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Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools.
Open accessAbstract
OBJECTIVES: To measure the levels of exposure to nitrogen trichloride (NCl3) in the atmosphere of indoor swimming pools and to examine how they relate to irritant and chronic respiratory symptoms, indices of pulmonary function, and bronchial hyperresponsiveness to methacholine in lifeguards working in the pools. METHOD: 334 lifeguards (256 men; 78 women) recruited from 46 public swimming pools (n = 228) and 17 leisure centre swimming pools (n = 106) were examined. Concentrations of NCl3 were measured with area samplers. Symptoms were assessed by questionnaire and methacholine bronchial challenge (MBC) test by an abbreviated method. Subjects were labelled MBC+ if forced expiratory volume in one second (FEV1) fell by > or = 20%. The linear dose-response slope was calculated as the percentage fall in FEV1 at the last dose divided by the total dose given. RESULTS: 1262 samples were taken in the 63 pools. Mean NCl3 concentrations were greater in leisure than in public pools. A significant concentration-response relation was found between irritant eye, nasal, and throat symptoms-but not chronic respiratory symptoms-and exposure concentrations. Among women, the prevalence of MBC+ was twice as great as in men. Overall, no relation was found between bronchial hyperresponsiveness and exposure. CONCLUSIONS: The data show that lifeguards exposed to NCl3 in indoor swimming pools are at risk of developing irritant eye, nasal, and throat symptoms. Exposure to NCl3 does not seem to carry the risk of developing permanent bronchial hyperresponsiveness, but this association might have been influenced by self selection. The possibility that subjects exposed to NCl3 are at risk of developing transient bronchial hyperresponsiveness cannot be confidently ruled out.
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In the citing paper
“Furthermore, despite the large number of chloramine measurements, no associations were studied between chloramine levels and basic characteristics, such as the number of bathers, disinfection methods and (free) chlorine concentrations in the water.”
From Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers (2007) · cites this paper as [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Conditions that determine production and air levels of trichloramines are believed to depend on the degree of water chlorination, contamination of water by nitrogen-containing compounds (which depends on the number of bathers, as well as their behaviour and hygiene), water temperature, water circulation and ventilation 3, 4.”
From Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers (2007) · cites this paper as [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Nitrogen trichloride concentrations were greater in leisure pools (mean±sd, 0.67±0.17 mg·m−3) than public pools (0.24±0.37 mg·m−3)”
From Occupational asthma caused by chloramines in indoor swimming-pool air (2002) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Personnel in swimming pool facilities typically experience ocular and respiratory symptoms. [11,16 -19]”
From Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools (2019) · cites this paper as [11]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The emission of unwanted by-products from the pool water into the indoor air depends on different factors such as the concentration in the water and their volatility, the number of bathers and their behavior, ventilation, water temperature and water circulation. [2,9 -12]”
From Occupational exposure to trichloramine and trihalomethanes: adverse health effects among personnel in habilitation and rehabilitation swimming pools (2019) · cites this paper as [11]
Experimental — accuracy not yet measured
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In the citing paper
“The exposure levels (arithmetic mean; AM) were usually 0.15-0.65 mg/m 3 for public and school baths and 0.2-1.25 mg/m 3 for adventure baths”
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 Massin et al. 1998
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“No significant associations have been found between levels or duration of trichloramine exposure and self-reported asthma symptom, pulmonary function, airway hyperreactivity and airway inflammation.”
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 Massin et al. 1998
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Irritative symptoms in eyes and upper respiratory tract are evident at airborne trichloramine levels of 0.5 mg/m 3 (H ery et al. 1995; Massin et al. 1998; Fantuzzi et al. 2013).”
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 Massin et al. 1998
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“No associations were found between exposure and BHR, chronic bronchitis and asthma.”
From Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers (2007) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“Trichloramine exposure was significantly associated with upper respiratory symptoms.”
From Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers (2007) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“In that study, no comparison was made with the general population.”
From Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers (2007) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“A dose/response relationship was found between nasal, eye and throat symptoms but not chronic respiratory symptoms.”
From Occupational asthma caused by chloramines in indoor swimming-pool air (2002) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“but no relationship has previously been found with bronchial hyperresponsiveness or asthma 6.”
From Occupational asthma caused by chloramines in indoor swimming-pool air (2002) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“There was no correlation between bronchial hyperresponsiveness to methacholine and exposure to chloramines.”
From Occupational asthma caused by chloramines in indoor swimming-pool air (2002) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“Massin et al. 6 studied 334 lifeguards working in 46 public swimming pools (n=228) and 17 leisure centre swimming pools.”
From Occupational asthma caused by chloramines in indoor swimming-pool air (2002) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“The experiment was designed to produce nitrogen trichloride at a concentration of 0.5 mg·m−3 in a challenge chamber, this concentration being at the upper end of the range measured in swimming pools 1, 6.”
From Occupational asthma caused by chloramines in indoor swimming-pool air (2002) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“Irritation (respiratory and ocular) associated with exposure to CAMs (particularly TCAM) among swimming pool attendees or workers are well acknowledged [8,9,10,11,12,13,14,15].”
From Occurrence and Spatial and Temporal Variations of Disinfection By-Products in the Water and Air of Two Indoor Swimming Pools (2012) · cites this paper as [11]
The cited source says what the claim attributes to it.
