, longitudinal cohort study (T-CHILD Study). Between November 2003 and December 2005, 1776 pregnant women were enrolled, and their offspring were followed up until age 5 years. Swimming school attendance at age 3 years and the presence of wheeze and/or rhinitis in the previous one year were examined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The relationship between swimming school attendance and wheeze and/or rhinitis was analyzed using multivariable logistic regression analysis. Results Data on the 1097 children were analyzed. At age 3 years, 126 (11.5%) children attended a swimming school, and at age 5 years, the prevalence of wheeze was 180 (16.4%) while that of rhinitis was 387 (35.3%). Swimming school attendance at age 3 showed no significant relationship with the development of either wheeze (aOR 0.83, 95% CI (0.43–1.60) or rhinitis (aOR 0.80, 95% CI (0.43–1.60) at age 5. Conclusions Swimming school attendance at age 3 years showed neither a preventive nor therapeutic effect on wheeze or rhinitis at age 5 years. There is thus no scientific evidence yet that swimming school attendance has a positive impact on the development of childhood wheeze or rhinitis.
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Affiliation(s)
- Makoto Irahara
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Limin Yang
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yusuke Inuzuka
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Toyokuni
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Koji Nishimura
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Fumi Ishikawa
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masami Narita
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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17
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Surda P, Tornari C, Putala M, Walker A. Exercise and Rhinitis in Athletes. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10310443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Peak sporting performance requires optimal levels of health and fitness. Rhinitis, with its proven detrimental effects on sleep and mood, and its association with asthma, can clearly compromise athletic ability. Nasal health is therefore of key importance to the athlete. While not a limiting factor in a single exercise effort, the effects of nasal dysfunction can have repercussions in the post-exercise recovery period. Furthermore, it is linked with the development of asthma and may increase susceptibility to upper respiratory tract symptoms. This review aims to investigate the physiology of the nose during exercise, examine the relationship between exercise and nasal dysfunction, and consider the impact that dysfunction may have on an athlete. Lastly, the authors describe the diagnosis and treatment of rhinitis in athletes.
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Affiliation(s)
- Pavol Surda
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
| | - Matus Putala
- Department of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Abigail Walker
- Department of Otorhinolaryngology, Guy’s and St Thomas’ University Hospital, London, UK
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18
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Gouveia P, Felgueiras F, Mourão Z, Fernandes EDO, Moreira A, Gabriel MF. Predicting health risk from exposure to trihalomethanes in an Olympic-size indoor swimming pool among elite swimmers and coaches. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:577-590. [PMID: 31262237 DOI: 10.1080/15287394.2019.1634383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Disinfection by-products (DBP) such as trihalomethanes (THM) are formed when chlorine and bromine interact with natural organic materials in chlorine-treated swimming pools. Epidemiological evidence demonstrated an association between exposure to swimming pool environment and adverse health effects. Therefore, this study aimed to assess carcinogenic and non-carcinogenic risk of long-term exposure of elite swimmers and their coaches. In an Olympic-size indoor chlorinated swimming pool, THM levels were determined in water (21-69 µg/L), in the boundary layer above the water surface (59-397 µg/m3), and in the air surrounding the pool (28-390 µg/m3). These values were used to predict multi-pathway chronic daily intake (CDI), cancer risk (CR) and hazard index (HI). Oral and dermal CDI for swimmers were 2.4 × 10-6 and 2.0 × 10-8, respectively. The swimmers' inhalation CDI (1.9 × 10-3 mg/kg/day) was estimated to be sixfold higher than levels obtained for coaches (3.3 × 10-4 mg/kg/day). According to guidelines, the HI was acceptable, but CR exceeded the recommended limit for both, coaches (CR: 5.5 × 10-7-8.5 × 10-5; HI: 6.5 × 10-4-1 × 10-1) and swimmers (CR: 1.4 × 10-5-3.6 × 10-4 HI: 1.6 × 10-2-4.3 × 10-1). Our findings provide further support to the need to develop comprehensive guidelines to safeguard the health of individuals involved in elite swimming.
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Affiliation(s)
- Pedro Gouveia
- a Faculty of Medicine, University of Porto , Porto , Portugal
| | - Fátima Felgueiras
- b Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal
| | - Zenaida Mourão
- b Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal
| | | | - André Moreira
- a Faculty of Medicine, University of Porto , Porto , Portugal
- d Serviço de Imunoalergologia, Centro Hospitalar São João , Porto , Portugal
- e EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto , Portugal
| | - Marta Fonseca Gabriel
- b Institute of Science and Innovation in Mechanical and Industrial Engineering , Porto , Portugal
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19
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Kotsiou OS, Peletidou S, Vavougios G, Karetsi E, Stavrou V, Zakynthinos G, Gourgoulianis KI, Daniil Z. Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers. Ann Allergy Asthma Immunol 2019; 123:249-255. [PMID: 31247303 DOI: 10.1016/j.anai.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Swimming is recommended for people with asthma. However, the inevitable exposure to chlorine and its disinfectant byproducts in indoor swimming pools could be responsible for bronchial inflammation and asthma development. Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation that predicts asthma exacerbations. OBJECTIVES To evaluate pretraining and posttraining FeNO levels in young swimmers with asthma attending an indoor chlorinated pool compared with a set of healthy swimmers and to examine the potential risk of exposure to chlorine as a factor associated with bronchial inflammation. METHODS A total of 146 children (8-18 years old) constantly attending an indoor chlorinated swimming pool were enrolled. Spirometry and FeNO measurements were performed 30 minutes after their arrival at the pool and immediately after exercise. Pre-exercise and postexercise spirometric and FeNO levels were assessed in a random subgroup of 14 swimmers (10 with asthma and 4 without) who performed cardiopulmonary exercise testing. RESULTS Asthma was detected in 23 swimmers. In swimmers with asthma, preswimming FeNO values were significantly elevated compared with swimmers without asthma and their FeNO values measured before cardiopulmonary exercise testing. Postexercise FeNO values were significantly decreased by approximately one-third in healthy children and children with asthma in all sporting backgrounds. However, postswimming FeNO values remained significantly higher in swimmers with asthma compared with those without asthma. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio values showed no significant difference before and after 2 types of activity. CONCLUSION Elevated FeNO levels before and after swimming were recorded in swimmers with asthma not observed in a different exercise field. The presence of chlorine in the indoor swimming pool seems to explain this finding.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Sotiria Peletidou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Vavougios
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Karetsi
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Stavrou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Zakynthinos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Abstract
An association between airway dysfunction and airborne pollutant inhalation exists. Volatilized airborne fluorocarbons in ski wax rooms, particulate matter, and trichloromines in indoor environments are suspect to high prevalence of exercise-induced bronchoconstriction and new-onset asthma in athletes competing in cross-country skiing, ice rink sports, and swimming. Ozone is implicated in acute decreases in lung function and the development of new-onset asthma from exposure during exercise. Mechanisms and genetic links are proposed for pollution-related new-onset asthma. Oxidative stress from airborne pollutant inhalation is a common thread to progression of airway damage. Key pollutants and mechanisms for each are discussed.
