1
|
Klain A, Giovannini M, Pecoraro L, Barni S, Mori F, Liotti L, Mastrorilli C, Saretta F, Castagnoli R, Arasi S, Caminiti L, Gelsomino M, Indolfi C, Del Giudice MM, Novembre E. Exercise-induced bronchoconstriction, allergy and sports in children. Ital J Pediatr 2024; 50:47. [PMID: 38475842 DOI: 10.1186/s13052-024-01594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.
Collapse
Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy.
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126, Verona, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Lucia Liotti
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, 60123, Ancona, Italy
| | - Carla Mastrorilli
- Pediatric and Emergency Department, Pediatric Hospital Giovanni XXIII, AOU Policlinic of Bari, 70126, Bari, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Riccardo Castagnoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98124, Messina, Italy
| | - Mariannita Gelsomino
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, University Foundation Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Elio Novembre
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| |
Collapse
|
2
|
Ora J, De Marco P, Gabriele M, Cazzola M, Rogliani P. Exercise-Induced Asthma: Managing Respiratory Issues in Athletes. J Funct Morphol Kinesiol 2024; 9:15. [PMID: 38249092 PMCID: PMC10801521 DOI: 10.3390/jfmk9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma is a complex respiratory condition characterized by chronic airway inflammation and variable expiratory airflow limitation, affecting millions globally. Among athletes, particularly those competing at elite levels, the prevalence of respiratory conditions is notably heightened, varying between 20% and 70% across specific sports. Exercise-induced bronchoconstriction (EIB) is a common issue among athletes, impacting their performance and well-being. The prevalence rates vary based on the sport, training environment, and genetics. Exercise is a known trigger for asthma, but paradoxically, it can also improve pulmonary function and alleviate EIB severity. However, athletes' asthma phenotypes differ, leading to varied responses to medications and challenges in management. The unique aspects in athletes include heightened airway sensitivity, allergen, pollutant exposure, and temperature variations. This review addresses EIB in athletes, focusing on pathogenesis, diagnosis, and treatment. The pathogenesis of EIB involves complex interactions between physiological and environmental factors. Airway dehydration and cooling are key mechanisms, leading to osmotic and thermal theories. Airway inflammation and hyper-responsiveness are common factors. Elite athletes often exhibit distinct inflammatory responses and heightened airway sensitivity, influenced by sport type, training, and environment. Swimming and certain sports pose higher EIB risks, with chlorine exposure in pools being a notable factor. Immune responses, lung function changes, and individual variations contribute to EIB in athletes. Diagnosing EIB in athletes requires objective testing, as baseline lung function tests can yield normal results. Both EIB with asthma (EIBA) and without asthma (EIBwA) must be considered. Exercise and indirect bronchoprovocation tests provide reliable diagnoses. In athletes, exercise tests offer effectiveness in diagnosing EIB. Spirometry and bronchodilation tests are standard approaches, but the diagnostic emphasis is shifting toward provocation tests. Despite its challenges, achieving an optimal diagnosis of EIA constitutes the cornerstone for effective management, leading to improved performance, reduced risk of complications, and enhanced quality of life. The management of EIB in athletes aligns with the general principles for symptom control, prevention, and reducing complications. Non-pharmacological approaches, including trigger avoidance and warming up, are essential. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy in athletes. Short-acting beta agonists (SABA) are discouraged as sole treatments. Leukotriene receptor antagonists (LTRA) and mast cell stabilizing agents (MCSA) are potential options. Optimal management improves the athletes' quality of life and allows them to pursue competitive sports effectively.
