Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools

The acute effects of endurance exercise on epithelial integrity of the airways in athletes and non-athletes: A systematic review and meta-analysis

INTRODUCTION

Acute endurance exercise may induce airway epithelium injury. However, the response of epithelial integrity markers of the airways including club cell secretory protein (CC16) and surfactant protein D (SP-D) to endurance exercise have not been systematically reviewed. Therefore, the aim of this systematic review and meta-analysis was to assess the acute effects of endurance exercise on markers of epithelial integrity of the airways (CC16, SP-D and the CC16/SP-D ratio) in athletes and non-athletes.

METHODS

A systematic search was performed utilizing PubMed/Medline, EMBASE, Web of Science, and hand searching bibliographies of retrieved articles through to September 2022. Based on the inclusion criteria, articles with available data about the acute effects of endurance exercise on serum or plasma concentrations of CC16, SP-D and CC16/SP-D ratio in athletes and non-athletes were included. Quality assessment of studies and statistical analysis were conducted via Review Manager 5.4 software.

RESULTS

The search resulted in 908 publications. Finally, thirteen articles were included in the review. Acute endurance exercise resulted in an increase in CC16 (P = 0.0006, n = 13) and CC16/SP-D ratio (P = 0.005, n = 2) whereas SP-D (P = 0.47, n = 3) did not change significantly. Subgroup analysis revealed that the type (P = 0.003), but not the duration of exercise (P = 0.77) or the environmental temperature (P = 0.06) affected the CC16 response to endurance exercise.

CONCLUSIONS

Acute endurance exercise increases CC16 and the CC16/SP-D ratio, as markers of epithelial integrity, but not SP-D in athletes and non-athletes.

Swimming pool water disinfection by-products profiles and association patterns

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.

Studying Respiratory Symptoms Related to Swimming Pools Attendance in Young Athletes: The SPHeRA Study

This study investigates the prevalence of respiratory symptoms and the training factors possibly associated with them in a sample of young Italian competitive swimmers. A questionnaire about training information and symptoms was administered to participants during the winter and summer 2021 training seasons. In total, 396 athletes took part in the study. In the winter training subgroup (n = 197), we found significant associations between increasing training hours per session and the presence of nasal congestion/rhinorrhoea (OR = 3.10; p = 0.039) and cough (OR = 3.48; p = 0.015). Total training hours per week were significantly associated with nasal congestion/rhinorrhoea (OR = 1.12; p = 0.010). In the summer group (n = 199), the same factors were not associated with respiratory symptoms. Having an allergy was significantly related to nasal congestion/rhinorrhea in both the logistic models (model 1 OR = 2.69, p = 0.013; model 2 OR = 2.70, p = 0.012), while having asthma significantly increased the risk of coughing (OR = 3.24, p = 0.033). The kind of environment (indoor or outdoor facilities) did not affect the studied symptoms either in summer or winter. Further investigations are needed to better understand the mechanisms involved in the development of respiratory symptoms in swimmers, particularly on how inflammation and remodelling develop and which environmental conditions can favour these processes.

Distinct comammox Nitrospira catalyze ammonia oxidation in a full-scale groundwater treatment bioreactor under copper limited conditions

Microbial ammonia oxidation is the initial nitrification step used in biological nitrogen-removal during water treatment processes, and the discovery of complete ammonia-oxidizing (comammox) bacteria added a novel member to this functional group. It is important to identify and understand the predominant microorganisms responsible for ammonium removal in biotechnological process design and optimization. In this study, we used a full-scale bioreactor to treat ammonium in groundwater (9.3 ± 0.5 mg NH₄⁺-N/L) and investigated the key ammonia-oxidizing prokaryotes present. The groundwater ammonium was stably and efficiently oxidized throughout ∼700 days of bioreactor operation. 16S rRNA gene amplicon sequencing of the bioreactor community showed a high abundance of Nitrospira (12.5-45.9%), with the dominant sequence variant (3.5-37.8%) most closely related to Candidatus Nitrospira nitrosa. Furthermore, analyses of amoA, the marker gene for ammonia oxidation, indicated the presence of two distinct comammox Nitrospira populations, however, the relative abundance of only one of these populations was strongly correlated to ammonia oxidation rates and was robustly expressed. After 380 days of operation copper wires were immersed into the reactor at 0.04-0.06 m²/m³ tank, which caused a gradual abundance increase of one discrete comammox Nitrospira population. However, further increase of the copper dosing (0.08 m²/m³ tank) inverted the most abundant ammonia-oxidizing population to Nitrosomonas sp. These results indicate that comammox Nitrospira were capable of efficient ammonium removal in groundwater without exogenous nutrients, but copper addition can stimulate comammox Nitrospira or lead to dominance of Nitrosomonas depending on dosage.

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.

A systematic review and meta-analysis on the effectiveness of swimming on lung function and asthma control in children with asthma

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.

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.

