Respiratory, ocular and skin health in recreational and competitive swimmers: Beneficial effect of a new method to reduce chlorine oxidant derivatives

The Drinking Water and Swimming Pool Disinfectant Trichloroisocyanuric Acid Causes Chlorination Stress Enhancing Solar UV-Induced Inflammatory Gene Expression in AP-1 Transgenic SKH-1 Luciferase Reporter Mouse Skin

Freshwater sanitation and disinfection using a variety of chemical entities as chlorination agents is an essential public health intervention ensuring water safety for populations at a global scale. Recently, we have published our observation that the small molecule oxidant, innate immune factor and chlorination agent HOCl antagonize inflammation and photocarcinogenesis in murine skin exposed topically to environmentally relevant concentrations of HOCl. Chlorinated isocyanuric acid derivatives (including the chloramines trichloroisocyanuric acid [TCIC] and dichloroisocyanuric acid [DCIC]) are used worldwide as alternate chlorination agents serving as HOCl precursor and stabilizer compounds ensuring sustained release in aqueous environments including public water systems, recreational pools and residential hot tubs. Here, for the first time, we have examined the cutaneous TCIC-induced transcriptional stress response (in both an organotypic epidermal model and in AP-1 luciferase reporter SKH-1 mouse skin), also examining molecular consequences of subsequent treatment with solar ultraviolet (UV) radiation. Taken together, our findings indicate that cutaneous delivery of TCIC significantly enhances UV-induced inflammation (as profiled at the gene expression level), suggesting a heretofore unrecognized potential to exacerbate UV-induced functional and structural cutaneous changes. These observations deserve further molecular investigations in the context of TCIC-based freshwater disinfection with health implications for populations worldwide.

Antimicrobial efficacy, mode of action and in vivo use of hypochlorous acid (HOCl) for prevention or therapeutic support of infections

The objective is to provide a comprehensive overview of the rapidly developing field of the current state of research on in vivo use of hypochlorous acid (HOCl) to aid infection prevention and control, including naso-pharyngeal, alveolar, topical, and systemic HOCl applications. Also, examples are provided of dedicated applications in COVID-19. A brief background of HOCl's biological and chemical specifics and its physiological role in the innate immune system is provided to understand the effect of in vivo applications in the context of the body's own physiological defense mechanisms.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to 'core' members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.

Hypochlorous Acid: From Innate Immune Factor and Environmental Toxicant to Chemopreventive Agent Targeting Solar UV-Induced Skin Cancer

A multitude of extrinsic environmental factors (referred to in their entirety as the 'skin exposome') impact structure and function of skin and its corresponding cellular components. The complex (i.e. additive, antagonistic, or synergistic) interactions between multiple extrinsic (exposome) and intrinsic (biological) factors are important determinants of skin health outcomes. Here, we review the role of hypochlorous acid (HOCl) as an emerging component of the skin exposome serving molecular functions as an innate immune factor, environmental toxicant, and topical chemopreventive agent targeting solar UV-induced skin cancer. HOCl [and its corresponding anion (OCl-; hypochlorite)], a weak halogen-based acid and powerful oxidant, serves two seemingly unrelated molecular roles: (i) as an innate immune factor [acting as a myeloperoxidase (MPO)-derived microbicidal factor] and (ii) as a chemical disinfectant used in freshwater processing on a global scale, both in the context of drinking water safety and recreational freshwater use. Physicochemical properties (including redox potential and photon absorptivity) determine chemical reactivity of HOCl towards select biochemical targets [i.e. proteins (e.g. IKK, GRP78, HSA, Keap1/NRF2), lipids, and nucleic acids], essential to its role in innate immunity, antimicrobial disinfection, and therapeutic anti-inflammatory use. Recent studies have explored the interaction between solar UV and HOCl-related environmental co-exposures identifying a heretofore unrecognized photo-chemopreventive activity of topical HOCl and chlorination stress that blocks tumorigenic inflammatory progression in UV-induced high-risk SKH-1 mouse skin, a finding with potential implications for the prevention of human nonmelanoma skin photocarcinogenesis.

Health effects of exposure to chlorination by-products in swimming pools

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.

