The determinants of prevalence of health complaints among young competitive swimmers

  • Benoit Lévesque
  • Jean-François Duchesne
  • Suzanne Gingras
  • Robert Lavoie
  • Denis Prud’Homme
  • Emmanuelle Bernard
  • Louis-Philippe Boulet
  • Pierre Ernst
Original Article

Abstract

Objectives: Chloramines, which are produced by the reaction of chlorine with the organic matter present in indoor pools, are potential airway irritants in swimmers. The objective of this study was to compare the prevalence of health complaints of young swimmers and young indoor soccer players and to evaluate the relationship between chloramine concentrations and the athletes’ health complaints. Methods: Health complaints were first (Part 1) documented by questionnaire in 305 competitive swimmers and 499 indoor soccer players of the Québec City region (Canada). Then, (Part 2) health complaints were documented during five training sessions in 72 competitive swimmers in comparison to 73 soccer players. The chloramines in the swimming pool air and water were measured as well as the peak expiratory flow (PEF) before and after the training session. Results: In Part 1, the swimmers reported more lower (adjusted OR: 1.5; IC95%= 1.0–2.2) and upper respiratory symptoms (adjusted OR: 3.7; IC95%= 2.4–5.8). In Part 2, the swimmers experienced more frequent lower (adjusted OR: 3.5; IC95%= 2.0–6.0) and upper respiratory symptoms (adjusted OR: 3.1; IC95%= 1.8–5.4). Overall, swimmers exposed to the highest levels of chloramines in the air and water had more respiratory complaints. Conclusions: Swimmers exposed to chlorination by-products in both the water and air of indoor swimming pools experience frequent respiratory symptoms that could potentially be reduced by limiting exposure to these products.