Analysis of the Kinetics of Swimming Pool Water Reaction in Analytical Device Reproducing Its Circulation on a Small Scale

The most common cause of diseases in swimming pools is the lack of sanitary control of water quality; water may contain microbiological and chemical contaminants. Among the people most at risk of infection are children, pregnant women, and immunocompromised people. The origin of the problem is a need to develop a system that can predict the formation of chlorine water disinfection by-products, such as trihalomethanes (THMs). THMs are volatile organic compounds from the group of alkyl halides, carcinogenic, mutagenic, teratogenic, and bioaccumulating. Long-term exposure, even to low concentrations of THM in water and air, may result in damage to the liver, kidneys, thyroid gland, or nervous system. This article focuses on analysis of the kinetics of swimming pool water reaction in analytical device reproducing its circulation on a small scale. The designed and constructed analytical device is based on the SIMATIC S7-1200 PLC driver of SIEMENS Company. The HMI KPT panel of SIEMENS Company enables monitoring the process and control individual elements of device. Value of the reaction rate constant of free chlorine decomposition gives us qualitative information about water quality, it is also strictly connected to the kinetics of the reaction. Based on the experiment results, the value of reaction rate constant was determined as a linear change of the natural logarithm of free chlorine concentration over time. The experimental value of activation energy based on the directional coefficient is equal to 76.0 [kJ×mol−1]. These results indicate that changing water temperature does not cause any changes in the reaction rate, while it still affects the value of the reaction rate constant. Using the analytical device, it is possible to constantly monitor the values of reaction rate constant and activation energy, which can be used to develop a new way to assess pool water quality.

Indoor acids and bases

Numerous acids and bases influence indoor air quality. The most abundant of these species are CO₂ (acidic) and NH₃ (basic), both emitted by building occupants. Other prominent inorganic acids are HNO₃ , HONO, SO₂ , H₂ SO₄ , HCl, and HOCl. Prominent organic acids include formic, acetic, and lactic; nicotine is a noteworthy organic base. Sources of N-, S-, and Cl-containing acids can include ventilation from outdoors, indoor combustion, consumer product use, and chemical reactions. Organic acids are commonly more abundant indoors than outdoors, with indoor sources including occupants, wood, and cooking. Beyond NH₃ and nicotine, other noteworthy bases include inorganic and organic amines. Acids and bases partition indoors among the gas-phase, airborne particles, bulk water, and surfaces; relevant thermodynamic parameters governing the partitioning are the acid-dissociation constant (K_a ), Henry's law constant (K_H ), and the octanol-air partition coefficient (K_oa ). Condensed-phase water strongly influences the fate of indoor acids and bases and is also a medium for chemical interactions. Indoor surfaces can be large reservoirs of acids and bases. This extensive review of the state of knowledge establishes a foundation for future inquiry to better understand how acids and bases influence the suitability of indoor environments for occupants, cultural artifacts, and sensitive equipment.

Swimming pools quality risk assessment for heavy metal deposition and intake via oral and dermal exposure

The deplorable environmental conditions coupled to poor management practices employed by public swimming pool owners have led to suspicions over the safety of these recreational sites. This study was carried out to determine the physicochemical properties, heavy metal contents and accumulation, and associated risks of six swimming pools in Owerri, Capital of Imo State, Nigeria. Physicochemical analysis was conducted using standard methods while determination of heavy metals was carried out using an atomic absorption spectrophotometer. Results obtained showed that the turbidities and total dissolved solutes exceeded the Nigeria standard for water quality. Iron (Fe), cadmium (Cd), mercury (Hg), arsenic (As), nickel (Ni), and lead (Pb) exceeded the drinking safety values from United States Environmental Protection Agency, National Standards for Drinking Water Quality, and World Health Organization, while selenium (Se), chromium (Cr), and zinc (Zn) values fell within the permissible limits. From the bioaccumulation models applied, the enrichment factors showed anthropogenic source of deposition of the metals in all swimming pool while the heavy metal index were in a range of 27.30-70.19. For the risk assessment results, the chronic daily intake showed that Hg, and As levels for all the swimming pools, and Cu for some swimming pools exceeded the oral reference doses, while the hazard quotient for Hg (5.65-16.95), As (2.26-3.77), and Cu (1.13-4.11) indicated potentials of causing related toxicities. This study has shown that the aesthetic quality of the swimming pools were compromised, and contained elevated levels of Hg, As, and Cu significant enough to threaten the health safety of users of these swimming pools, which should instigate tough measures from Nigerian water regulatory bodies to ensure compliance from public swimming pool owners.