Collapse
Affiliation(s)
- Josuel Ora
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
| | - Patrizia De Marco
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
| | - Mariachiara Gabriele
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Paola Rogliani
- Division of Respiratory Medicine, University Hospital “Tor Vergata”, 00133 Rome, Italy
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| |
Collapse
|
3
|
Kawabata A, Motoyama Y, Takeuchi J, Kusunoki T. Swimming was associated with rhinitis and pollinosis in a duration-dependent manner. Pediatr Int 2024; 66:e15758. [PMID: 38780222 DOI: 10.1111/ped.15758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Previous studies have reported conflicting results regarding the effects of childhood swimming on respiratory allergic symptoms. We investigated the relationship between swimming and respiratory allergic symptoms in schoolchildren. METHODS A questionnaire regarding participation in sports club activities and respiratory allergic symptoms in schoolchildren was distributed to the parents of all 6853 public school students (aged 6-14 years) in Omihachiman City, Shiga, Japan. The relationships between participation in sports club activities and the prevalence of respiratory allergic symptoms were analyzed by multivariable logistic regression analyses. RESULTS Questionnaires were returned for 4991 schoolchildren (response rate: 72.8%). Logistic regression analysis revealed significant positive associations between swimming and rhinitis (42.9% vs. 38.9%; adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.44), and swimming and pollinosis (32.1% vs. 28.1%; adjusted odds ratio, 1.28; 95% confidence interval, 1.11-1.47). The duration of participation in swimming activities was also significantly positively associated with the prevalence of rhinitis and pollinosis. Those who had participated in swimming activities for 6 years or more showed significantly higher prevalences of rhinitis and pollinosis (46.3% and 36.4%, respectively) than those without swimming activities (38.9% and 28.1%, respectively) and those who had participated in swimming activities for 5 years or less (40.1% and 28.5%, respectively). CONCLUSIONS Swimming was associated with the prevalence of rhinitis and pollinosis in schoolchildren, especially among those who had participated in swimming activities for 6 years or more. Preventive measures and early interventions for rhinitis and pollinosis should be recommended to these children.
Collapse
Affiliation(s)
- Ayu Kawabata
- Laboratory of Child Health and Nutrition, Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan
| | - Yuie Motoyama
- Laboratory of Child Health and Nutrition, Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan
| | - Jiro Takeuchi
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Takashi Kusunoki
- Laboratory of Child Health and Nutrition, Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Shiga, Japan
- Department of Pediatrics, Shiga Medical Center for Children, Shiga, Japan
| |
Collapse
|
4
|
Mitri EJ, Ferhani S, Gao J, Cardenas V, Espinola JA, Mehta G, Hasegawa K, Camargo CA. Chlorinated pool exposure, allergic sensitization, and risk of age 5-year asthma. Pediatr Res 2023; 94:1254-1257. [PMID: 37165036 DOI: 10.1038/s41390-023-02615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/17/2022] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Elie J Mitri
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sabrina Ferhani
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Vanessa Cardenas
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Geneva Mehta
- Division of Allergy and Clinical Immunology, Brigham & Women's Hospital, Boston, MA, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
5
|
O'Connor C, McCarthy S, Murphy M. Pooling the evidence: A review of swimming and atopic dermatitis. Pediatr Dermatol 2023; 40:407-412. [PMID: 37029288 PMCID: PMC10946598 DOI: 10.1111/pde.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
Swimming is an excellent form of aerobic exercise and is an essential life skill. Many children with atopic dermatitis (AD) are advised not to swim because of concerns about negative impacts on their skin disease, and some children with AD do not swim because they are self-conscious about the appearance of their skin. We aimed to perform a narrative review of the available literature on swimming and AD and scientifically analyze the potential impact of all components of swimming in AD-water, skin barrier, swimming gear, and exercise. Studies examined the impact of swimming on the skin barrier and the relative contraindications to swimming. Constituents of water which may affect AD include hardness, pH, temperature, antiseptics, and other chemicals. Potential interventions to reduce damage included emollient application, special swim gear, and showering post-submersion. The benefits of swimming as a form of exercise in AD included reduced sweating, cardiorespiratory fitness, and maintenance of healthy weight. Drawbacks of swimming as a form of exercise in AD included the limited benefit on bone mineral density. Future research should examine the impact of swimming on flares of AD using noninvasive biomarkers as well as clinical severity assessment and assess the role for different types of emollient as an intervention for optimal eczema control. This review highlights gaps in the scientific literature on swimming and AD and provides evidence-based guidance on interventions to minimize deleterious effects on skincare and maximize opportunities for children with AD to swim.
Collapse
Affiliation(s)
- Cathal O'Connor
- DermatologySouth Infirmary Victoria University HospitalCorkIreland
- Paediatrics and Child HealthCork University HospitalCorkIreland
- MedicineUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Siobhan McCarthy
- DermatologySouth Infirmary Victoria University HospitalCorkIreland
- MedicineUniversity College CorkCorkIreland
| | - Michelle Murphy
- DermatologySouth Infirmary Victoria University HospitalCorkIreland
- MedicineUniversity College CorkCorkIreland
| |
Collapse
|
6
|
Couto M, Bernard A, Delgado L, Drobnic F, Kurowski M, Moreira A, Rodrigues‐Alves R, Rukhadze M, Seys S, Wiszniewska M, Quirce S. Health effects of exposure to chlorination by-products in swimming pools. Allergy 2021; 76:3257-3275. [PMID: 34289125 DOI: 10.1111/all.15014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/14/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area.