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Ilyas H, Masih I, van der Hoek JP. An exploration of disinfection by-products formation and governing factors in chlorinated swimming pool water. JOURNAL OF WATER AND HEALTH 2018; 16:861-892. [PMID: 30540262 DOI: 10.2166/wh.2018.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This paper investigates disinfection by-products (DBPs) formation and their relationship with governing factors in chlorinated swimming pools. The study compares concentrations of DBPs with WHO guidelines for drinking water quality recommended to screen swimming pool water quality. The statistical analysis is based on a global database of 188 swimming pools accumulated from 42 peer-reviewed journal publications from 16 countries. The mean and standard deviation of dichloroacetic acid and trichloroacetic acid were estimated as 282 ± 437 and 326 ± 517 μg L-1, respectively, which most often surpassed the WHO guidelines. Similarly, more than half of the examined pools had higher values of chloral hydrate (102 ± 128 μg L-1). The concentration of total chloramines (650 ± 490 μg L-1) was well above the WHO guidelines in all reported cases. Nevertheless, the reported values remained below the guidelines for most of the studied pools in the case of total trihalomethanes (134 ± 160 μg L-1), dichloroacetonitrile (12 ± 12 μg L-1) and dibromoacetonitrile (8 ± 11 μg L-1). Total organic carbon, free residual chlorine, temperature, pH, total nitrogen and bromide ions play a pivotal role in DBPs formation processes. Therefore, proper management of these governing factors could significantly reduce DBPs formation, thereby, contributing towards a healthy swimming pool environment.
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Affiliation(s)
- Huma Ilyas
- Water Treatment and Management Consultancy B.V., 2289 ED Rijswijk, The Netherlands E-mail:
| | - Ilyas Masih
- Water Treatment and Management Consultancy B.V., 2289 ED Rijswijk, The Netherlands E-mail: ; IHE Delft, Institute for Water Education, 2611 AX Delft, The Netherlands
| | - Jan Peter van der Hoek
- Department of Water Management, Faculty of Civil Engineering and Geosciences, Delft University of Technology, 2600 GA Delft, The Netherlands and Strategic Centre, Waternet, 1096 AC Amsterdam, The Netherlands
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22
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Mao Y, Zhang L, Dong H. Formation of trihalomethanes in swimming pool waters using sodium dichloroisocyanurate as an alternative disinfectant. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2018; 78:1633-1641. [PMID: 30500787 DOI: 10.2166/wst.2018.439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Disinfection is essential to preventing infection caused by microbial pathogens in swimming pool water. The most commonly used disinfection methods are chlorine disinfectant, including sodium hypochlorite (NaOCl) and sodium dichloroisocyanurate (SDIC, C3O3N3Cl2Na) with characteristics of available chlorine formation and stability. In this study, we estimate the formation of trihalomethanes (THM4) in indoor swimming pools filled with seawater that adopt these disinfection methods, and we investigated the factors influencing the formation of THM4. Formation of THM4 by free chlorine (FC) and SDIC respectively is 327.8 μg L-1 and 307.6 μg L-1; Br-THMs is 226.7 μg L-1 for FC, 198 μg L-1 for SDIC. SDIC has less THM4 formation than FC in the same molar Br- dosage (10 μM) and total chlorine dosage (20 μM), and bromoform is the main Br-THMs species. The occurrence of THM4 is inhibited at high dosages of natural organic matter and Br-. The total Br-THMs increase from 75 μg L-1 to 189.7 μg L-1 and from 64.6 μg L-1 to 190 μg L-1 by FC and SDIC at pH 5.0-9.0, both of which are highly dependent on pH. In real water, similar results were found in Br--containing water (1 mg-Br- L-1).
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Affiliation(s)
- Yuanxiang Mao
- School of Chemical and Environmental Engineering, China University of Mining and Technology, Beijing 100083, China E-mail: ; Key Laboratory of Drinking Water Science and Technology, Research Center for Eco- Environmental Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 18 Shuang-qing Road, Beijing 100085, China
| | - Liping Zhang
- School of Chemical and Environmental Engineering, China University of Mining and Technology, Beijing 100083, China E-mail:
| | - Huiyu Dong
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco- Environmental Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, 18 Shuang-qing Road, Beijing 100085, China
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23
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Araneda OF, Contreras-Briceño F, Cavada G, Viscor G. Swimming versus running: effects on exhaled breath condensate pro-oxidants and pH. Eur J Appl Physiol 2018; 118:2319-2329. [PMID: 30094648 DOI: 10.1007/s00421-018-3958-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The respiratory redox-state of swimmers can be affected by chronic exposures to chlorinated pools, and the effects of different exercises on it are unknown. Our aim was to compare two exercises performed at high-intensity and under habitual environmental conditions (swimming indoor vs. running outdoor) on the production of pro-oxidants (hydrogen peroxide and nitrite) and pH in exhaled breath condensate (EBC) and spirometry parameters in competitive swimmers chronically exposed to chlorinated pools. METHODS Seventeen men and women (mean age ± SD = 21 ± 2 years) swam 3.5 km in an indoor pool treated with Cl2, and after 2-weeks, they ran 10 km outdoors. The pHEBC, [H2O2]EBC, [NO2-]EBC, [NO2-]EBC/[NO2-]Plasma and spirometry parameters were analyzed pre-exercise and 20 min and 24 h after exercise ended. RESULTS Two mixed models were applied to compare EBC parameters between swimming and running. Lower levels of [H2O2]EBC and [NO2-]EBC (p = 0.008 and p = 0.018, respectively) were found 24-h post-swimming, and the same trend was observed for [NO2-]EBC/[NO2-]Plasma (p = 0.062). Correlations were found in both exercises between pre-exercise levels of pHEBC, [H2O2]EBC, [NO2-]EBC, and [NO2-]EBC/[NO2-]Plasma and their changes (Δ) after 24-h as well as between [H2O2]EBC and [NO2-]EBC for basal levels and for changes after 24 h. A relationship was also found for running exercise between pulmonary ventilation and changes after 24 h in [H2O2]EBC. Spirometry data were unaffected in both types of exercise. CONCLUSION In competitive swimmers, at 24-h acute post-exercise follow-up, swimming decreased and running increased pro-oxidant biomarkers of pulmonary origin, without changes in lung function.