Modelling the concentration of chloroform in the air of a Norwegian swimming pool facility-A repeated measures study

Certain volatile disinfection by-products (DBPs) off-gassing from pool water can cause eye and skin irritations, respiratory problems, and even cancer. No guidelines or recommendations concerning DBPs in the air exist in Norway. Traditionally, ventilation strategies in indoor swimming pools are based on reducing condensation on the windows rather than ensuring proper air quality in the users' breathing zone. A total of 93 air samples of airborne concentrations of trihalomethanes (THMs) were collected via stationary sampling. We investigated the distribution of total THM (tTHM) 0.05 m and 0.60 m above the water surface at six different locations in the poolroom and the covariation between the water and air quality parameters. Based on a linear mixed effects model, the most important determinants in terms of predicting the air concentration of CHCl₃ were height above water surface, air changes of fresh air per hour, concentration of combined chlorine in the water, relative humidity (RH) and day of the week. Approximately 36% of the total variability could be attributed to these variables; hence, to reduce the average exposure in the poolroom, hazard control should focus on these variables. Based on the identified predictor variables, the supplied air should be controlled based on water quality in addition to the traditional control censors for RH and air temperature used in the ventilation system of Norwegian swimming facilities.

N2 yields from monochloramine conversion by granular activated carbons are decisive for effective swimming pool water treatment

Inorganic chloramines (mono-, di- and trichloramine) are formed in swimming pool water from the unintended reaction of free chlorine with ammonia that is introduced by bathers. Monochloramine is of particular interest as it is known to react further in pool water forming harmful DBPs, such carcinogenic N-nitrosodimethylamine (NDMA). During pool water treatment with granular activated carbon (GAC) filters, monochloramine is transformed by chemical reactions on the carbon surface to N₂ and ammonia. As ammonia is led back into the pool where it is chlorinated again under the renewed formation of inorganic chloramines, it is recommended to use GACs with a high N₂ yield for monochloramine transformation in pool water treatment. In this study, yields of N₂ and ammonia from monochloramine conversion by commercially available GACs were determined using a fixed-bed reactor system under conditions that are typical for swimming pool water treatment. The N₂ yields remained constant with on-going exposure of the GAC to monochloramine and ranged from 0.5% to 21.3%, depending on the type of GAC used. Correlation analyses were conducted to identify carbon properties that can determine the N₂ yield for monochloramine conversion, such as the amount of oxygen groups, the elemental composition and the trace metal content. It was found that the N₂ yield significantly correlates with the copper content of the tested carbons. Model calculations combining pool hydraulics with formation/abatement of inorganic chloramines and NDMA as well as chloramine transformations in GAC filters showed that the concentration of inorganic chloramines and carcinogenic NDMA can be decreased by a factor of ∼2, if the tested GACs could be modified to convert up to ∼50% of the monochloramine to N₂.

Asthma and exercise-induced respiratory disorders in athletes. The position paper of the Polish Society of Allergology and Polish Society of Sports Medicine

Exercise-induced respiratory symptoms describe acute airway narrowing that occurs as a result of exercise. It includes exercise-induced bronchoconstriction (EIB) and exercise-induced asthma (EIA) issues. To provide clinicians with practical guidelines, a multidisciplinary panel of stakeholders was convened to review the pathogenesis of EIB/EIA and to develop evidence-based guidelines for the diagnosis and treatment. Recommendations for the diagnosis and treatment of EIB were developed. High-intensity exercise in polluted environment (cold air, humidity, contamination, allergens) may increase the risk of EIB and asthma symptoms in athletes. Diagnostic procedures should include history taking, physical examination, atopy assessment and functional tests of the respiratory system. A strong recommendation was made for regular use of inhaled glucocorticosteroids and avoidance of short-acting β₂-agonists as the only treatment. The treatment of asthma in athletes should always take into account current anti-doping regulations. This position paper reflects the currently available evidence.

Nonpharmacologic Strategies to Manage Exercise-Induced Bronchoconstriction

Pharmacologic management of exercise-induced bronchoconstriction (EIB) is the mainstay of preventative therapy. There are some nonpharmacologic interventions, however, that may assist the management of EIB. This review discusses these nonpharmacologic interventions and how they may be applied to patients and athletes with EIB.

An exploration of disinfection by-products formation and governing factors in chlorinated swimming pool water

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.

Early life swimming pool exposure and asthma onset in children - a case-control study

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.

Pore diffusion limits removal of monochloramine in treatment of swimming pool water using granular activated carbon

Overall apparent reaction rates for the removal of monochloramine (MCA) in granular activated carbon (GAC) beds were determined using a fixed-bed reactor system and under conditions typical for swimming pool water treatment. Reaction rates dropped and quasi-stationary conditions were reached quickly. Diffusional mass transport in the pores was shown to be limiting the overall reaction rate. This was reflected consistently in the Thiele modulus, in the effect of temperature, pore size distribution and of grain size on the reaction rates. Pores <2.5 times the diameter of the monochloramine molecule were shown to be barely accessible for the monochloramine conversion reaction. GACs with a significant proportion of large mesopores were found to have the highest overall reactivity for monochloramine removal.

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

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.

