An outbreak of swimming-pool related respiratory symptoms: An elusive source of trichloramine in a municipal indoor swimming pool
Abstract
Background Several members of a swimming club complained of respiratory symptoms associated with attending a municipal indoor swimming pool. Trichloramine, a volatile chlorination by-product and a potent respiratory irritant, was the most probable culprit, but the exact cause for its presence in excessive concentrations remained elusive. Methods Twenty-two competitive swimmers and six coaches were evaluated during the outbreak and nine swimmers and four coaches were re-evaluated one year later. Symptoms were recorded by non-standardized history taking; pulmonary function testing included spirometry, measurement of fraction of exhaled nitric oxide (FENO) and histamine provocation. Concentrations of trichloramine in air were measured repeatedly by the method of Héry. Results The most commonly reported symptoms consisted of cough (n=16), dyspnoea (n=13), tearing eyes (n=10) and blocked or runny nose (n=6). Mean FEV1% predicted was 109.1%. Mean FENO level was 19.7 ppb (higher than 25 ppb in 3 subjects). Airway hyperreactivity to histamine (PC20 ≤ 8 mg/ml) was detected in 22/26 subjects. Measured trichloramine concentrations in air exceeded the maximal concentration (WHO) of 0.5mg/m(3) four times between May and October 2011 and four times between January and March 2012. Polyamine compounds, present in glue used for repairing pipework, were identified as a probable external source of nitrogen resulting in increasing trichloramine concentrations. After the removal of the presumed c…
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A high prevalence of airway hyperreactivity has been found in pool workers as well as in competitive swimmers.
“A high prevalence of airway hyperreactivity has been found in pool workers (Demange et al. 2009) as well as in competitive swimmers (Helenius et al. 1998;Seys et al. 2015).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Seys et al. 2015
In that study, airway hyperreactivity was detected in 22/28 swimmers (85%).
“Airway hyperreactivity was detected in 22/28 | swimmers (85%)”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Seys et al. (2015)
In that study, mean FEV1% predicted was 109%.
“Mean FEV 1 % predicted | was 109%.”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Seys et al. (2015)
In that study, mean FENO level was 19.7 ppb; the cut off value of 25 ppb was exceeded in 3 subjects.
“Mean FENO level was 19.7 ppb; the cut | off value of 25 ppb was exceeded in 3 subjects.”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Seys et al. (2015)
In a cross-sectional study of Belgian competitive swimmers, common symptoms from lower airways were cough (57%) and dyspnea (46%).
“Common symptoms from lower airways were cough | (57%) and dyspnea (46%).”
From Inorganic chloramines: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting (2020) · cites this paper as Seys et al. (2015)
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Asthma, Airway Inflammation and Epithelial Damage in Swimmers and Cold-Air Athletes
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Indoor swimming pools, water chlorination and respiratory health
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Wastensson, G., & Eriksson, K. (2020) · Critical Reviews in Toxicology · doi:10.1080/10408444.2020.1744514 · Cited by 30 · see citing works
- Authors
- Seys, S. F., Feyen, L., Keirsbilck, S., Adams, E., Dupont, L. J., & Nemery, B.
- Affiliations
- KU Leuven (BE)
- Universitair Ziekenhuis Leuven (BE)
- Venue
- International Journal of Hygiene and Environmental Health
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 218
- Issue
- 4
- Pages
- 386-391
- ISSN
- 1438-4639 (ISSN-L)
- OpenAlex
- W2025538149
- Cited by
- 37
- References
- 8
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 6 · 2018: 7 · 2017: 2 · 2016: 4
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Hygiene and Environmental Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- trichloramine, indoor swimming pools, chlorination by-products, respiratory symptoms, airway hyperresponsiveness, nitrogen source, competitive swimmers, lung function, exhaled nitric oxide, histamine provocation
- MeSH terms
- Adolescent, Adult, Belgium, Child, Chlorides, Disease Outbreaks, Female, Humans, Male, Middle Aged, Respiratory Function Tests, Respiratory Tract Diseases, Swimming Pools, Air Pollution, Indoor, Nitrogen Compounds, Inhalation Exposure, Young Adult
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