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Affiliation(s)
- Oscar F Araneda
- Laboratorio de Fisiología Integrativo de Biomecánica y Fisiología Integrativa (LIBFE), Escuela de Kinesiología, Facultad de Medicina, Universidad de Los Andes, Santiago, Chile.
| | - Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Department of Health of Science, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
| | - Gabriel Cavada
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ginés Viscor
- Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
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Surda P, Putala M, Siarnik P, Walker A, Bernic A, Fokkens W. Rhinitis and its impact on quality of life in swimmers. Allergy 2018; 73:1022-1031. [PMID: 29150854 DOI: 10.1111/all.13359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Limited data suggest that swimmers might be affected by rhinitis significantly more often than the general population. This can have impact on quality of life but also on performance. The aim of this study was to determine the prevalence and impact of QOL of rhinitis in swimming compared to nonswimming athletes and controls. MATERIALS AND METHODS This was an observational case-control, questionnaire-based study involving elite (n = 101) and nonelite swimming athletes (n = 107), nonswimming athletes (n = 38) and sex- and age-matched controls (n = 50). The survey instrument consisted of a general and the miniRQLQ. Main question used to assess the prevalence of rhinitis was from the ISAAC study. RESULTS Rhinitis was reported significantly more often by the elite swimmers (45%) than nonelite swimmers (31%), nonswimming athletes (32%) and controls (24%). Allergic rhinitis prevalence was similar in all groups (12%-18%). The prevalence of nonallergic rhinitis (NAR) was significantly higher in elite swimmers (33%) and nonelite swimmers (22%) compared to nonswimming athletes and controls. Overall mean miniRQLQ score and all subdomains except the "eye" domain showed significantly reduced QOL in elite and nonelite swimmers compared to nonswimming athletes and controls. Regular nasal medication was used significantly less by elite swimmers (18%) compared to controls (67%) and nonswimming athletes (42%). CONCLUSION This study revealed a high prevalence of NAR in swimmers and related impact on QoL. These findings highlight the importance to increase the awareness towards upper airway disorders in the swimming athletes and to ensure adequate management.
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Affiliation(s)
- P. Surda
- Department of Otorhinolaryngology; Guy's and St Thomas’ University Hospital; London UK
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - M. Putala
- Department of Physical Education and Sports; Comenius University; Bratislava Slovakia
| | - P. Siarnik
- Department of Neurology; Faculty of Medicine; Comenius University; Bratislava Slovakia
| | - A. Walker
- Department of Otorhinolaryngology; Guy's and St Thomas’ University Hospital; London UK
| | - A. Bernic
- Department of Otorhinolaryngology; Guy's and St Thomas’ University Hospital; London UK
| | - W. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
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Andersson M, Backman H, Nordberg G, Hagenbjörk A, Hedman L, Eriksson K, Forsberg B, Rönmark E. Early life swimming pool exposure and asthma onset in children - a case-control study. Environ Health 2018; 17:34. [PMID: 29642932 PMCID: PMC5896097 DOI: 10.1186/s12940-018-0383-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/03/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Trichloramine exposure in indoor swimming pools has been suggested to cause asthma in children. We aimed to investigate the risk of asthma onset among children in relation to individual trichloramine exposure. METHODS A longitudinal nested case-control study of 337 children with asthma (cases) and 633 controls aged 16-17 years was performed within a population-based cohort from The Obstructive Lung Disease in Northern Sweden studies (OLIN). Year of asthma onset and exposure time at different ages were obtained in telephone interviews. Trichloramine concentrations in the pool buildings were measured. Skin prick test results for inhalant allergens were available from previous examinations of the cohort. The risk for asthma was analyzed in relation to the cumulative trichloramine exposure before onset of asthma. RESULTS The participation rate was high in the original cohort (88 to 96%), and in the case-control study (80%). Trichloramine concentrations ranged from 0.020 to 0.55 mg/m3 (mean 0.15 mg/m3). Swimming pool exposure in early life was associated with a significantly higher risk of pre-school asthma onset. A dose-response relationship between swimming pool exposure and asthma was indicated in children with asthma onset at 1 year of age. Children who were both sensitized and exposed had a particularly high risk. CONCLUSIONS Early life exposure to chlorinated swimming pool environments was associated with pre-school asthma onset.
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Affiliation(s)
- Martin Andersson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| | - Gunnar Nordberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Annika Hagenbjörk
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| | - Kåre Eriksson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
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26
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Systemic and airway oxidative stress in competitive swimmers. Respir Med 2018; 137:129-133. [DOI: 10.1016/j.rmed.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/02/2018] [Indexed: 11/20/2022]
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Cavaleiro Rufo J, Paciência I, Silva D, Martins C, Madureira J, de Oliveira Fernandes E, Padrão P, Moreira P, Delgado L, Moreira A. Swimming pool exposure is associated with autonomic changes and increased airway reactivity to a beta-2 agonist in school aged children: A cross-sectional survey. PLoS One 2018. [PMID: 29529048 PMCID: PMC5846785 DOI: 10.1371/journal.pone.0193848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. Methods A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. Results Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case-case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. Conclusions Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
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Affiliation(s)
- João Cavaleiro Rufo
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- * E-mail:
| | - Inês Paciência
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Carla Martins
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Joana Madureira
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Eduardo de Oliveira Fernandes
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
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Duyx B, Urlings MJE, Swaen GMH, Bouter LM, Zeegers MP. Selective citation in the literature on swimming in chlorinated water and childhood asthma: a network analysis. Res Integr Peer Rev 2017; 2:17. [PMID: 29451547 PMCID: PMC5803637 DOI: 10.1186/s41073-017-0041-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/02/2017] [Indexed: 01/16/2023] Open
Abstract
Background Knowledge development depends on an unbiased representation of the available evidence. Selective citation may distort this representation. Recently, some controversy emerged regarding the possible impact of swimming on childhood asthma, raising the question about the role of selective citation in this field. Our objective was to assess the occurrence and determinants of selective citation in scientific publications on the relationship between swimming in chlorinated pools and childhood asthma. Methods We identified scientific journal articles on this relationship via a systematic literature search. The following factors were taken into account: study outcome (authors' conclusion, data-based conclusion), other content-related article characteristics (article type, sample size, research quality, specificity), content-unrelated article characteristics (language, publication title, funding source, number of authors, number of affiliations, number of references, journal impact factor), author characteristics (gender, country, affiliation), and citation characteristics (time to citation, authority, self-citation). To assess the impact of these factors on citation, we performed a series of univariate and adjusted random-effects logistic regressions, with potential citation path as unit of analysis. Results Thirty-six articles were identified in this network, consisting of 570 potential citation paths of which 191 (34%) were realized. There was strong evidence that articles with at least one author in common, cited each other more often than articles that had no common authors (odds ratio (OR) 5.2, 95% confidence interval (CI) 3.1-8.8). Similarly, the chance of being cited was higher for articles that were empirical rather than narrative (OR 4.2, CI 2.6-6.7), that reported a large sample size (OR 5.8, CI 2.9-11.6), and that were written by authors with a high authority within the network (OR 4.1, CI 2.1-8.0). Further, there was some evidence for citation bias: articles that confirmed the relation between swimming and asthma were cited more often (OR 1.8, CI 1.1-2.9), but this finding was not robust. Conclusions There is clear evidence of selective citation in this research field, but the evidence for citation bias is not very strong.