Collapse
Affiliation(s)
- Mariana Couto
- Centro de Alergia Hospital CUF Descobertas Lisboa Portugal
| | - Alfred Bernard
- Louvain Centre for Toxicology and Applied Pharmacology Institute of Experimental and Clinical Research (IREC) Catholic University of Louvain Brussels Belgium
| | - Luís Delgado
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de ImunoalergologiaCentro Hospitalar de São João E.P.E. Porto Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE) Faculty of Medicine University of Porto Porto Portugal
| | | | - Marcin Kurowski
- Department of Immunology and Allergy Medical University of Łódź Łódź Poland
| | - André Moreira
- Basic and Clinical Immunology Department of Pathology Faculty of Medicine University of Porto Porto Portugal
- Serviço de ImunoalergologiaCentro Hospitalar de São João E.P.E. Porto Portugal
- Epidemiology Research Unit‐ Instituto de Saúde Pública Universidade do Porto Porto Portugal
| | | | - Maia Rukhadze
- Center of Allergy & Immunology Teaching University Geomedi LLC Tbilisi Georgia
| | - Sven Seys
- Laboratory of Clinical Immunology Department of Clinical Immunology KU Leuven Leuven Belgium
| | - Marta Wiszniewska
- Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland
| | - Santiago Quirce
- Department of Allergy La Paz University HospitalIdiPAZ, and Universidad Autónoma de Madrid Madrid Spain
| |
Collapse
|
7
|
Sun Y, Xia PF, Xie J, Mustieles V, Zhang Y, Wang YX, Messerlian C. Association of blood trihalomethane concentrations with asthma in U.S. adolescents: nationally representative cross-sectional study. Eur Respir J 2021; 59:13993003.01440-2021. [PMID: 34625481 PMCID: PMC9133491 DOI: 10.1183/13993003.01440-2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
Background Population studies show that the use of swimming pools is associated with the risk of asthma and allergic diseases among children. Our objective was to explore the associations between blood trihalomethane (THM) concentrations and asthma among US adolescents, and assess to what extent the association is modified by active tobacco smoke exposure. Methods We included 2359 adolescents aged 12–19 years with measured blood concentrations of chloroform (trichloromethane (TCM)), bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform (tribromomethane (TBM)) from the National Health and Nutrition Examination Survey 2005–2012. Logistic regression models were fitted to assess the odds ratios for the association of blood THM concentrations (three or four categories) with the risk of self-reported current and ever (lifetime) asthma. Results Blood DBCM concentrations were associated with a higher risk of ever asthma among all adolescents (OR 1.54 (95% CI 1.07–2.21), comparing the extreme exposure categories). The relationship was stronger among adolescents exposed to tobacco smoke (OR 3.96 (95% CI 1.89–8.30), comparing the extreme exposure categories). We also found positive relationships between blood brominated THM concentrations (sum of BDCM, DBCM and TBM) and risk of ever asthma and between blood DBCM and brominated THM concentrations and risk of current asthma among adolescents with tobacco smoke exposure. The relative excess risk of ever asthma due to the interaction between high blood DBCM and brominated THM concentrations and tobacco smoke exposure was 1.87 (95% CI 0.30–3.43) and 0.78 (95% CI 0.07–1.49), respectively. Conclusions Exposure to THMs is associated with a higher risk of asthma in adolescents, particularly among those exposed to tobacco smoke. Among a representative sample of 2359 US adolescents, we found that exposure to THMs was associated with a greater risk of asthma, particularly among those who were co-exposed to tobacco smokehttps://bit.ly/3mpHxgq
Collapse
Affiliation(s)
- Yang Sun
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peng-Fei Xia
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Jing Xie
- Department of Gastroenterology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Vicente Mustieles
- University of Granada, Center for Biomedical Research (CIBM), Granada, Spain.,Instituto de Investigación Biosanitaria Ibs GRANADA, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yi-Xin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
8
|
Management of Exercise-Induced Bronchoconstriction in Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2183-2192. [PMID: 32620432 DOI: 10.1016/j.jaip.2020.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/25/2020] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is a phenomenon observed in asthma but is also seen in healthy individuals and frequently in athletes. High prevalence rates are observed in athletes engaged in endurance sports, winter sports, and swimming. The pathophysiology of EIB is thought to be related to hyperventilation, cold air, and epithelial damage caused by chlorine and fine particles in inspired air. Several diagnostic procedures can be used; however, the diagnosis of EIB based on self-reported symptoms is not reliable and requires an objective examination. The hyperosmolar inhalation test and eucapnic voluntary hyperpnea test, which involve indirect stimulation of the airway, are useful for the diagnosis of EIB. A short-acting β-agonist is the first choice for prevention of EIB, and an inhaled corticosteroid is essential for patients with asthma. Furthermore, treatment should accommodate antidoping requirements in elite athletes. Tailoring of the therapeutic strategy to the individual case and the prognosis after cessation of athletic activity are issues that should be clarified in the future.