Effects of exposure to water disinfection by-products in a swimming pool: A metabolome-wide association study

BACKGROUND

Exposure to disinfection by-products (DBPs) in drinking water and chlorinated swimming pools are associated with adverse health outcomes, but biological mechanisms remain poorly understood.

OBJECTIVES

Evaluate short-term changes in metabolic profiles in response to DBP exposure while swimming in a chlorinated pool.

MATERIALS AND METHODS

The PISCINA-II study (EXPOsOMICS project) includes 60 volunteers swimming 40min in an indoor pool. Levels of most common DBPs were measured in water and in exhaled breath before and after swimming. Blood samples, collected before and 2h after swimming, were used for metabolic profiling by liquid-chromatography coupled to high-resolution mass-spectrometry. Metabolome-wide association between DBP exposures and each metabolic feature was evaluated using multivariate normal (MVN) models. Sensitivity analyses and compound annotation were conducted.

RESULTS

Exposure levels of all DBPs in exhaled breath were higher after the experiment. A total of 6,471 metabolic features were detected and 293 features were associated with at least one DBP in exhaled breath following Bonferroni correction. A total of 333 metabolic features were associated to at least one DBP measured in water or urine. Uptake of DBPs and physical activity were strongly correlated and mutual adjustment reduced the number of statistically significant associations. From the 293 features, 20 could be identified corresponding to 13 metabolites including compounds in the tryptophan metabolism pathway.

CONCLUSION

Our study identified numerous molecular changes following a swim in a chlorinated pool. While we could not explicitly evaluate which experiment-related factors induced these associations, molecular characterization highlighted metabolic features associated with exposure changes during swimming.

Selective citation in the literature on swimming in chlorinated water and childhood asthma: a network analysis

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.

Swimming attendance during childhood and development of asthma: Meta-analysis

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.

Effect of chloride on the formation of volatile disinfection byproducts in chlorinated swimming pools

Chloride can accumulate in chlorinated swimming pool water. Although substantial efforts have been made to examine the effects of halide ions on the formation of volatile disinfection byproducts (DBPs), most have focused on bromide. The effects of chloride ion concentration on the formation of volatile DBPs in swimming pools remain largely unstudied. In this study, chlorination of typical precursors and body fluid analogue (BFA) were investigated with variable chloride concentration and pH. The formation of three volatile DBPs (NCl₃, CHCl₃ and CNCHCl₂) was observed to be linearly correlated with chloride concentration, both in bench experiments and in actual swimming pool water samples. Free chlorine consumption was also observed to increase with chloride concentration. These behaviors appear to be attributable to shifts in speciation of free chlorine, with higher chloride resulting in higher concentration of molecular chlorine (Cl₂), which is much more reactive than HOCl. The results of this work suggest that changes in pool management strategies to promote low chloride concentration could be important for control of volatile DBPs in pools and to economize free chlorine usage.

Progressive Increase in Disinfection Byproducts and Mutagenicity from Source to Tap to Swimming Pool and Spa Water: Impact of Human Inputs

Pools and spas are enjoyed throughout the world for exercise and relaxation. However, there are no previous studies on mutagenicity of disinfected spa (hot tub) waters or comprehensive identification of disinfection byproducts (DBPs) formed in spas. Using 28 water samples from seven sites, we report the first integrated mutagenicity and comprehensive analytical chemistry of spas treated with chlorine, bromine, or ozone, along with pools treated with these same disinfectants. Gas chromatography (GC) with high-resolution mass spectrometry, membrane-introduction mass spectrometry, and GC-electron capture detection were used to comprehensively identify and quantify DBPs and other contaminants. Mutagenicity was assessed by the Salmonella mutagenicity assay. More than 100 DBPs were identified, including a new class of DBPs, bromoimidazoles. Organic extracts of brominated pool/spa waters were 1.8× more mutagenic than chlorinated ones; spa waters were 1.7× more mutagenic than pools. Pool and spa samples were 2.4 and 4.1× more mutagenic, respectively, than corresponding tap waters. The concentration of the sum of 21 DBPs measured quantitatively increased from finished to tap to pool to spa; and mutagenic potency increased from finished/tap to pools to spas. Mutagenic potencies of samples from a chlorinated site correlated best with brominated haloacetic acid concentrations (Br-HAAs) (r = 0.98) and nitrogen-containing DBPs (N-DBPs) (r = 0.97) and the least with Br-trihalomethanes (r = 0.29) and Br-N-DBPs (r = 0.04). The mutagenic potencies of samples from a brominated site correlated best (r = 0.82) with the concentrations of the nine HAAs, Br-HAAs, and Br-DBPs. Human use increased significantly the DBP concentrations and mutagenic potencies for most pools and spas. These data provide evidence that human precursors can increase mutagenic potencies of pools and spas and that this increase is associated with increased DBP concentrations.

Airway dysfunction in elite swimmers: prevalence, impact, and challenges

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.

