Swimming pool attendance and risk of asthma and allergic symptoms in children
Open accessAbstract
Increased asthma risk has been associated with pool attendance in children but evidence is inconsistent and inconclusive. A survey was conducted of 3,223 9–12-yr-old children in Sabadell (Spain) to evaluate association between swimming pool attendance and prevalence of asthma and allergic conditions and symptoms. Parents completed a questionnaire on lifetime frequency of pool attendance and symptoms in the last 12 months (wheezing, asthma medication, rhinitis and allergic rhinitis), ever having asthma and eczema, and potential confounders. Indicators of indoor and outdoor swimming pool attendance early in life, cumulatively and currently were calculated. Swimming pool attendance before the age of 2 yrs was associated with slightly lower prevalence of current asthma (OR 0.79, 95% CI 0.43–1.46), rhinitis (OR 0.86, 95% CI 0.68–1.08) and allergic rhinitis symptoms (OR 0.72, 95% CI 0.54–0.96) compared to those who started attending swimming pools after 4 yrs of age. An increased prevalence of eczema was associated with duration of lifetime pool attendance (OR 1.71, 95%CI 1.38–2.12 for >5 yrs versus 0 yrs). Swimming pool attendance in Spanish children was associated with slightly less upper and lower respiratory tract symptoms and with more eczema. Longitudinal studies are required to confirm these findings and avoid potential reverse causation.
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Studies in other European countries found no association between cumulative swimming pool attendance and respiratory symptoms among children.
“Studies in other European countries such as Spain (Font-Ribera et al. 2009, 2014), the United Kingdom (Font-Ribera et al. 2011) and the Netherlands (Jacobs et al. 2012) found no association between cumulative swimming pool attendance and respiratory symptoms among children.”
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 Font-Ribera et al. 2009
The Results report that more years of pool attendance, particularly in summer, were associated with fewer rhinitis and allergic rhinitis symptoms in Spanish children. Table 4 shows lower odds of both symptoms for children with 6–9 years of summer attendance than for those with 0–5 years, contrary to the claim of no association between cumulative attendance and respiratory symptoms. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredStudies in Germany, Spain, the UK, and the Netherlands found no association between swimming pool attendance and respiratory symptoms among children.
“However, studies in other European countries such as Germany [91], Spain [92,93], the UK [94•], and the Netherlands [95], have found no association between swimming pool attendance and respiratory symptoms among children.”
From Overview of Disinfection By-products and Associated Health Effects (2015) · cites this paper as [92]
For the Spanish study, the Discussion states that pool attendance was associated with slightly fewer upper and lower respiratory tract symptoms, rather than no association. The Results also report a lower prevalence of current asthma among children currently attending pools (OR 0.46, 95% CI 0.25–0.83) and less rhinitis with longer attendance. This paper does not provide the findings for the other countries cited in the sentence. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredReported levels of trichloramine in swimming pool air from studies in Belgium, Spain, and the Netherlands were overall below the 0.5 mg/m3 recommended by the WHO.
“Reported levels of trichloramine in swimming pool air from studies in Belgium [88,89], Spain [92], and the Netherlands [95] have noted overall levels that were below the 0.5 mg/m 3 recommended by the WHO [96].”
From Overview of Disinfection By-products and Associated Health Effects (2015) · cites this paper as [92]
The Discussion reports trichloramine levels below the 0.5 mg/m³ WHO recommendation in the Spanish study population (median 0.16 mg/m³) and in the cited Belgian study (0.325 mg/m³). But it reports 0.565 mg/m³ for the Netherlands, above that threshold, so the claim does not hold for all three countries. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn a cross-sectional study of Spanish children, swimming pool attendance during the last 12 months was associated with a slightly lower prevalence of current asthma (OR 0.5, 95% CI 0.2-0.8) compared to children who never attended pools.
“Swimming pool attendance during the last 12 months | was associated with a slightly lower prevalence of | current asthma (OR 0.5, 95% CI 0.2-0.8) compared | to children who never attended pools”
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 Font-Ribera et al. (2009)
In that study, a similar (non-significant) finding was shown for ever asthma (OR 0.7, 95% CI 0.4-1.1).
“a similar | (non-significant) finding was shown for ever asthma | (OR 0.7, 95% CI 0.4-1.1)”
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 Font-Ribera et al. (2009)
The role of previous atopic status is unclear because some studies found higher asthma risk for swimming pool attendance among atopics but another did not.
“The role of previous atopic status is unclear because some studies have found higher asthma risk for swimming pool attendance among atopics (Bernard et al. 2006, 2007, 2008), but another has not (Font-Ribera et al. 2009).”
From Short-Term Changes in Respiratory Biomarkers after Swimming in a Chlorinated Pool (2010) · cites this paper as Font-Ribera et al. 2009
An increased asthma risk among children attending pools has been suggested but not confirmed.
“Although an increased asthma risk among children attending pools has been suggested but not confirmed (Font-Ribera et al. 2009; Goodman and Hays 2008)”
From Short-Term Changes in Respiratory Biomarkers after Swimming in a Chlorinated Pool (2010) · cites this paper as Font-Ribera et al. 2009
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EXPOSURES AND RISKS ASSOCIATED WITH ACTIVITIES AND BEHAVIORS IN SWIMMING POOL ENVIRONMENTS
Suppes, L. M. (2013) · UA Campus Repository (The University of Arizona)
- Authors
- Font-Ribera, L., Kogevinas, M., Zock, J.-P., Nieuwenhuijsen, M. J., Heederik, D., & Villanueva, C. M.
- Affiliations
- Center for Research in Environmental Epidemiology (ES)
- University of Crete (GR)
- Corresponding author
- Villanueva, C. M.
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2009-05-14
- Volume
- 34
- Issue
- 6
- Pages
- 1304-1310
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W1991592756
- Semantic Scholar
- e66f56e4e339e6c03f42016a6142bf0978b1a2da
- Cited by
- 77
- References
- 30
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 5 · 2020: 4 · 2019: 1 · 2018: 6 · 2017: 2 · 2016: 3 · 2015: 7 · 2014: 6 · 2013: 7 · 2012: 7
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Funders
- Universiteit Utrecht
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- 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
- Keywords
- childhood asthma, allergic rhinitis, atopic dermatitis, wheezing, allergic symptoms, early childhood swimming, respiratory symptoms
- MeSH terms
- Adolescent, Asthma, Child, Chlorine, Cross-Sectional Studies, Eczema, Female, Humans, Male, Surveys and Questionnaires, Respiration Disorders, Respiratory Sounds, Rhinitis, Spain, Swimming Pools
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