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Affiliation(s)
- Bram Duyx
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Miriam J E Urlings
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Gerard M H Swaen
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Lex M Bouter
- 3Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,4Department of Philosophy, Faculty of Humanities, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maurice P Zeegers
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
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Valeriani F, Protano C, Vitali M, Romano Spica V. Swimming pool attendance during childhood and development of asthma: Reply. Pediatr Int 2017; 59:847-848. [PMID: 28745462 DOI: 10.1111/ped.13311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/10/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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30
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Valeriani F, Protano C, Vitali M, Romano Spica V. Swimming attendance during childhood and development of asthma: Meta-analysis. Pediatr Int 2017; 59:614-621. [PMID: 28032933 DOI: 10.1111/ped.13230] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/02/2016] [Accepted: 12/27/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between asthma and swimming pool attendance has not been demonstrated and currently there are conflicting results. In order to clarify the association between asthma diagnosis in children and swimming pool attendance, and to assess the consistency of the available epidemiological studies, we completed a literature analysis on the relationship between the exposure to disinfection by-products in indoor swimming pools during childhood and asthma diagnosis. METHODS Following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, a systematic review and meta-analysis was performed by searching MEDLINE via PubMed, TOXNET, and Scopus databases (from inception to 20 April 2015) using the key word "Asthma" together with "swimming pool", "disinfection by-products", "indoor air pollution" and "children". Inclusion criteria were: English language, a complete analytic study design involving a cohort of children (0-16 years), a well-defined definition of exposure, and the presence of data on effect and variance. Studies on in vivo, in vitro or professional and accidental exposure were excluded. RESULTS After a screening process, seven reports (n = 5851 subjects) were included out of a total of 2928 references. The reported OR of the association between swimming pool attendance and asthma prevalence ranged from 0.58 to 2.30. The present meta-analysis failed to identify a significant difference in asthma development between children attending swimming pools and controls (OR, 1.084; 95% CI: 0.89-1.31). CONCLUSIONS Swimming in childhood does not increase the likelihood of doctor-diagnosed asthma. Based on this meta-analysis review, the association of the disease with indoor pool attendance is still unclear.
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Affiliation(s)
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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31
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Occurrence, origin, and toxicity of disinfection byproducts in chlorinated swimming pools: An overview. Int J Hyg Environ Health 2017; 220:591-603. [DOI: 10.1016/j.ijheh.2017.01.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/16/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
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Del Giacco S. Exercise, Asthma and the Olympics: A 2000-year-old tale. Porto Biomed J 2016; 1:127-128. [PMID: 32258562 DOI: 10.1016/j.pbj.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Two separated phenotypes of Exercise-Induced-Asthma existOlympic Athletes have won more medals than their non-asthmatic peersCompetitive swimmers show an increased asthma prevalenceAsthmatics have no limitations in sports practice if they receive adequate medical treatmentAerobic exercise programs are beneficial for asthmatics and should be included in asthma action plans.
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Affiliation(s)
- Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
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33
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Morici G, Gruttad'Auria CI, Baiamonte P, Mazzuca E, Castrogiovanni A, Bonsignore MR. Endurance training: is it bad for you? Breathe (Sheff) 2016; 12:140-7. [PMID: 27408632 PMCID: PMC4933620 DOI: 10.1183/20734735.007016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Educational aims Endurance exercise training exerts many positive effects on health, including improved metabolism, reduction of cardiovascular risk, and reduced all-cause and cardiovascular mortality. Intense endurance exercise causes mild epithelial injury and inflammation in the airways, but does not appear to exert detrimental effects on respiratory health or bronchial reactivity in recreational/non-elite athletes. Conversely, elite athletes of both summer and winter sports show increased susceptibility to development of asthma, possibly related to environmental exposures to allergens or poor conditioning of inspired air, so that a distinct phenotype of “sports asthma” has been proposed to characterise such athletes, who more often practise aquatic and winter sports. Overall, endurance training is good for health but may become deleterious when performed at high intensity or volume. Endurance training is good for health but may become deleterious when performed at high intensity or volumehttp://ow.ly/4n9jR4
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Affiliation(s)
- Giuseppe Morici
- BioNeC Dept, University of Palermo, Palermo, Italy; Institute of Biomedicine and Molecular Immunology (IBIM), CNR, Palermo, Italy
| | | | | | | | | | - Maria R Bonsignore
- Institute of Biomedicine and Molecular Immunology (IBIM), CNR, Palermo, Italy; DiBiMIS, University of Palermo, Palermo, Italy
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Abstract
The prevalence of airway dysfunction in elite swimmers is among the highest in elite athletes. The traditional view that swimmers naturally gravitate toward swimming because of preexisting respiratory disorders has been challenged. There is now sufficient evidence that the higher prevalence of bronchial tone disorders in elite swimmers is not the result of a natural selection bias. Rather, the combined effects of repeated chlorine by-product exposure and chronic endurance training can lead to airway dysfunction and atopy. This review will detail the underpinning causes of airway dysfunction observed in elite swimmers. It will also show that airway dysfunction does not prevent success in elite level swimming. Neither does it inhibit lung growth and might be partially reversible when elite swimmers retire from competition.
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Affiliation(s)
- Mitch Lomax
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, UK
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35
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Kusunoki T, Takeuchi J, Morimoto T, Sakuma M, Mukaida K, Yasumi T, Nishikomori R, Heike T. Sports activities enhance the prevalence of rhinitis symptoms in schoolchildren. Pediatr Allergy Immunol 2016; 27:209-13. [PMID: 26613558 DOI: 10.1111/pai.12516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the association between sports activities and allergic symptoms, especially rhinitis, among schoolchildren. METHODS This longitudinal survey of schoolchildren collected data from questionnaires regarding allergic symptoms based on the International Study of Asthma and Allergies in Childhood (ISAAC) program and sports participation that were distributed to the parents of children at all 12 public primary schools in Ohmi-Hachiman City, Shiga Prefecture, Japan. Data were collected annually from 2011 until 2014, when the children reached 10 years of age. Blood samples were obtained in 2014, and the levels of immunoglobulin (Ig)E specific to four inhalant allergens were measured. RESULTS Data from 558 children were analyzed. At 10 years of age, prevalence of asthma and eczema did not differ significantly, while rhinitis was significantly higher (p = 0.009) among children who participated in sports. Prevalence of rhinitis increased as the frequency or duration of sports participation increased (p < 0.01). The prevalence of new-onset rhinitis increased significantly among 10-year-olds with increasing duration of participation in sports (p = 0.03). Among those who participated in continuous sports activities, the prevalence of rhinitis was significantly higher with prolonged eczema (p = 0.006). Sports activities did not increase sensitization to inhalant allergens. CONCLUSION Sports activities enhance the prevalence of rhinitis in schoolchildren. Prolonged eczema, together with sports participation, further promotes the symptoms. The mechanisms of these novel findings warrant further investigation.