Asthma in Olympians

High prevalence of asthma has been reported repeatedly among elite athletes, especially among endurance athletes. So many athletes used asthma drugs that the objective demonstration of bronchial hyperresponsiveness was required to obtain approval for their use in international sports until 2012 when the most used inhaled asthma drugs was allowed for free use, but with a maximum dose for inhaled β2-agonists. Several factors contribute to the development of asthma among the Olympians causing airways inflammation and bronchial hyper-responsiveness.

Occupational Exposure to Trichloramine and Trihalomethanes in Swedish Indoor Swimming Pools: Evaluation of Personal and Stationary Monitoring

Introduction:

Chlorination is a method commonly used to keep indoor swimming pool water free from pathogens. However, chlorination of swimming pools produces several potentially hazardous by-products as the chlorine reacts with nitrogen containing organic matter. Up till now, exposure assessments in indoor swimming pools have relied on stationary measurements at the poolside, used as a proxy for personal exposure. However, measurements at fixed locations are known to differ from personal exposure.

Methods:

Eight public swimming pool facilities in four Swedish cities were included in this survey. Personal and stationary sampling was performed during day or evening shift. Samplers were placed at different fixed positions around the pool facilities, at ~1.5 m above the floor level and 0–1 m from the poolside. In total, 52 personal and 110 stationary samples of trichloramine and 51 personal and 109 stationary samples of trihalomethanes, were collected.

Results:

The average concentration of trichloramine for personal sampling was 71 µg m⁻³, ranging from 1 to 240 µg m⁻³ and for stationary samples 179 µg m⁻³, ranging from 1 to 640 µg m⁻³. The air concentrations of chloroform were well below the occupational exposure limit (OEL). For the linear regression analysis and prediction of personal exposure to trichloramine from stationary sampling, only data from personal that spent >50% of their workday in the pool area were included. The linear regression analysis showed a correlation coefficient (r²) of 0.693 and a significant regression coefficient β of 0.621; (95% CI = 0.329–0.912, P = 0.001).

Conclusion:

The trichloramine exposure levels determined in this study were well below the recommended air concentration level of 500 µg m⁻³; a WHO reference value based on stationary sampling. Our regression data suggest a relation between personal exposure and area sampling of 1:2, implying an OEL of 250 µg m⁻³ based on personal sampling.

Chlorinated pool attendance, airway epithelium defects and the risks of allergic diseases in adolescents: Interrelationships revealed by circulating biomarkers

It has been suggested that allergic diseases might be epithelial disorders driven by various environmental stressors but the epidemiological evidence supporting this concept is limited. In a cross-sectional study of 835 school adolescents (365 boys; mean age, 15.5 yr), we measured the serum concentrations of Club cell protein (CC16), surfactant-associated protein D (SP-D) and of total and aeroallergen-specific IgE. We used the serum CC16/SP-D concentration ratio as an index integrating changes in the permeability (SP-D) and secretory function (CC16) of the airway epithelium. In both sexes, early swimming in chlorinated pools emerged as the most consistent and strongest predictor of low CC16 and CC16/SP-D ratio in serum. Among girls, a low CC16/SP-D ratio was associated with increased odds (lowest vs. highest tertile) for pet sensitization (OR 2.97, 95% CI 1.19-8.22) and for hay fever in subjects sensitized to pollen (OR 4.12, 95% CI 1.28-14.4). Among boys, a low CC16/SP-D ratio was associated with increased odds for house-dust mite (HDM) sensitization (OR 2.01, 95% CI 1.11-3.73), for allergic rhinitis in subjects sensitized to HDM (OR 3.52, 95% CI 1.22-11.1) and for asthma in subjects sensitized to any aeroallergen (OR 3.38, 95% CI 1.17-11.0), HDM (OR 5.20, 95% CI 1.40-24.2) or pollen (OR 5.82, 95% CI 1.51-27.4). Odds for allergic sensitization or rhinitis also increased with increasing SP-D or decreasing CC16 in serum. Our findings support the hypothesis linking the development of allergic diseases to epithelial barrier defects due to host factors or environmental stressors such as early swimming in chlorinated pools.

The role of sports and exercise in allergic disease: drawbacks and benefits

Although training and exercise have several benefits, overdoing it might not necessarily be a good thing. For instance, elite athletes have an increased risk for asthma and allergy. Several mechanisms can be implicated for this risk, which include the interplay between environmental training factors and athlete's personal risk factors, such as genetic susceptibility, neurogenic-mediated inflammation, and epithelial sensitivity. However, an overwhelming amount of scientific evidence shows the positive effects of sports as part of a healthy lifestyle. Training reduces breathlessness and asthma symptoms and attenuates Th2-mediated inflammatory responses. Taken together, the benefits far outweigh the potential hazards of training. An easily administered therapeutic healthy lifestyle intervention, which could be used alongside current treatment, must be developed.

Swimming pool attendance is related to asthma among atopic school children: a population-based study

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.