Collapse
|
9
|
Ramachandran HJ, Jiang Y, Shan CH, Tam WWS, Wang W. A systematic review and meta-analysis on the effectiveness of swimming on lung function and asthma control in children with asthma. Int J Nurs Stud 2021; 120:103953. [PMID: 34051586 DOI: 10.1016/j.ijnurstu.2021.103953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Swimming has been considered the most appropriate activity for children with asthma for its lower asthmogenicity compared to land-based activities. However, the benefits of swimming have been hampered by reports of increased asthma risks, airway inflammation and bronchial hyper-responsiveness from exposure to chlorine by-products in swimming pools. Thus, the role of swimming for children with asthma remains unclear. OBJECTIVES To determine the effectiveness of swimming as an intervention on lung function and asthma control in children below the age of 18 years. Any adverse effects from swimming on asthma were also examined. METHODS Searches were performed across six databases systematically (PubMed, CINAHL, Embase, CENTRAL, Scopus, and PsycINFO). Randomized controlled trials (RCTs), quasi-experimental studies and interventional studies with at least one control/comparator group that were published in English were included. All eligible studies were screened with risk of bias examined by two independent reviewers. Meta-analyses were conducted using Review Manager 5.4 software while narrative syntheses were performed where meta-analysis was inappropriate and heterogeneity was present. RESULTS 1710 records were retrieved from the search. A total of 9 studies with 387 participants were included in this review after screening. Swimming was found to have favourable effects on forced expiratory volume in one second (L) and forced vital capacity (%), but not for forced expiratory volume in one second (%) and peak expiratory flow (%). Narrative synthesis on asthma control and adverse effects were in favour of the swimming group. CONCLUSION Future studies that are adequately powered, involve swimming interventions of sufficient intensity, frequency and duration, examine cumulative exposures to chlorine by-products and take into account potential cofounders are warranted.
Collapse
Affiliation(s)
- Hadassah Joann Ramachandran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Coral Hui Shan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD 11,10 Medical Drive, Singapore 117597, Singapore.
| |
Collapse
|
10
|
Wastensson G, Eriksson K. Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting. Crit Rev Toxicol 2020; 50:219-271. [PMID: 32484073 DOI: 10.1080/10408444.2020.1744514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Inorganic chloramines are not commercially available, but monochloramine is produced in situ for disinfection or for use in chemical synthesis. Inorganic chloramines are also formed when free chlorine reacts with nitrogen containing substances, e.g. ammonia and urea, present in chlorinated water sources. Occupational exposure may, therefore, occur in e.g. swimming pool facilities and the food processing industry. Monochloramine is soluble and stable in water and the dominating inorganic chloramine in chlorinated water sources. No clinical effects were seen in healthy volunteers given monochloramine in drinking water during 4 or 12 weeks in doses of 0.043 or 0.034 mg/kg bw/day, respectively. Limited data indicate that monochloramine is weakly mutagenic in vitro but not genotoxic in vivo. One drinking water study indicated equivocal evidence of carcinogenicity in female rats but not in male rats and mice. No reproductive or developmental effects were shown in rodents in the few studies located. Dichloramine is soluble but unstable in water. In the only study located, mild histological effects in kidneys, thyroid and gastric cardia were observed in rats administered dichloramine in drinking water for 13 weeks. Trichloramine is immiscible with water and evaporates easily from water into air. Therefore, the primary exposure route of concern in the occupational setting is inhalation. Occupational exposure to trichloramine has been demonstrated in indoor swimming pool facilities and in the food processing industry where chlorinated water is used for disinfection. Exposure-response relationships between airborne levels and self-reported ocular and upper airway irritation have been shown in several studies. Exposure to trichloramine may aggravate asthma symptoms in individuals with existing asthma. The risk of developing asthma following long-term exposure to trichloramine cannot be evaluated at present. No data on genotoxic, carcinogenic, reproductive or developmental effects were located. The toxicological data for mono- and dichloramine are insufficient to recommend health-based occupational exposure limits (OELs).As regard trichloramine, the critical effect is judged to be irritation observed in several studies on pool workers, starting at approximately 0.4 mg/m3 (stationary sampling). Based on these data, a health-based OEL of 0.1 mg/m3 (8-h time-weighted average) is recommended. This corresponds to 0.2 mg/m3 for stationary measurements in swimming pool facilities. No short-term exposure limit (STEL) is recommended.