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Affiliation(s)
- Takashi Kusunoki
- Department of Pediatrics, Shiga Medical Center for Children, Shiga, Japan
| | | | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Mio Sakuma
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | | | - Takahiro Yasumi
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuta Nishikomori
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Heike
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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36
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Villanueva CM, Cordier S, Font-Ribera L, Salas LA, Levallois P. Overview of Disinfection By-products and Associated Health Effects. Curr Environ Health Rep 2016; 2:107-15. [PMID: 26231245 DOI: 10.1007/s40572-014-0032-x] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The presence of chemical compounds formed as disinfection by-products (DBPs) is widespread in developed countries, and virtually whole populations are exposed to these chemicals through ingestion, inhalation, or dermal absorption from drinking water and swimming pools. Epidemiological evidence has shown a consistent association between long-term exposure to trihalomethanes and the risk of bladder cancer, although the causal nature of the association is not conclusive. Evidence concerning other cancer sites is insufficient or mixed. Numerous studies have evaluated reproductive implications, including sperm quality, time to pregnancy, menstrual cycle, and pregnancy outcomes such as fetal loss, fetal growth, preterm delivery, and congenital malformation. The body of evidence suggests only minor effects from high exposure during pregnancy on fetal growth indices such as small for gestational age (SGA) at birth. Populations highly exposed to swimming pools such as pool workers and professional swimmers show a higher prevalence of respiratory symptoms and asthma, respectively, although the direction of the association, and thus causality, is not clear among professional swimmers. The risk of asthma, wheezing, eczema, and other respiratory outcomes among children attending swimming pools has been the object of extensive research. Early studies suggested a positive association, while subsequent larger studies found no correlations or showed a protective association. Future research should develop methods to evaluate the effects of the DBP mixture and the interaction with personal characteristics (e.g., genetics, lifestyle), clarify the association between swimming pools and respiratory health, evaluate the occurrence of DBPs in low- and middle-income countries, and evaluate outcomes suggested by animal studies that have not been considered in epidemiological investigations.
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Affiliation(s)
- Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park (PRBB), Doctor Aiguader 88, 08003, Barcelona, Spain,
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Rundell KW, Anderson SD, Sue-Chu M, Bougault V, Boulet LP. Air quality and temperature effects on exercise-induced bronchoconstriction. Compr Physiol 2016; 5:579-610. [PMID: 25880506 DOI: 10.1002/cphy.c130013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Kenneth W Rundell
- Department of The Basic Sciences, The Commonwealth Medical College, Scranton, PA, USA
| | - Sandra D Anderson
- Clinical Professor Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Malcolm Sue-Chu
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Kim A, Silverberg JI. A systematic review of vigorous physical activity in eczema. Br J Dermatol 2015; 174:660-2. [PMID: 26385020 DOI: 10.1111/bjd.14179] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A Kim
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A
| | - J I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, U.S.A.,Northwestern Medicine Multidisciplinary Eczema Center, Chicago, IL, U.S.A
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015. [PMID: 26672959 DOI: 10.3402/ecrj.v2.27984.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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40
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Del Giacco SR, Firinu D, Bjermer L, Carlsen KH. Exercise and asthma: an overview. Eur Clin Respir J 2015; 2:27984. [PMID: 26672959 PMCID: PMC4653278 DOI: 10.3402/ecrj.v2.27984] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 09/04/2015] [Indexed: 01/03/2023] Open
Abstract
The terms 'exercise-induced asthma' (EIA) and 'exercise-induced bronchoconstriction' (EIB) are often used interchangeably to describe symptoms of asthma such as cough, wheeze, or dyspnoea provoked by vigorous physical activity. In this review, we refer to EIB as the bronchoconstrictive response and to EIA when bronchoconstriction is associated with asthma symptoms. EIB is a common occurrence for most of the asthmatic patients, but it also affects more than 10% of otherwise healthy individuals as shown by epidemiological studies. EIA and EIB have a high prevalence also in elite athletes, especially within endurance type of sports, and an athlete's asthma phenotype has been described. However, the occurrence in elite athletes shows that EIA/EIB, if correctly managed, may not impair physical activity and top sports performance. The pathogenic mechanisms of EIA/EIB classically involve both osmolar and vascular changes in the airways in addition to cooling of the airways with parasympathetic stimulation. Airways inflammation plays a fundamental role in EIA/EIB. Diagnosis and pharmacological management must be carefully performed, with particular consideration of current anti-doping regulations, when caring for athletes. Based on the demonstration that the inhaled asthma drugs do not improve performance in healthy athletes, the doping regulations are presently much less strict than previously. Some sports are at a higher asthma risk than others, probably due to a high environmental exposure while performing the sport, with swimming and chlorine exposure during swimming as one example. It is considered very important for the asthmatic child and adolescent to master EIA/EIB to be able to participate in physical activity on an equal level with their peers, and a precise early diagnosis with optimal treatment follow-up is vital in this aspect. In addition, surprising recent preliminary evidences offer new perspectives for moderate exercise as a potential therapeutic tool for asthmatics.
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Affiliation(s)
- Stefano R Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy;
| | - Davide Firinu
- Department of Medical Sciences "M. Aresu", University of Cagliari, Cagliari, Italy
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Font-Ribera L, Gracia-Lavedan E, Esplugues A, Ballester F, Jiménez Zabala A, Santa Marina L, Fernández-Somoano A, Sunyer J, Villanueva CM. Water hardness and eczema at 1 and 4 y of age in the INMA birth cohort. ENVIRONMENTAL RESEARCH 2015; 142:579-585. [PMID: 26298601 DOI: 10.1016/j.envres.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Exposure to hard water has been suggested as a risk factor for eczema in childhood, based on limited evidence from two ecologic and two cross-sectional studies. OBJECTIVES We evaluate this hypothesis for the first time in early infancy using prospective data from a mother-child cohort study. METHODS We used data from the INMA cohorts in Gipuzkoa, Sabadell and Valencia, Spain (N=1638). Current and ever eczema, bathing frequency and duration and covariables were collected by questionnaires at 14 months (14 m) and 4 years (4 y). Calcium carbonate (CaCO3) level in municipal water was assigned to home addresses at birth, 14 m and 4 y. We calculated Odds Ratio (OR) of eczema related to CaCO3 at home, bath exposure and a combination of both. RESULTS Prevalence of eczema ever was 18.4% at 14 m and 33.4% at 4 y. Mean CaCO3 ranged from 51.6 to 272.8 mg/L among areas. No association was detected between water hardness at home and current or ever eczema. Adjusted OR was 0.79 (95%CI=0.45, 1.39) at 14 m and 0.93 (0.56, 1.52) at 4 y among children in the highest vs. lowest tertiles of CaCO3. Bath exposure alone or in combination with water hardness did not increase the OR of eczema at 14 m or 4 y either. CONCLUSIONS We did not find an association between eczema and water hardness at home or bathing exposure during the first four years of life. This first cohort study in a critical age period with improved exposure assessment does not confirm the association suggested among children by previous studies.