The influence of caregivers' knowledge and understanding of asthma aetiology on domiciliary management of children with asthma

INTRODUCTION

Asthma is a common childhood disease, and paediatric patients with asthma rely on caregivers to administer domiciliary asthma care. This study aimed to explore the knowledge, understanding, perceptions and main concerns of caregivers and its influence on their home management of children with asthma.

METHODS

Data from 14 caregivers of children with asthma was collected during three focus group discussions held in two polyclinics in Singapore. The collected data was analysed using standard content analysis and classified into themes.

RESULTS

The caregivers' main concerns included the perceived effects of infection, food and exercise on children with asthma. Several caregivers considered the disease to be infectious and had a lower threshold for physician consultation, as they believed that any delay in treating the infection would be detrimental to the child's health. Some also perceived asthma to be episodic and self-limiting, and that their children could 'outgrow' it. Many caregivers believed that asthma could be modified by abstinence from, or intake of, certain foods. Others had the perception that sports, including swimming, would worsen asthma. These perceptions resulted in unnecessary restrictions of the children's diet and activities. Most caregivers were unaware of influenza vaccination as a preventive measure to reduce triggers due to respiratory viral infections.

CONCLUSION

We found that the caregivers' perceptions of asthma aetiology, its triggers and preventive measures affected their help-seeking behaviour and care of children with asthma. Healthcare professionals managing paediatric patients with asthma should recognise such caregiver misperceptions, and take a proactive approach to rectify and bridge the gaps in caregivers' knowledge and understanding of the disease.

Trichloramine reactions with nitrogenous and carbonaceous compounds: kinetics, products and chloroform formation

Trichloramine is a hazardous disinfection by-product that is of particular relevance in indoor swimming pools. To better understand its fate in pool waters, apparent second order rate constants (kapp) at pH 7 for its reaction with several model compounds were determined. kapp values at pH 7 for nitrogenous compounds were found to increase in the following order: ammonia ∼ amides (∼10(-2)-10(-1) M(-1) s(-1)) < primary amines (∼10(-1)-10(0) M(-1) s(-1)) < relevant body fluid compounds (l-histidine, creatinine) (∼10(0)-10(1) M(-1) s(-1)) < secondary amines (∼10(1)-10(2) M(-1) s(-1)) < trimethylamine (∼10(3) M(-1) s(-1)). kapp values at pH 7 of trichloramine with hydroxylated aromatic compounds (∼10(2)-10(5) M(-1) s(-1)) are higher than for the nitrogenous compounds and depend on the number and position of the hydroxyl groups (phenol < hydroquinone < catechol < resorcinol). The measurement of kapp as a function of pH revealed that mainly the deprotonated species react with trichloramine. The reaction of trichloramine with Suwannee River and Pony Lake fulvic acid standards showed a decrease of their reactivity upon chlorination, which can be related to the electron donating capacity and the SUVA254. Chlorinated nitrogenous compounds (e.g. uric acid) also have a reduced reactivity with trichloramine. Hence, the residual chlorine in pool water hinders a fast consumption of trichloramine. This explains why trichloramine degradation in pool water is lower than expected from the reactivity with the estimated bather input. Trichloramine also has the potential to form secondary disinfection by-products such as chlorinated aromatic compounds or chloroform by electron transfer or Cl(+)-transfer reactions. The chloroform formation from the reaction of trichloramine with resorcinol occurs with a similar yield and rate as for chlorination of resorcinol. Since the trichloramine concentration in pool water is commonly about one order of magnitude lower than the free chlorine concentration, its contribution to the disinfection by-product formation is assumed to be minor in most cases but might be relevant for few precursors (e.g. phenols) that react faster with trichloramine than with free chlorine.

Health effects from swimming training in chlorinated pools and the corresponding metabolic stress pathways

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.

Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers

BACKGROUND

Dysautonomia has been independently associated with training and exercise-induced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers.

METHODS

Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200™ Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD20 and pupillary parameters was investigated with Spearman's correlation test.

RESULTS

No statistically significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p<0.001), percentage of constriction (r = -0.59, p = 0.011) and latency (r = 0.490, p = 0.039).

CONCLUSIONS

No significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters, but among those with relevant AHR an association was found. Although limited by the sample size, these findings support the relation between dysautonomia and AHR in asthmatic swimmers.