Collapse
Affiliation(s)
- Gunilla Wastensson
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kåre Eriksson
- Department of Sustainable Health, Umeå University, Umeå, Sweden
| |
Collapse
|
11
|
Kaczmarek W, Panasiuk J, Borys S, Pobudkowska A, Majsterek M. Analysis of the Kinetics of Swimming Pool Water Reaction in Analytical Device Reproducing Its Circulation on a Small Scale. SENSORS 2020; 20:s20174820. [PMID: 32858989 PMCID: PMC7506937 DOI: 10.3390/s20174820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 01/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Wojciech Kaczmarek
- Faculty of Mechatronics and Aerospace, Military University of Technology, Kaliskiego 2 Street, 00-908 Warsaw, Poland; (W.K.); (J.P.)
| | - Jarosław Panasiuk
- Faculty of Mechatronics and Aerospace, Military University of Technology, Kaliskiego 2 Street, 00-908 Warsaw, Poland; (W.K.); (J.P.)
| | - Szymon Borys
- Faculty of Mechatronics and Aerospace, Military University of Technology, Kaliskiego 2 Street, 00-908 Warsaw, Poland; (W.K.); (J.P.)
- Correspondence:
| | - Aneta Pobudkowska
- Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3 Street, 00-664 Warsaw, Poland;
| | - Mikołaj Majsterek
- Virtual Power Plant Sp. z.o.o., Dubois 114/116 Street premises 2.30, 93-465 Łódź, Poland;
| |
Collapse
|
12
|
Irahara M, Yamamoto-Hanada K, Yang L, Saito-Abe M, Sato M, Inuzuka Y, Toyokuni K, Nishimura K, Ishikawa F, Miyaji Y, Fukuie T, Narita M, Ohya Y. Impact of swimming school attendance in 3-year-old children with wheeze and rhinitis at age 5 years: A prospective birth cohort study in Tokyo. PLoS One 2020; 15:e0234161. [PMID: 32516323 PMCID: PMC7282662 DOI: 10.1371/journal.pone.0234161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background In Japan, swimming school attendance is promoted as a form of therapy or as a prophylactic measure against asthma in young children. However, the putative beneficial effects have not been sufficiently verified. Objective The aim of the present study was to clarify whether or not swimming school attendance at age 3 years affects the onset and/or improvement of wheeze and rhinitis at age 5 years. Methods This study was a single-center, prospective, general, longitudinal cohort study (T-CHILD Study). Between November 2003 and December 2005, 1776 pregnant women were enrolled, and their offspring were followed up until age 5 years. Swimming school attendance at age 3 years and the presence of wheeze and/or rhinitis in the previous one year were examined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The relationship between swimming school attendance and wheeze and/or rhinitis was analyzed using multivariable logistic regression analysis. Results Data on the 1097 children were analyzed. At age 3 years, 126 (11.5%) children attended a swimming school, and at age 5 years, the prevalence of wheeze was 180 (16.4%) while that of rhinitis was 387 (35.3%). Swimming school attendance at age 3 showed no significant relationship with the development of either wheeze (aOR 0.83, 95% CI (0.43–1.60) or rhinitis (aOR 0.80, 95% CI (0.43–1.60) at age 5. Conclusions Swimming school attendance at age 3 years showed neither a preventive nor therapeutic effect on wheeze or rhinitis at age 5 years. There is thus no scientific evidence yet that swimming school attendance has a positive impact on the development of childhood wheeze or rhinitis.
Collapse
Affiliation(s)
- Makoto Irahara
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Limin Yang
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mayako Saito-Abe
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yusuke Inuzuka
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Toyokuni
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Koji Nishimura
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Fumi Ishikawa
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yumiko Miyaji
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masami Narita
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
13
|
Heaney LM, Kang S, Turner MA, Lindley MR, Thomas CLP. Evidence for alternative exhaled elimination profiles of disinfection by-products and potential markers of airway responses to swimming in a chlorinated pool environment. INDOOR AIR 2020; 30:284-293. [PMID: 31814168 DOI: 10.1111/ina.12630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/28/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
Chlorine-based disinfectants protect pool water from pathogen contamination but produce potentially harmful halogenated disinfection by-products (DBPs). This study characterized the bioaccumulation and elimination of exhaled DBPs post-swimming and investigated changes in exhaled breath profiles associated with chlorinated pool exposure. Nineteen participants provided alveolar-enriched breath samples prior to and 5, 90, 300, 510, and 600 minutes post-swimming. Known DBPs associated with chlorinated water were quantitated by thermal desorption-gas chromatography-mass spectrometry. Two distinct exhaled DBP elimination profiles were observed. Most participants (84%) reported peak concentrations immediately post-swimming that reduced exponentially. A sub-group exhibited a previously unobserved and delayed washout profile with peak levels at 90 minutes post-exposure. Metabolomic investigations tentatively identified two candidate biomarkers associated with swimming pool exposure, demonstrating an upregulation in the hours after exposure. These data demonstrated a hitherto undescribed exhaled DBP elimination profile in a small number of participants which contrasts previous findings of uniform accumulation and exponential elimination. This sub-group which exhibited delayed peak-exhaled concentrations suggests the uptake, processing, and immediate elimination of DBPs are not ubiquitous across individuals as previously understood. Additionally, non-targeted metabolomics highlighted extended buildup of compounds tentatively associated with swimming in a chlorinated pool environment that may indicate airway responses to DBP exposure.