Keywords

Asthma Wheezing Respiratory diseases Chlorine byproducts Swimming pool 

References

  1. Aggarwal AN, Gupta D, Chaganti S, Jindal SK (2000) Diurnal variation in peak expiratory flow in healthy young adults. Indian J Chest Dis Allied Sci 42:15–19PubMedGoogle Scholar
  2. Anonymous (1979) Wheezing at the swimming pool Lancet 2:1342–1343PubMedGoogle Scholar
  3. APHA (1998) Standard method for the examination of water and wastewater. American Public Health Association, Washington, DCGoogle Scholar
  4. Bernard A, Carbonnelle S, Michel O, Higuet S, De Burbure C, Buchet JP, Hermans C, Dumont X, Doyle I (2003) Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools. Occup Environ Med 60:385–394CrossRefPubMedGoogle Scholar
  5. Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2:92–98PubMedGoogle Scholar
  6. Fitch KD, Morton AR (1971) Specificity of exercise in exercise-induced asthma. Br Med J 4:577–581PubMedGoogle Scholar
  7. Gagnaire F, Azim S, Bonnet P, Hecht G, Hery M (1994) Comparison of the sensory irritation response in mice to chlorine and nitrogen trichloride. J Appl Toxicol 14:405–409PubMedGoogle Scholar
  8. Gold DR, Weiss ST, Tager IB, Segal MR, Speizer FE (1989) Comparison of questionnaire and diary methods in acute childhood respiratory illness surveillance. Am Rev Respir Dis 139:847–849PubMedGoogle Scholar
  9. Helenius IJ, Rytila P, Metso T, Haahtela T, Venge P, Tikkanen HO (1998a) Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers. Allergy 53:346–352Google Scholar
  10. Helenius IJ, Tikkanen HO, Sarna S, Haahtela T (1998b) Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors. J Allergy Clin Immunol 101:646–652CrossRefGoogle Scholar
  11. Helenius I, Rytila P, Sarna S, Lumme A, Helenius M, Remes V, Haahtela T (2002) Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers. J Allergy Clin Immunol 109:962–968CrossRefPubMedGoogle Scholar
  12. Hery M, Hecht G, Gerber JM, Gendre JC, Hubert G, Rebuffaud J (1995) Exposure to chloramines in the atmosphere of indoor swimming pools. Ann Occup Hyg 39:427–439CrossRefGoogle Scholar
  13. ISAAC (1998) Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 351:1225–1232Google Scholar
  14. ISQ (2002) Enquête sociale et de santé auprès des enfants et adolescents québécois, 1999. Direction Santé Québec, Institut de la statistique du Québec Google Scholar
  15. Langdeau JB, Turcotte H, Bowie DM, Jobin J, Desgagne P, Boulet LP (2000) Airway hyperresponsiveness in elite athletes. Am J Respir Crit Care Med 161:1479–1484PubMedGoogle Scholar
  16. Massin N, Bohadana AB, Wild P, Hery M, Toamain JP, Hubert G (1998) Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools. Occup Environ Med 55:258–263PubMedGoogle Scholar
  17. Monto AS, Napier JA, Metzner HL (1971) The Tecumseh study of respiratory illness. I. Plan of study and observations on syndromes of acute respiratory disease. Am J Epidemiol 94:269–279PubMedGoogle Scholar
  18. Mustchin CP, Pickering CA (1979) “Coughing water”: bronchial hyperreactivity induced by swimming in a chlorinated pool. Thorax 34:682–683PubMedCrossRefGoogle Scholar
  19. Penny PT (1983) Swimming pool wheezing. Br Med J 287:461–462CrossRefGoogle Scholar
  20. Potts J (1994) Adverse respiratory health effects of competitive swimming: The prevalence of symptoms, illness, and bronchial responsiveness to metacholine and exercise. Faculty of Graduate Studies University of British Columbia, VancouverGoogle Scholar
  21. Potts J (1996) Factors associated with respiratory problems in swimmers. Sports Med 21:256–261PubMedGoogle Scholar
  22. Quackenboss JJ, Lebowitz MD, Krzyzanowski M (1991) The normal range of diurnal changes in peak expiratory flow rates. Relationship to symptoms and respiratory disease. Am Rev Respir Dis 143:323–330PubMedGoogle Scholar
  23. Thickett KM, McCoach JS, Gerber JM, Sadhra S, Burge PS (2002) Occupational asthma caused by chloramines in indoor swimming-pool air. Eur Respir J 19:827–832CrossRefPubMedGoogle Scholar
  24. Weiler JM, Layton T, Hunt M (1998) Asthma in United States Olympic athletes who participated in the 1996 Summer Games. J Allergy Clin Immunol 102:722–726CrossRefPubMedGoogle Scholar
  25. Weiler JM, Ryan EJ (2000) Asthma in United States olympic athletes who participated in the 1998 olympic winter games. J Allergy Clin Immunol 106:267–271CrossRefPubMedGoogle Scholar
  26. World Health Organization (2000) Draft guidelines for safe recreational-water environment: swimming pools, spas and similar recreational-water environments. GenevaGoogle Scholar
  27. Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130PubMedCrossRefGoogle Scholar
  28. Zureik M, Liard R, Segala C, Henry C, Korobaeff M, Neukirch F (1995) Peak expiratory flow rate variability in population surveys. Does the number of assessments matter? Chest 107:418–423PubMedGoogle Scholar
  29. Zwick H, Popp W, Budik G, Wanke T, Rauscher H (1990) Increased sensitization to aeroallergens in competitive swimmers. Lung 168:111–115PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Benoit Lévesque
    • 1
    • 2
  • Jean-François Duchesne
    • 2
  • Suzanne Gingras
    • 1
    • 2
  • Robert Lavoie
    • 3
  • Denis Prud’Homme
    • 4
  • Emmanuelle Bernard
    • 4
  • Louis-Philippe Boulet
    • 3
  • Pierre Ernst
    • 5
  1. 1.Institut national de santé publique du QuébecSainte-Foy, QuébecCanada
  2. 2.Unité de recherche en santé publique du CHUL-CHUQSainte-Foy, QuébecCanada
  3. 3.Hôpital Laval, Université LavalSainte-Foy, QuébecCanada
  4. 4.School of Human Kinetics, Faculty of Health Sciences, University of Ottawa and Behavioral and Metabolic Research Unit, Montfort HospitalOttawa, OntarioCanada
  5. 5.Department of MedicineMcGill UniversityMontréal, QuébecCanada

Personalised recommendations