Enhanced Visible-Light Absorption of Fe2O3 Covered by Activated Carbon for Multifunctional Purposes: Tuning the Structural, Electronic, Optical, and Magnetic Properties

Visible-light absorption is a critical factor for photocatalyst activity and absorption of electromagnetic (EM) interference application. The band gap of Fe2O3 is 2 eV, which can be increased by doping with a high-band-gap material such as carbon from activated carbon (AC) with a band gap of 4.5 eV for increased visible-light absorption. The porosity decreases from 88 to 81.6%, and the band gap increases from 2.14 to 2.64 eV by increasing the AC from 10 to 25%, respectively. The photocatalytic activity takes 120 min to produce a harmless product for 10-20% AC, but 25% AC shows 89.5% degradation in only 90 min and the potential to attenuate the EM wave up to 99% due to the RL being below -20 dB. The second- and third-cycle degradation achieved by the composite Fe2O3-AC having 25% AC is 88.2 and 86.5% in 90 min, respectively. The pore of the surface state of AC contains a trapped charge, and interaction occurs between the charge (electron/hole) and O2 or H2O to produce OH and superoxide (O2 -) radicals. These radicals move inside the molecule of the pollutant (methylene blue (MB)) to break up the bond, with the final products being H2O and CO2. The X-ray photoelectron (XPS) spectra show that oxygen plays a key role in the interatomic bonding with Fe, C, and MB atoms. The best absorption of EM interference is -21.43 dB, with degradation reaching 89.51% in only 90 min for 25% AC due to its higher band gap and anisotropy constant. Fe2O3-carbon is a multifunctional material for the green environment because of its electromagnetic interference absorption and photodegradation of wastewater.

Asthma, allergies and respiratory symptoms in different activity groups of swimmers exercising in swimming halls

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.

Topical hypochlorous acid (HOCl) blocks inflammatory gene expression and tumorigenic progression in UV-exposed SKH-1 high risk mouse skin

Hypochlorous acid (HOCl) is the active oxidizing principle underlying drinking water disinfection, also delivered by numerous skin disinfectants and released by standard swimming pool chemicals used on a global scale, a topic of particular relevance in the context of the ongoing COVID-19 pandemic. However, the cutaneous consequences of human exposure to HOCl remain largely unknown, posing a major public health concern. Here, for the first time, we have profiled the HOCl-induced stress response in reconstructed human epidermis and SKH-1 hairless mouse skin. In addition, we have investigated the molecular consequences of solar simulated ultraviolet (UV) radiation and HOCl combinations, a procedure mimicking co-exposure experienced for example by recreational swimmers exposed to both HOCl (pool disinfectant) and UV (solar radiation). First, gene expression elicited by acute topical HOCl exposure was profiled in organotypic human reconstructed epidermis. Next, co-exposure studies (combining topical HOCl and UV) performed in SKH-1 hairless mouse skin revealed that the HOCl-induced cutaneous stress response blocks redox and inflammatory gene expression elicited by subsequent acute UV exposure (Nos2, Ptgs2, Hmox1, Srxn1), a finding consistent with emerging clinical evidence in support of a therapeutic role of topical HOCl formulations for the suppression of inflammatory skin conditions (e.g. atopic dermatitis, psoriasis). Likewise, in AP-1 transgenic SKH-1 luciferase-reporter mice, topical HOCl suppressed UV-induced inflammatory signaling assessed by bioluminescent imaging and gene expression analysis. In the SKH-1 high-risk mouse model of UV-induced human keratinocytic skin cancer, topical HOCl blocked tumorigenic progression and inflammatory gene expression (Ptgs2, Il19, Tlr4), confirmed by immunohistochemical analysis including 3-chloro-tyrosine-epitopes. These data illuminate the molecular consequences of HOCl-exposure in cutaneous organotypic and murine models assessing inflammatory gene expression and modulation of UV-induced carcinogenesis. If translatable to human skin these observations provide novel insights on molecular consequences of chlorination stress relevant to environmental exposure and therapeutic intervention.

Impact of swimming pool water treatment system factors on the content of selected disinfection by-products

Recommendations regarding disinfection by-products (DBPs) in pool waters consider the content of trihalomethanes (THMs) and combined chlorine (CC) as indicators of DBPs based on which the health risk for swimmers and staff of pool facility can be determined. However, the content of DBPs in swimming pools depends on many factors. In this paper, the influence of selected factors (physicochemical parameters of water and technological parameters) on the content of THMs and CC in pool water was determined. During the 6-month period, 9 pools of various functions were analyzed. The water in pools was subjected to the same method of treatment. The content of THMs and CC was compared against the content of organic matter, free chlorine and nitrates, pH, temperature, redox potential and turbidity, technological, and operational parameters. The THM content did not exceed the limit value of 0.1 mg/L. The content of CC varied significantly, from 0.05 to 1.13 mg Cl2/L. It was found that a very large water volume per person, in comparison to a very small one, contributed to the low content of CC and THMs. The high load expressed as m3 of water per person or m2 of water per person and the specific function of hot tubs (HT1 and HT2) led to the average concentration of CC in these pools exceeding 0.3 mg Cl2/L. The THM concentrations in hot tubs (especially in HT1) were also among the largest (0.038-0.058 mg/L). In terms of the analyzed microbiological indicators, the quality of the tested pool water samples was not in doubt. It was found that the purpose of the pool, its volume, and number of swimmers should be the key parameters that determine the choice of methods of water treatment. The research on the pool water quality in the actual working conditions of swimming pool facilities is necessary due to the need to preserve the health safety of swimmers and staff.