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Affiliation(s)
- Laia Font-Ribera
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, 88 Doctor Aiguader, Barcelona 08003, Spain; Universitat Pompeu Fabra (UPF), 80 Doctor Aiguader, Barcelona 08003, Spain; IMIM (Hospital del Mar Medical Research Institute), 88 Doctor Aiguader, Barcelona 08003, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain.
| | - Esther Gracia-Lavedan
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, 88 Doctor Aiguader, Barcelona 08003, Spain; Universitat Pompeu Fabra (UPF), 80 Doctor Aiguader, Barcelona 08003, Spain; IMIM (Hospital del Mar Medical Research Institute), 88 Doctor Aiguader, Barcelona 08003, Spain.
| | - Ana Esplugues
- CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain; FISABIO-UJI-Universitat de València Joint Research Unit, Av. Catalunya 21, Valencia 46020, Spain.
| | - Ferran Ballester
- CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain; FISABIO-UJI-Universitat de València Joint Research Unit, Av. Catalunya 21, Valencia 46020, Spain.
| | - Ana Jiménez Zabala
- Public Health Division of Gipuzkoa, Basque Government, 4 Av. de Navarra, San Sebastian 20013, Spain; BIODONOSTIA Health Research Institute, Paseo Dr. Beguiristain, San Sebastian 20014, Spain.
| | - Loreto Santa Marina
- CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain; Public Health Division of Gipuzkoa, Basque Government, 4 Av. de Navarra, San Sebastian 20013, Spain; BIODONOSTIA Health Research Institute, Paseo Dr. Beguiristain, San Sebastian 20014, Spain.
| | - Ana Fernández-Somoano
- CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain; Universidad de Oviedo, Campus del Cristo, Oviedo, Spain.
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, 88 Doctor Aiguader, Barcelona 08003, Spain; Universitat Pompeu Fabra (UPF), 80 Doctor Aiguader, Barcelona 08003, Spain; IMIM (Hospital del Mar Medical Research Institute), 88 Doctor Aiguader, Barcelona 08003, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain.
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona Biomedical Research Park, 88 Doctor Aiguader, Barcelona 08003, Spain; Universitat Pompeu Fabra (UPF), 80 Doctor Aiguader, Barcelona 08003, Spain; IMIM (Hospital del Mar Medical Research Institute), 88 Doctor Aiguader, Barcelona 08003, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), 3-5 Melchor Fernández Almagro, Madrid 28029, Spain.
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Roncada C, Dias CP, Goecks S, Cidade SEF, Pitrez PMC. Usefulness of the WHOQOL-BREF questionnaire in assessing the quality of life of parents of children with asthma. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rppede.2015.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chowdhury S. Predicting human exposure and risk from chlorinated indoor swimming pool: a case study. ENVIRONMENTAL MONITORING AND ASSESSMENT 2015; 187:502. [PMID: 26164734 DOI: 10.1007/s10661-015-4719-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/29/2015] [Indexed: 06/04/2023]
Abstract
This study predicted human exposure to disinfection by-products (DBPs) in a chlorinated indoor swimming pool. Human exposure was predicted through ingestion, inhalation, and dermal routes while ingestion exposure was accidental with water intake of 18-34 mL/h. The number of pool attendants and duration and frequency of swimming were in the ranges of 14-62 persons/day, 40-85 min/event, and 26-48 times/year, respectively. Trihalomethanes (THMs) in pool water and air were 28.7-95.5 μg/L and 44.1-133.6 μg/m(3), respectively, while haloacetic acids (HAAs) in pool water were 68.9-158.9 μg/L. The brominated THMs in water and air were 95.4 and 94.3% of total THMs, respectively, while brominated HAAs were 94.4 % of total HAAs. Chronic daily intakes of THMs and HAAs were 2.16 × 10(-5)-3.14 × 10(-3) and 8.4 × 10(-8)-4.6 × 10(-6) mg/kg-day, respectively. The cancer risk from three THMs and two HAAs was 2.46 × 10(-5) with a range of 8.1 × 10(-6)-5.7 × 10(-5), in which THMs contributed 99.6% of total risks. Approximately 99.3% of risks were through inhalation and dermal routes, indicating that the ingestion route may be insignificant. The cancer risks from THMs in swimming pool were 4.06-6.64 times to the cancer risks from THMs in drinking water.
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Affiliation(s)
- Shakhawat Chowdhury
- Department of Civil and Environmental Engineering, King Fahd University of Petroleum and Minerals, Dhahran, 31261, Saudi Arabia,
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Roncada C, Dias CP, Goecks S, Cidade SEF, Pitrez PMC. [Usefulness of the WHOQOL-BREF questionnaire in assessing the quality of life of parents of children with asthma]. REVISTA PAULISTA DE PEDIATRIA 2015; 33:268-74. [PMID: 26137868 PMCID: PMC4620952 DOI: 10.1016/j.rpped.2015.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/22/2015] [Accepted: 01/23/2015] [Indexed: 11/25/2022]
Abstract
Objective:: To evaluate the quality of life (QOL) of parents of children with asthma and to
analyze the internal consistency of the generic QOL tool World Health Organization
Quality of Life, abbreviated version (WHOQOL-BREF). Methods:: We evaluated the QOL of parents of asthmatic and healthy children aged between 8
and 16, using the generic WHOQOL-BREF questionnaire. We also evaluated the
internal consistency using Cronbach's alpha (αC), in order to
determine whether the tool had good validity for the target audience. Results:: The study included 162 individuals with a mean age of 43.8±13.6 years, of which
104 were female (64.2%) and 128 were married (79.0%). When assessing the QOL, the
group of parents of healthy children had higher scores than the group of parents
of asthmatic children in the four areas evaluated by the questionnaire (Physical,
Psychological Health, Social Relationships and Environment), indicating a better
quality of life. Regarding the internal consistency of the WHOQOL-BREF, values of
˛C were 0.86 points for the group of parents of asthmatic children, and 0.88 for
the group of parents of healthy children. Conclusions:: Parents of children with asthma have impaired quality of life due to their
children's disease. Furthermore, the WHOQOL-BREF, even as a generic tool, showed
to be practical and efficient to evaluate the quality of life of parents of
asthmatic children. © 2015 Sociedade de Pediatria de São Paulo. Published by
Elsevier Editora Ltda. All rights reserved.