In the citing paper
“Duration of exposure was taken into account in some studies, and an association between the prevalence of irritation in upper airways or eyes and cumulative trichloramine exposure was observed (Massin et al. 1998;Jacobs et al. 2007;Parrat et al. 2012).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“This value is supported by several other studies on pool workers which show irritation at approximately 0.5 mg/m 3 (H ery et al. 1995; Massin et al. 1998; Fantuzzi et al. 2013).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“Significantly higher prevalences of irritative symptoms in eyes and nose were reported in pool workers in one study at 0.36 (0.30-0.52) mg/m 3 of trichloramine (Parrat et al. 2012) and in three other studies with pool workers from around 0.5 mg/m 3 (H ery et al. 1995; Massin et al. 1998; Fantuzzi et al. 2013).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“An association between the prevalence of irritation in upper airways or eyes and cumulative trichloramine exposure was observed in some studies (Massin et al. 1998;Jacobs et al. 2007;Parrat et al. 2012).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“In addition, significant concentration-response trends for eye, nose and throat irritation over the whole exposure range (4 sub-groups) were reported for lifeguards (Massin et al. 1998).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“Several of these studies reported irritation at approximately 0.5 mg/m 3 of trichloramine (H ery et al. 1995;Massin et al. 1998;Fantuzzi et al. 2013).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“Duration of exposure seems to be of importance; an association between the prevalence of irritative symptoms in exposed pool workers and cumulative trichloramine exposure has been shown (Massin et al. 1998;Jacobs et al. 2007;Nordberg et al. 2012;Parrat et al. 2012).”
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 Massin et al. 1998
The cited source says what the claim attributes to it.
In the citing paper
“No associations between exposure levels and airway | hyperresponsiveness”
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 Massin et al. (1998)
In the citing paper
“Subjects exposed chronically to the swimming pool environment, such as pool workers, showed irritant eye, nasal, and throat symptoms (Jacobs et al. 2007; Massin et al. 1998).”
From Short-Term Changes in Respiratory Biomarkers after Swimming in a Chlorinated Pool (2010) · cites this paper as Massin et al. 1998
In the citing paper
“For lifeguards at swimming pools, an exposure–response relationship has been identified between trichloramine, measured as total chloramines, and irritant eye, nasal, and throat symptoms, although not chronic respiratory symptoms or bronchial hyperresponsiveness (Massin et al. 1998).”
From Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations (2009) · cites this paper as Massin et al. 1998
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Ahmadpour, E., Halle, S., Valois, I., Ryan, P. E., Haddad, S., Rodríguez, M. J., Tardif, R., & Debia, M. (2022) · Research Square · doi:10.21203/rs.3.rs-1336660/v2
Young, C. J. (2022) · Atmospheric measurement techniques · doi:10.5194/amt-2022-130-ac2
Young, C. J. (2022) · Atmospheric measurement techniques · doi:10.5194/amt-2022-130-ac1
Liu, Q., Shao, P., Sun, J., Shi, R., Li, L., Zeng, W., Chen, F., Li, W., & Li, L. (2024) · Research Square · doi:10.21203/rs.3.rs-4489283/v1
Brans, R. (2025) · Springer eBooks · doi:10.1007/978-3-319-40221-5_123-3
Fritz, R., Stubnya, G. R., & Fritz, R. (2026) · Applied Sciences · doi:10.3390/app16083821
Active air stripping and direct point exhaust of trichloramine (NCl3) from indoor pools
Blatchley, E. R., Coletto, A., & Pochini, I. (2026) · Chemosphere · doi:10.1016/j.chemosphere.2026.145000
Electrochemical Oxidation of Chlorination By-Products in Swimming Pool Water
Levinsson, A., Darnell, A., Boethius, S., Wickman, B., & Hellman, A. (2026) · Water · doi:10.3390/w18151828
Metadata
- Authors
- Massin, N., Bohadana, A. B., Wild, P., Héry, M., Toamain, J. P., & Hubert, G.
- Affiliations
- Institut National de Recherche et de Sécurité (FR)
- Venue
- Occupational and Environmental Medicine
- Publisher
- BMJ
- Published
- 1998-04
- Volume
- 55
- Issue
- 4
- Pages
- 258-263
- ISSN
- 0007-1072 (ISSN-L)
- 1351-0711
- 1470-7926
- PMC
- PMC1757567
- OpenAlex
- W2168911878
- Cited by
- 181
- References
- 19
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 3 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 8 · 2016: 3 · 2015: 9 · 2014: 8 · 2013: 7 · 2012: 15
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Occupational and Environmental Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Keywords
- nitrogen trichloride, indoor swimming pools, lifeguards, occupational exposure, airway hyperresponsiveness, methacholine challenge, lung function, dose-response relationship, sex differences
- MeSH terms
- Adult, Bronchial Provocation Tests, Bronchitis, Chlorides, Eye Diseases, Female, Forced Expiratory Volume, France, Humans, Irritants, Male, Nose Diseases, Pharyngitis, Regression Analysis, Respiration Disorders, Respiratory Tract Diseases, Swimming Pools, Vital Capacity, Occupational Exposure, Nitrogen Compounds
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