Pilot Test on Pre-Swim Hygiene as a Factor Limiting Trihalomethane Precursors in Pool Water by Reducing Organic Matter in an Operational Facility

Pool water must be constantly disinfected. Chlorine compounds used to disinfect pools react with organic substances such as sweat, urine, and personal care products introduced into pool water by users and results in the formation of disinfection byproducts. Trihalomethanes (THM), including chloroform and dissolved organic carbon (DOC) concentrations, were quantified using a two-stage process: determining initial THM and chloroform levels; then searching for a cheap and easy-to-use method to improve water quality. The method proposed here to limit THM and DOC concentrations in water is controlled showering. At three swimming pool facilities, chloroform concentrations (13.8 ± 0.33 µg/L, 15.5 ± 0.44 µg/L, and 13.9 ± 0.06 µg/L) were below the threshold concentration of 30 μg/L. At a fourth facility, however, the chloroform concentration exceeded that threshold (40.7 ± 9.68 μg/L) when showering was not controlled. Those conditions improved after the introduction of a mandatory shower; concentrations of DOC, THMs, and chloroform all decreased. The chloroform concentration decreased to 29.4 ± 3.8 μg/L, the THM concentration was 31.3 ± 3.9 μg/L, and the DOC concentration was 6.09 ± 0.05 mg/L. Pilot tests were carried out at real facilities to determine whether the control of pre-swim hygiene was possible. The introduction of proper pre-swim hygiene limited the concentration of DOC in water and can lead to a healthier environment for everyone attending the swimming facility.

Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

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.

Comparative study on the microbial quality in the swimming pools disinfected by the ozone-chlorine and chlorine processes in Tabriz, Iran

Applying a desirable disinfestation process is necessary to control the pathogenic microorganisms in the swimming pools and prevent both dermal and intestinal effects. Therefore, the present study was conducted to compare the bacterial community and diversity in the two swimming pools disinfected by the chlorine and ozone (O₃)-chlorine processes. A total of 24 samples were taken from the two swimming pools in three distinct seasons to analyze the bacterial and physico-chemical indicators. Culture and molecular methods were used to evaluate the microbial quality. Two sets of sample taken from the pools with the maximum swimmer load in the summer were investigated by the next-generation sequencing (NGS) technique. In total, 410 and 406 bacterial species were identified in the chlorine- and ozone-chlorine-disinfected pools, respectively. Among the eight dominant bacterial species in each swimming pool, Pseudomonas alcaliphila, Pseudomonas stutzeri, and Pseudomonas acnes were common species between the two studied pools. Oleomonas sagaranensis (350 reads/18593), Staphylococcus caprae (302 reads /18593), and Anaerococcus octavius (110 reads/18593) were among the dominant bacteria in the chlorine-disinfected pool. Bacterial diversity was lower in the ozone-chlorine-disinfected pool than the other one, and the highest bacterial sequencing belonged to the genus Pseudomonas (85.79%). Results showed that water quality of in O₃-chlorine-disinfected pool was more desirable than the chlorine-disinfected pool. Molecular methods along with conventional culture methods would be advantageous for microbial assessment in the swimming pools.

Analysis of Free and Combined Chlorine Concentrations in Swimming Pool Water and an Attempt to Determine a Reliable Water Sampling Point

The analysis of free chlorine concentrations in swimming pool water makes it possible to assess the antiseptic effect of the disinfectant. The concentration of combined chlorine determines the comfort of swimming and indicates if there is a threat from DBP (disinfection by-products). The distribution of free and combined chlorine concentration was analyzed in four basins differing in seasonality of use and in the applied water flow systems. After considering the distribution of free and combined chlorine content in characteristic points of pools, an attempt was made to determine the most reliable point for assessing the quality of water and its suitability for swimming. Such searches should aim to identify the places with the worst water quality. The most uniform distribution of the concentrations of both free and combined chlorine was observed at the middle point of swimming pools, while at points near the corners and walls of swimming pools a varied distribution was observed. Such a control strategy, based on the least favorable test results at a point considered as characteristic, would make it possible to verify the parameters of the swimming pool water treatment system and thus minimize the risk to swimmers’ health.