Collapse
Affiliation(s)
- Liam M Heaney
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Shuo Kang
- Centre for Analytical Science, Department of Chemistry, Loughborough University, Loughborough, UK
| | - Matthew A Turner
- Centre for Analytical Science, Department of Chemistry, Loughborough University, Loughborough, UK
| | - Martin R Lindley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Translational Chemical Biology Research Group, Loughborough University, Loughborough, UK
| | - Charles L Paul Thomas
- Centre for Analytical Science, Department of Chemistry, Loughborough University, Loughborough, UK
| |
Collapse
|
14
|
Kotsiou OS, Peletidou S, Vavougios G, Karetsi E, Stavrou V, Zakynthinos G, Gourgoulianis KI, Daniil Z. Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers. Ann Allergy Asthma Immunol 2019; 123:249-255. [PMID: 31247303 DOI: 10.1016/j.anai.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Swimming is recommended for people with asthma. However, the inevitable exposure to chlorine and its disinfectant byproducts in indoor swimming pools could be responsible for bronchial inflammation and asthma development. Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation that predicts asthma exacerbations. OBJECTIVES To evaluate pretraining and posttraining FeNO levels in young swimmers with asthma attending an indoor chlorinated pool compared with a set of healthy swimmers and to examine the potential risk of exposure to chlorine as a factor associated with bronchial inflammation. METHODS A total of 146 children (8-18 years old) constantly attending an indoor chlorinated swimming pool were enrolled. Spirometry and FeNO measurements were performed 30 minutes after their arrival at the pool and immediately after exercise. Pre-exercise and postexercise spirometric and FeNO levels were assessed in a random subgroup of 14 swimmers (10 with asthma and 4 without) who performed cardiopulmonary exercise testing. RESULTS Asthma was detected in 23 swimmers. In swimmers with asthma, preswimming FeNO values were significantly elevated compared with swimmers without asthma and their FeNO values measured before cardiopulmonary exercise testing. Postexercise FeNO values were significantly decreased by approximately one-third in healthy children and children with asthma in all sporting backgrounds. However, postswimming FeNO values remained significantly higher in swimmers with asthma compared with those without asthma. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio values showed no significant difference before and after 2 types of activity. CONCLUSION Elevated FeNO levels before and after swimming were recorded in swimmers with asthma not observed in a different exercise field. The presence of chlorine in the indoor swimming pool seems to explain this finding.
Collapse
Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Sotiria Peletidou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Vavougios
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Karetsi
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Stavrou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Zakynthinos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| |
Collapse
|
15
|
Holm SM, Leonard V, Durrani T, Miller MD. Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes. Am J Infect Control 2019; 47:82-91. [PMID: 30172610 DOI: 10.1016/j.ajic.2018.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/24/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Children in child care settings have a high infectious burden. They are frequently exposed to sanitizing and disinfecting agents, whose toxicities have not been studied in these settings. Current guidance on the preferred disinfection agents for child care is vague. METHODS This article combines 2 different sources of information: the Environmental Protection Agency registration data on the efficacy of hospital-grade disinfectants and a review of the research on the toxicities of the most common of these disinfectants to summarize information that could be used for more evidence-based early care and education disinfection regulations and guidelines. RESULTS Coverage of these organisms varied both between disinfectant classes (defined by active ingredient), as well as within classes. The 3 most common active ingredients in the database-quaternary ammonias, bleaches, and hydrogen peroxides-had 251, 63, and 31 products, respectively. Quaternary ammonias and bleaches are both known asthmagens, with the potential for toxic gas release when mixed. Quaternary ammonias may also cause reproductive toxicity. Disinfectant-grade peroxides have relatively low inhalational toxicity. CONCLUSIONS A clear rationale is needed to establish policies for determining preferable disinfection products for use in child care settings, based on efficacy against relevant pathogens, toxicity, ease of use, and cost. When other factors are equal, the use of peroxide-based disinfectant products is recommended to minimize inhalational toxicity.