Seasonal dynamics of water and air chemistry in an indoor chlorinated swimming pool

Although swimming is known to be beneficial in terms of cardiovascular health, as well as for some forms of rehabilitation, swimming is also known to present risks to human health, largely in the form of exposure to microbial pathogens and disinfection byproducts (DBPs). Relatively little information is available in the literature to characterize the seasonal dynamics of air and water chemistry in indoor chlorinated swimming pools. To address this issue, water samples were collected five days per week from an indoor chlorinated swimming pool facility at a high school during the academic year and once per week during summer over a fourteen-month period. The samples were analyzed for free and combined chlorine, urea, volatile DBPs, pH, temperature and total alkalinity. Membrane Introduction Mass Spectrometry (MIMS) was used to identify and measure the concentrations of eleven aqueous-phase volatile DBPs. Variability in the concentrations of these DBPs was observed. Factors that influenced variability included bather loading and mixing by swimmers. These compounds have the ability to adversely affect water and air quality and human health. A large fraction of the existing literature regarding swimming pool air quality has focused on trichloramine (NCl₃). For this work, gas-phase NCl₃ was analyzed by an air sparging-DPD/KI method. The results showed that gas-phase NCl₃ concentration is influenced by bather loading and liquid-phase NCl₃ concentration. Urea is the dominant organic-N compound in human urine and sweat, and is known to be an important precursor for producing NCl₃ in swimming pools. Results of daily measurements of urea indicated a link between bather load and urea concentration in the pool.

Association between infant swimming and rhinovirus-induced wheezing

AIM

Infant swimming has been considered as a risk factor for wheezing, but the role that respiratory viruses play is unclear. We explored the effects of infant swimming on the risk of all wheezing illnesses and wheezing associated with rhinoviruses.

METHODS

We followed up a birth cohort of 1827 children until 17 months of age, collecting data on infant swimming, other risk factors and physician-diagnosed bronchiolitis or recurrent wheezing. Viral diagnostics were performed in a subset of children with all respiratory tract infections.

RESULTS

Data on infant swimming were obtained for 1038 children, with viral follow-up for 635 children. At least one wheezing illness was documented in 45/469 (9.6%) swimming children versus 39/569 (6.9%) nonswimming children (p = 0.11), and rhinoviruses were associated with wheezing in 11/296 (3.7%) swimming children versus 4/339 (1.2%) nonswimming children (p = 0.04). In adjusted logistic regression analyses, swimming had an odds ratio of 1.71 (p = 0.05) for bronchiolitis and 3.57 (p = 0.06) for rhinovirus-associated wheezing. An association between infant swimming and rhinovirus-associated wheezing was detected for children with atopic eczema (p = 0.006).

CONCLUSION

There may be a link between infant swimming and rhinovirus-induced wheezing illnesses in atopic infants.

Analysis of an explosion accident of nitrogen trichloride in a waste liquid containing ammonium ion and platinum black

Five liters of sodium hypochlorite aqueous solution (12 mass%) was poured into 300 L of liquid waste containing ammonium ion of about 1.8 mol/L in a 500 L tank in a plant area; then, two minutes later the solution exploded with a flash on March 30th, 2005. The tank cover, the fluorescent lamp and the air duct were broken by the blast wave. Thus, we have conducted 40 runs of laboratory-scale explosion tests under various conditions (solution concentrations of (NH4)2SO4 and NaClO, temperatures, Pt catalysts, pH, etc.) to investigate the causes for such an explosion. When solutions of ammonium sulfate and sodium hypochlorite are mixed in the presence of platinum black, explosions result. This is ascribable to the formation of explosive nitrogen trichloride (NCl3). In the case where it is necessary to mix these 2 solutions (ammonium sulfate and sodium hypochlorite) in the presence of platinum black, the following conditions would reduce a probability of explosion; the initial concentration of NH4(+) should be less than 3 mol/L and the pH should be higher than 6. The hypochlorite solution (in 1/10 in volume) to be added at room temperature is recommended to be less than 0.6 mol/L.

WITHDRAWN: Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers

This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.05.004. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Comparison of a novel extraction-based colorimetric (ABTS) method with membrane introduction mass spectrometry (MIMS): trichloramine dynamics in pool water

Trichloramine is a hazardous disinfection by-product, which is present in chlorinated swimming pools. Although it is primarily taken up by inhalation, the concentration in pool water is important to monitor pool water quality and to assess trichloramine mitigation strategies. To date, scarce data is available on trichloramine concentration in pool water due to the lack of a suitable and easily applicable analytical method. This study presents a novel low cost, colorimetric method which is easy to operate and suitable for on-site measurements of trichloramine concentrations ≥0.05 μM (≥0.01 mg L(-1) as Cl2). The analytical method (termed "extraction-based ABTS method") consists of, (i) trichloramine stripping from pool water samples, (ii) passing it through a solid phase filter, composed of silica gel impregnated with sulfamic acid to eliminate interferences and (iii) trichloramine reaction with the indicator 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) to produce the coloured ABTS(•-) radical, which is measured at λ = 405 nm to determine the trichloramine concentration in the pool water sample. A comparison of the extraction-based ABTS method with membrane introduction mass spectrometry (MIMS) for 28 pool samples revealed a good correlation of the two methods. The trichloramine concentration in pool samples is correlated to HOCl, which is the most important factor for its formation. Other parameters such as combined chlorine and pH play a minor role while no correlation between trichloramine and the urea or the TOC concentration was observed. On-site measurements with MIMS in a wading pool over 6 days with a time resolution of 1 h confirmed that trichloramine concentrations strongly responded to changes in free chlorine concentrations. A diurnal measurement of trichloramine with a time resolution of 20 min revealed that trichloramine concentrations reacted quickly and sensitively to the bather load and that urea is probably not the main precursor for its formation.