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Affiliation(s)
- Cristian Roncada
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil.
| | | | - Suelen Goecks
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brasil
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Andersson M, Hedman L, Nordberg G, Forsberg B, Eriksson K, Rönmark E. Swimming pool attendance is related to asthma among atopic school children: a population-based study. Environ Health 2015; 14:37. [PMID: 25890001 PMCID: PMC4411937 DOI: 10.1186/s12940-015-0023-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/07/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND By-products of water disinfectants have been suggested to cause asthma, especially in atopic children. However, studies on indoor swimming pool attendance and asthma in children have presented conflicting results. The present study examined the relationship between indoor swimming pool attendance and asthma among sensitized and non-sensitized children aged 11-12 years. METHODS An extended ISAAC questionnaire was sent to the families of all children attending fifth or sixth grade, aged 11-12 years, in two municipalities in Northern Sweden in 2010. A total of 1866 participated (96% of those invited) in the questionnaire study and 1652 (89%) also participated in skin prick testing for 10 standard airborne allergens. Asthma was defined as physician-diagnosed asthma in combination with wheeze or use of asthma medication in the last 12 months. Current swimming pool attendance was reported as ≥ 1/week or <1/week. Logistic regression models were used for data analysis. RESULTS The prevalence of current asthma was 8.9% (10.0% of boys; 7.9% of girls) and 14% had attended indoor pools ≥ 1/week. Children currently attending swimming pools ≥ 1/week had an increased risk of current asthma. Stratified analyses for allergic sensitization adjusted for sex, parental smoking, parental asthma, and damp housing, showed a statistically significant association for current asthma only among sensitized subjects (OR 95% CI 1.90 1.09-3.32). No association was found between current pool attendance and wheeze, sensitization, rhinitis or eczema. CONCLUSIONS The present study supports the proposed link between indoor swimming pool attendance and asthma in sensitized children.
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Affiliation(s)
- Martin Andersson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden.
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden.
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.
| | - Gunnar Nordberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden.
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden.
| | - Kåre Eriksson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden.
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187, Umeå, Sweden.
- The OLIN Studies, Norrbotten County Council, Luleå, Sweden.
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Health effects from swimming training in chlorinated pools and the corresponding metabolic stress pathways. PLoS One 2015; 10:e0119241. [PMID: 25742134 PMCID: PMC4351252 DOI: 10.1371/journal.pone.0119241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/27/2015] [Indexed: 11/19/2022] Open
Abstract
Chlorination is the most popular method for disinfecting swimming pool water; however, although pathogens are being killed, many toxic compounds, called disinfection by-products (DBPs), are formed. Numerous epidemiological publications have associated the chlorination of pools with dysfunctions of the respiratory system and with some other diseases. However, the findings concerning these associations are not always consistent and have not been confirmed by toxicological studies. Therefore, the health effects from swimming in chlorinated pools and the corresponding stress reactions in organisms are unclear. In this study, we show that although the growth and behaviors of experimental rats were not affected, their health, training effects and metabolic profiles were significantly affected by a 12-week swimming training program in chlorinated water identical to that of public pools. Interestingly, the eyes and skin are the organs that are more directly affected than the lungs by the irritants in chlorinated water; instead of chlorination, training intensity, training frequency and choking on water may be the primary factors for lung damage induced by swimming. Among the five major organs (the heart, liver, spleen, lungs and kidneys), the liver is the most likely target of DBPs. Through metabolomics analysis, the corresponding metabolic stress pathways and a defensive system focusing on taurine were presented, based on which the corresponding countermeasures can be developed for swimming athletes and for others who spend a lot of time in chlorinated swimming pools.
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Dick S, Friend A, Dynes K, AlKandari F, Doust E, Cowie H, Ayres JG, Turner SW. A systematic review of associations between environmental exposures and development of asthma in children aged up to 9 years. BMJ Open 2014; 4:e006554. [PMID: 25421340 PMCID: PMC4244417 DOI: 10.1136/bmjopen-2014-006554] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Childhood asthma is a complex condition where many environmental factors are implicated in causation. The aim of this study was to complete a systematic review of the literature describing associations between environmental exposures and the development of asthma in young children. SETTING A systematic review of the literature up to November 2013 was conducted using key words agreed by the research team. Abstracts were screened and potentially eligible papers reviewed. Papers describing associations between exposures and exacerbation of pre-existing asthma were not included. Papers were placed into the following predefined categories: secondhand smoke (SHS), inhaled chemicals, damp housing/mould, inhaled allergens, air pollution, domestic combustion, dietary exposures, respiratory virus infection and medications. PARTICIPANTS Children aged up to 9 years. PRIMARY OUTCOMES Diagnosed asthma and wheeze. RESULTS 14,691 abstracts were identified, 207 papers reviewed and 135 included in the present review of which 15 were systematic reviews, 6 were meta-analyses and 14 were intervention studies. There was consistent evidence linking exposures to SHS, inhaled chemicals, mould, ambient air pollutants, some deficiencies in maternal diet and respiratory viruses to an increased risk for asthma (OR typically increased by 1.5-2.0). There was less consistent evidence linking exposures to pets, breast feeding and infant dietary exposures to asthma risk, and although there were consistent associations between exposures to antibiotics and paracetamol in early life, these associations might reflect reverse causation. There was good evidence that exposures to house dust mites (in isolation) was not associated with asthma risk. Evidence from observational and intervention studies suggest that interactions between exposures were important to asthma causation, where the effect size was typically 1.5-3.0. CONCLUSIONS There are many publications reporting associations between environmental exposures and modest changes in risk for asthma in young children, and this review highlights the complex interactions between exposures that further increase risk.