Collapse
|
16
|
Andersson M, Backman H, Nordberg G, Hagenbjörk A, Hedman L, Eriksson K, Forsberg B, Rönmark E. Early life swimming pool exposure and asthma onset in children - a case-control study. Environ Health 2018; 17:34. [PMID: 29642932 PMCID: PMC5896097 DOI: 10.1186/s12940-018-0383-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/03/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND Trichloramine exposure in indoor swimming pools has been suggested to cause asthma in children. We aimed to investigate the risk of asthma onset among children in relation to individual trichloramine exposure. METHODS A longitudinal nested case-control study of 337 children with asthma (cases) and 633 controls aged 16-17 years was performed within a population-based cohort from The Obstructive Lung Disease in Northern Sweden studies (OLIN). Year of asthma onset and exposure time at different ages were obtained in telephone interviews. Trichloramine concentrations in the pool buildings were measured. Skin prick test results for inhalant allergens were available from previous examinations of the cohort. The risk for asthma was analyzed in relation to the cumulative trichloramine exposure before onset of asthma. RESULTS The participation rate was high in the original cohort (88 to 96%), and in the case-control study (80%). Trichloramine concentrations ranged from 0.020 to 0.55 mg/m3 (mean 0.15 mg/m3). Swimming pool exposure in early life was associated with a significantly higher risk of pre-school asthma onset. A dose-response relationship between swimming pool exposure and asthma was indicated in children with asthma onset at 1 year of age. Children who were both sensitized and exposed had a particularly high risk. CONCLUSIONS Early life exposure to chlorinated swimming pool environments was associated with pre-school asthma onset.
Collapse
Affiliation(s)
- Martin Andersson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| | - Gunnar Nordberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Annika Hagenbjörk
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| | - Kåre Eriksson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, S-90187 Umeå, Sweden
- The OLIN studies, S-97189 Luleå, Sweden
| |
Collapse
|
17
|
Cavaleiro Rufo J, Paciência I, Silva D, Martins C, Madureira J, de Oliveira Fernandes E, Padrão P, Moreira P, Delgado L, Moreira A. Swimming pool exposure is associated with autonomic changes and increased airway reactivity to a beta-2 agonist in school aged children: A cross-sectional survey. PLoS One 2018. [PMID: 29529048 PMCID: PMC5846785 DOI: 10.1371/journal.pone.0193848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. Methods A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. Results Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case-case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. Conclusions Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
Collapse
Affiliation(s)
- João Cavaleiro Rufo
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- * E-mail:
| | - Inês Paciência
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Carla Martins
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Joana Madureira
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Eduardo de Oliveira Fernandes
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| |
Collapse
|
18
|
Bonini M, Silvers W. Exercise-Induced Bronchoconstriction: Background, Prevalence, and Sport Considerations. Immunol Allergy Clin North Am 2018; 38:205-214. [PMID: 29631730 DOI: 10.1016/j.iac.2018.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The transient airway narrowing that occurs as a result of exercise is defined as exercise-induced bronchoconstriction (EIB). The prevalence of EIB has been reported to be up to 90% in asthmatic patients, reflecting the level of disease control. However, EIB may develop even in subjects without clinical asthma, particularly in children, athletes, patients with atopy or rhinitis, and following respiratory infections. The intensity, duration, and type of training have been associated with the occurrence of EIB. In athletes, EIB seems to be only partly reversible, and exercise seems to be a causative factor of airway inflammation and symptoms.
Collapse
Affiliation(s)
- Matteo Bonini
- Airways Disease Section, National Heart and Lung Institute (NHLI), Royal Brompton Hospital, Imperial College London, Dovehouse Street, London SW3 6LY, UK.