Photolysis of inorganic chloramines and efficiency of trichloramine abatement by UV treatment of swimming pool water

Trichloramine, one of the three inorganic chloramines (mono-, di- and trichloramine), is a problematic disinfection by-product in recreational pool water since it causes skin and eye irritations as well as irritations of the respiratory tract. The most commonly used chloramine mitigation strategy in pool water is UV treatment. Experiments with membrane inlet mass spectrometry (MIMS) confirmed that inorganic chloramines are effectively degraded by UV irradiation with low-pressure (LP) and medium-pressure (MP) mercury lamps (apparent quantum yields (QY): NH2Cl = 0.50 (LP) and 0.31 (MP) mol einstein(-1), NHCl2: 1.06 (LP) and 0.85 (MP) mol einstein(-1)). Trichloramine showed the fastest depletion with a quantum yield slightly above 2 mol einstein(-1) in purified (LP and MP) and pool water (MP). This high quantum yield can partly be explained by reactions involving OH radicals (purified water) and the reaction of trichloramine with moieties formed during UV irradiation of pool water. The presence of free chlorine affects trichloramine degradation (QY: ∼1.5 mol einstein(-1)) since it scavenges OH radicals and competes with trichloramine for reactive species (e.g. organic amines). Measurements in a pool facility revealed that the installed UV reactors degraded trichloramine by 40-50% as expected from laboratory experiments. However, trichloramine reduction in the pools was less pronounced than in the UV reactors. Model calculations combining pool hydraulics with formation/abatement of trichloramine showed that there was a fast trichloramine formation in the pool from the residual chlorine and nitrogenous precursors. The main factors influencing trichloramine concentrations in pool water are the free chlorine concentration and the UV treatment in combination with the recirculation rate through the water treatment system.

Indoor swimming pool attendance and respiratory and dermal health in schoolchildren--HITEA Catalonia

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.

The effectiveness of an indoor intermittent training program for improving lung function, physical capacity, body composition and quality of life in children with asthma

OBJECTIVE

The objective of this study is to analyze the effects of a 12-week indoor intermittent training program on lung function, physical capacity, body composition and quality of life in children with asthma.

METHODS

Participants were randomized in an experimental group (EG, 58 children, age = 11.55 ± 1.01 years) and in a control group (CG, 47 children, age = 11.51 ± 1.42 years). The training program was conducted indoors and consisted of alternating high- and low-intensity stimuli, for three sessions of 60 min/week, for 12 weeks. Physical exercise and sports activities were organized to follow the criteria of the American College of Sports Medicine (1999) and previous interventions' studies.

RESULTS

In EG, there was a significant improvement (p < 0.05) in FEV1, FEV6, 6MWT, handgrip strength, CMJ and flexibility. Reductions in BMI and fat mass as well as an increase in quality of life were all shown. The dyspnea index decreased significantly and there were no episodes of EIA. There is a significant positive correlation (p < 0.01) between the ΔFEV1 with Δhandgrip strength and Δ6MWT and a negative correlation with Δfat mass.

CONCLUSIONS

An indoor intermittent training program with these characteristics has improved lung function, physical capacity, body composition and quality of life in children with asthma. These training adaptations are particularly relevant for those patients suffering from asthma as a regular physical exercise routine will greatly improve their quality of life.

Occupational exposures of airborne trichloramine at indoor swimming pools in Taipei

Ten indoor swimming pools in Taipei, Taiwan were included in the study to assess the exposure of people to airborne trichloramine (NCl3) and also to discover the factors that might affect the associated concentrations. An active air sampling method was performed to determine the levels of NCl3, while questionnaires were administered to swimming pool workers, including lifeguards, swimming instructors, and management employees. The results show that the concentrations of trichloramine ranged from 0.017 to 0.15 mg m(-3), which were generally lower than what have been reported from other studies. Symptoms of sore throat and phlegm were more frequent among lifeguards and swimming instructors (exposure group) than management employees (reference group) (odds ratios were 11.28 and 4.22 for sore throat and phlegm, respectively). It seems that the current exposure limit for airborne NCl3, which was recommended by WHO, was not lower enough to protect the health of pool attendants. Regulated level of free available chlorine in Taipei (i.e., 0.3-0.7 ppm) is lower than what is required in other countries (e.g., 1-3 ppm in the UK). This might be the main reason why the concentrations of NCl3 reported elsewhere were higher than what were found in this research. Further international comparisons will help to elucidate if low free chlorine concentration should be adopted as an operating standard. For the indoor swimming pools in Taipei, the air quality is suggested to be improved, since even with the low concentrations of NCl3, higher respiratory ailments among pool workers were observed.