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Affiliation(s)
- S Dick
- Occupational and Environmental Medicine, University of Aberdeen, Aberdeen, UK
| | - A Friend
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - K Dynes
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - F AlKandari
- Department of Child Health, University of Aberdeen, Aberdeen, UK
| | - E Doust
- Institute of Occupational Medicine, Edinburgh, UK
| | - H Cowie
- Institute of Occupational Medicine, Edinburgh, UK
| | - J G Ayres
- Occupational and Environmental Medicine, University of Aberdeen, Aberdeen, UK
- Environmental and Respiratory Medicine, University of Birmingham, Birmingham, UK
| | - S W Turner
- Department of Child Health, University of Aberdeen, Aberdeen, UK
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Grande AJ, Silva V, Andriolo BNG, Riera R, Parra SA, Peccin MS. Water-based exercise for adults with asthma. Cochrane Database Syst Rev 2014:CD010456. [PMID: 25032820 DOI: 10.1002/14651858.cd010456.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Asthma is a common condition characterised by airway inflammation and airway narrowing, which can result in intermittent symptoms of wheezing, coughing and chest tightness, possibly limiting activities of daily life. Water-based exercise is believed to offer benefits for people with asthma through pollen-free air, humidity and effects of exercise on physical function. OBJECTIVES To evaluate the effectiveness and safety of water-based exercise for adults with asthma. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of Trials (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), PsycINFO, the Latin American and Caribbean Health Science Information Database (LILACS), the Physiotherapy Evidence Database (PEDro), the System for Information on Grey Literature in Europe (SIGLE) and Google Scholar on 13 May 2014. We handsearched ongoing clinical trial registers and meeting abstracts of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the British Thoracic Society (BTS). SELECTION CRITERIA We included all randomised controlled trials (RCTs) of adults with asthma comparing a water-based exercise group versus one or more of the following groups: usual care, land-based exercise, non-exercise. DATA COLLECTION AND ANALYSIS Two review authors (AJG, VS) independently extracted data from the primary studies using a standard form developed for this purpose, which includes methods, participants, interventions and outcomes. We contacted trial authors to request additional data. Data were input by one review author and were double-checked by a second review author. MAIN RESULTS In this systematic review, we provide a narrative synthesis of available evidence from three small studies including 136 adult participants. The studies were at high risk of bias. No meta-analysis was possible because of methodological and interventional heterogeneity between included studies. The primary outcomes of quality of life and exacerbations leading to use of steroids were not reported by these studies. For exacerbations leading to health centre/hospital visits, uncertainty was wide because a very small number of events was reported (in a single study). Secondary outcomes symptoms, lung function, changes in medication and adverse effects, where available, described for each included study. The overall quality of the studies was very low, and no clear differences were noted between water-based exercise and comparator treatments. Therefore, we remain very uncertain about the effects of water-based exercise for adults with asthma. AUTHORS' CONCLUSIONS The small number of participants in the three included studies, the clinical and methodological heterogeneity observed and the high risk of bias assessed mean that we are unable to assess the place of water-based exercise in asthma. Randomised controlled trials are needed to assess the efficacy and safety of water-based exercise for adults with asthma. For future research, we suggest greater methodological rigour (participant selection, blinding of outcome assessors, reporting of all outcomes analysed and registering of the study protocol).
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Affiliation(s)
- Antonio Jose Grande
- Department of Public Health, Universidade do Extremo Sul Catarinense, Av. Universitária, 1105, Criciúma, Santa Catarina, Brazil, 88806-000
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Font-Ribera L, Villanueva CM, Gràcia-Lavedan E, Borràs-Santos A, Kogevinas M, Zock JP. Indoor swimming pool attendance and respiratory and dermal health in schoolchildren--HITEA Catalonia. Respir Med 2014; 108:1056-9. [PMID: 24835075 DOI: 10.1016/j.rmed.2014.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/11/2014] [Accepted: 04/22/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health benefits of swimming in pools may outweigh adverse health outcomes in children, but evidence from epidemiological studies is scarce or inconclusive for different health outcomes. We evaluated the association between indoor swimming pool attendance during childhood and respiratory and dermal conditions and symptoms in Catalan schoolchildren. METHODS Cross-sectional study in 2758 children aged 6-12 years from 18 primary schools in Barcelona province. Information on regular indoor swimming pool attendance in seven age periods, history of health conditions (asthma, wheezing, eczema, dermatitis, rhinitis, allergic rhinitis) and symptoms in the last 12 months (wheezing, dermatitis, rhinitis and number of cold, tonsillitis or otitis episodes) were collected through parental self-administered questionnaires. The associations between swimming pool attendance and health outcomes were evaluated using multivariate mixed logistic and Poisson regression models. RESULTS Regular indoor swimming before 2 years of age was not related to having ever had asthma (Odds Ratio (OR) = 1.14; 95%CI = 0.73-1.77), wheezing (OR = 1.02; 95%CI = 0.82-1.28), or eczema (OR = 1.09; 95%CI = 0.87-1.36). Current indoor swimming was not associated with symptoms in the last 12 months (Incidence Rate Ratio for otitis was 0.94; 95%CI = 0.77-1.15). Stratification by eczema or maternal education gave very similar results. CONCLUSION This new large population-based study indicates that regular indoor swimming during infancy does not increase respiratory, allergic or dermal symptoms in Catalan schoolchildren aged 6-12 years.
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Affiliation(s)
- Laia Font-Ribera
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Cristina M Villanueva
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Esther Gràcia-Lavedan
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Alícia Borràs-Santos
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; National School of Public Health, Athens, Greece
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Chowdhury S, Alhooshani K, Karanfil T. Disinfection byproducts in swimming pool: occurrences, implications and future needs. WATER RESEARCH 2014; 53:68-109. [PMID: 24509344 DOI: 10.1016/j.watres.2014.01.017] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 06/03/2023]
Abstract
Disinfection of swimming pool water is essential to deactivate pathogenic microorganisms. Many swimming pools apply chlorine or bromine based disinfectants to prevent microbial growth. The chlorinated swimming pool water contains higher chlorine residual and is maintained at a higher temperature than a typical drinking water distribution system. It constitutes environments with high levels of disinfection by-products (DBPs) in water and air as a consequence of continuous disinfection and constant organic loading from the bathers. Exposure to those DBPs is inevitable for any bather or trainer, while such exposures can have elevated risks to human health. To date, over 70 peer-reviewed publications have reported various aspects of swimming pool, including types and quantities of DBPs, organic loads from bathers, factors affecting DBPs formation in swimming pool, human exposure and their potential risks. This paper aims to review the state of research on swimming pool including with the focus of DBPs in swimming pools, understand their types and variability, possible health effects and analyze the factors responsible for the formation of various DBPs in a swimming pool. The study identifies the current challenges and future research needs to minimize DBPs formation in a swimming pool and their consequent negative effects to bathers and trainers.
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Affiliation(s)
- Shakhawat Chowdhury
- Department of Civil and Environmental Engineering, Water Research Group, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia.
| | - Khalid Alhooshani
- Department of Chemistry, King Fahd University of Petroleum and Minerals, Dhahran 31261, Saudi Arabia
| | - Tanju Karanfil
- Department of Environmental Engineering and Earth Sciences, Clemson University, SC, USA
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