| | - William Silvers
- University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO 80045, USA
| |
Collapse
|
19
|
Duyx B, Urlings MJE, Swaen GMH, Bouter LM, Zeegers MP. Selective citation in the literature on swimming in chlorinated water and childhood asthma: a network analysis. Res Integr Peer Rev 2017; 2:17. [PMID: 29451547 PMCID: PMC5803637 DOI: 10.1186/s41073-017-0041-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/02/2017] [Indexed: 01/16/2023] Open
Abstract
Background Knowledge development depends on an unbiased representation of the available evidence. Selective citation may distort this representation. Recently, some controversy emerged regarding the possible impact of swimming on childhood asthma, raising the question about the role of selective citation in this field. Our objective was to assess the occurrence and determinants of selective citation in scientific publications on the relationship between swimming in chlorinated pools and childhood asthma. Methods We identified scientific journal articles on this relationship via a systematic literature search. The following factors were taken into account: study outcome (authors' conclusion, data-based conclusion), other content-related article characteristics (article type, sample size, research quality, specificity), content-unrelated article characteristics (language, publication title, funding source, number of authors, number of affiliations, number of references, journal impact factor), author characteristics (gender, country, affiliation), and citation characteristics (time to citation, authority, self-citation). To assess the impact of these factors on citation, we performed a series of univariate and adjusted random-effects logistic regressions, with potential citation path as unit of analysis. Results Thirty-six articles were identified in this network, consisting of 570 potential citation paths of which 191 (34%) were realized. There was strong evidence that articles with at least one author in common, cited each other more often than articles that had no common authors (odds ratio (OR) 5.2, 95% confidence interval (CI) 3.1-8.8). Similarly, the chance of being cited was higher for articles that were empirical rather than narrative (OR 4.2, CI 2.6-6.7), that reported a large sample size (OR 5.8, CI 2.9-11.6), and that were written by authors with a high authority within the network (OR 4.1, CI 2.1-8.0). Further, there was some evidence for citation bias: articles that confirmed the relation between swimming and asthma were cited more often (OR 1.8, CI 1.1-2.9), but this finding was not robust. Conclusions There is clear evidence of selective citation in this research field, but the evidence for citation bias is not very strong.
Collapse
Affiliation(s)
- Bram Duyx
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Miriam J E Urlings
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Gerard M H Swaen
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Lex M Bouter
- 3Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,4Department of Philosophy, Faculty of Humanities, Vrije Universiteit, Amsterdam, The Netherlands
| | - Maurice P Zeegers
- 1Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, The Netherlands.,2Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
20
|
Valeriani F, Protano C, Vitali M, Romano Spica V. Swimming pool attendance during childhood and development of asthma: Reply. Pediatr Int 2017; 59:847-848. [PMID: 28745462 DOI: 10.1111/ped.13311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/10/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | | |
Collapse
|
21
|
Bernard A. Swimming attendance during childhood and development of asthma: Meta-analysis. Pediatr Int 2017; 59:846-847. [PMID: 28745459 DOI: 10.1111/ped.13276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Alfred Bernard
- Laboratory of Toxicology and Applied Pharmacology, Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium
| |
Collapse
|
22
|
Valeriani F, Protano C, Vitali M, Romano Spica V. Swimming attendance during childhood and development of asthma: Meta-analysis. Pediatr Int 2017; 59:614-621. [PMID: 28032933 DOI: 10.1111/ped.13230] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/02/2016] [Accepted: 12/27/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The association between asthma and swimming pool attendance has not been demonstrated and currently there are conflicting results. In order to clarify the association between asthma diagnosis in children and swimming pool attendance, and to assess the consistency of the available epidemiological studies, we completed a literature analysis on the relationship between the exposure to disinfection by-products in indoor swimming pools during childhood and asthma diagnosis. METHODS Following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, a systematic review and meta-analysis was performed by searching MEDLINE via PubMed, TOXNET, and Scopus databases (from inception to 20 April 2015) using the key word "Asthma" together with "swimming pool", "disinfection by-products", "indoor air pollution" and "children". Inclusion criteria were: English language, a complete analytic study design involving a cohort of children (0-16 years), a well-defined definition of exposure, and the presence of data on effect and variance. Studies on in vivo, in vitro or professional and accidental exposure were excluded. RESULTS After a screening process, seven reports (n = 5851 subjects) were included out of a total of 2928 references. The reported OR of the association between swimming pool attendance and asthma prevalence ranged from 0.58 to 2.30. The present meta-analysis failed to identify a significant difference in asthma development between children attending swimming pools and controls (OR, 1.084; 95% CI: 0.89-1.31). CONCLUSIONS Swimming in childhood does not increase the likelihood of doctor-diagnosed asthma. Based on this meta-analysis review, the association of the disease with indoor pool attendance is still unclear.
Collapse
Affiliation(s)
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | | |
Collapse
|
23
|
Occurrence, origin, and toxicity of disinfection byproducts in chlorinated swimming pools: An overview. Int J Hyg Environ Health 2017; 220:591-603. [DOI: 10.1016/j.ijheh.2017.01.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/16/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
|