Indoor swimming pools, water chlorination and respiratory health

Nemery, B.; Hoet, P.H.M.; Nowak, D.

doi:10.1183/09031936.02.00308602

Cited by 107Indoor Air Quality and Microbial ExposureWater Treatment and DisinfectionOccupational exposure and asthma

Indoor swimming pools, water chlorination and respiratory health

Nemery, B., Hoet, P.H.M., Nowak, D.·2002·European Respiratory Journal

DOI 10.1183/09031936.02.00308602

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Abstract

Swimming is generally considered to be a healthy leisure activity for both the young and old. Swimming is even often advised as the most appropriate sport for asthmatic children 1–3, mainly (but probably not solely) on the grounds that inhaling moist air is less conducive to triggering exercise-induced asthma 4. However, for obvious reasons of microbiological safety, the water of public and private swimming pools must be disinfected 5. The most common procedure for water disinfection consists of chlorination. As with all human and technological intervention, the use of chlorine-based products to disinfect swimming water may lead to a number of unwanted effects, in particular the presence of chlorine-containing compounds in the air. Consequently, chlorination may affect the respiratory health of either those who work as swimming attendants or instructors, or those who use the pools as customers, particularly children and the general public, but also competitive swimmers. Although the issue of the chlorination of public water supplies has received considerable attention, mainly with regard to the presence of potentially carcinogenic or teratogenic chlorinated by-products 6, 7, the respiratory hazards of chlorinated swimming water have been less well addressed. Thus, old 8, 9 and even more recent 10 reports on indoor pollution do not deal with the air of chlorinated swimming pools, despite the generally obvious and readily noticeable irritant character of this type of environment, even in well-maintained pools 11. Chlorination is the most common procedure for water disinfection of public water supplies and swimming pools. Chlorine may be added to water as the gaseous form (Cl2), which rapidly hydrolyzes to hypochlorous acid (HOCl), or as sodium or calcium hypochlorite (NaOCl or Ca(OCl)2). Hypochlorite, for disinfection, may also be produced by adding so-called hypochlorite-generating agents, such as dichloroisocyanurate, …

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Irritation (respiratory and ocular) associated with exposure to CAMs, particularly TCAM, among swimming pool attendees or workers is well acknowledged.
“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 [12]

Occupational asthma caused by chloramines in indoor swimming-pool air
Thickett, K. M., McCoach, J. S., Gerber, J. M., Sadhra, S., & Burge, P. S. (2002) · European Respiratory Journal · doi:10.1183/09031936.02.00232802 · Cited by 266 · see citing works
Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools.
Massin, N., Bohadana, A. B., Wild, P., Héry, M., Toamain, J. P., & Hubert, G. (1998) · Occupational and Environmental Medicine · doi:10.1136/oem.55.4.258 · Cited by 181 · see citing works
Exposure to chloramines in the atmosphere of indoor swimming pools
HERY, M. (1995) · The Annals of Occupational Hygiene · doi:10.1016/0003-4878(95)00013-5 · Cited by 167 · see citing works

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Childhood asthma
Mrázek, D. (2015) · doi:10.1016/b978-1-4557-0790-4.00110-4 · Cited by 305
“…exposure to respiratory irritants is associated with asthma in children who visit the indoor swimming pool environment when they are very young (Bernard et al. 2003, 2006, 2007; Carbonnelle et al. 2008; Carraro et al. 2006; Lagerkvist et al. 2004; Nemery et al. 2002; Nickmilder and Bernard 2007).”
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Chowdhury, S., Alhooshani, K., & Karanfil, T. (2014) · Water Research · doi:10.1016/j.watres.2014.01.017 · Cited by 224 · see citing works
Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers
Jacobs, J. H., Spaan, S., van Rooy, G. B. G. J., Meliefste, C., Zaat, V. A. C., Rooyackers, J. M., & Heederik, D. (2007) · European Respiratory Journal · doi:10.1183/09031936.00024706 · Cited by 223 · see citing works
“... in adults and children and serum surfactant protein-A and -B, which are markers of lung epithelium hyperpermeability in a variety of acute or chronic lung disorders [8, 9]. However, as swimming is often considered healthy for asthmatics, especially for children, asthma-related referral to improve their general con…”
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Weisel, C. P., Richardson, S. D., Nemery, B., Aggazzotti, G., Baraldi, E., Blatchley, E. R., Blount, B. C., Carlsen, K.-H., Eggleston, P. A., Frimmel, F. H., et al. (2009) · Environmental Health Perspectives · doi:10.1289/ehp.11513 · Cited by 153 · see citing works
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Dickinson, J., Whyte, G., McConnell, A., & Harries, M. (2005) · Thorax · doi:10.1136/thx.2004.037499 · Cited by 118 · see citing works
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Carter, R. A. A., & Joll, C. A. (2017) · Journal of Environmental Sciences · doi:10.1016/j.jes.2017.06.013 · Cited by 145 · see citing works
Asthma and Swimming: A Meta-Analysis
Goodman, M., & Hays, S. (2008) · Journal of Asthma · doi:10.1080/02770900802165980 · Cited by 109 · see citing works
“In recent years, public attention began to shift from well known sources of pool-related morbidity and mortality such as injuries and infections (4, 5) towards the potential link between swimming and asthma (6).”
Background
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Bernard, A., Nickmilder, M., & Voisin, C. (2008) · European Respiratory Journal · doi:10.1183/09031936.00114807 · Cited by 100 · see citing works
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Bonsignore, M. R., Morici, G., Vignola, A. M., Riccobono, L., Bonanno, A., Profita, M., Abate, P., Scichilone, N., Amato, G. M., Bellia, V., et al. (2003) · Clinical & Experimental Allergy · doi:10.1046/j.1365-2222.2003.01557.x · Cited by 94 · see citing works
Prevalence of ocular, respiratory and cutaneous symptoms in indoor swimming pool workers and exposure to disinfection by-products (DBPs)
Fantuzzi, G., Righi, E., Predieri, G., Giacobazzi, P., Mastroianni, K., & Aggazzotti, G. (2010) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph7041379 · Cited by 95 · see citing works
The Respiratory Health of Swimmers
Bougault, V., Turmel, J., Lévesque, B., & Boulet, L. (2009) · Sports Medicine · doi:10.2165/00007256-200939040-00003 · Cited by 98 · see citing works
Assessment of Occupational and Public Exposure to Trichloramine in Swiss Indoor Swimming Pools: A Proposal for an Occupational Exposure Limit
(2012) · The Annals of Occupational Hygiene · doi:10.1093/annhyg/mer125 · Cited by 84 · see citing works
“Various authors (Nemery et al., 2002; Thoumelin et al., 2005; Jacobs et al., 2007) reported that the quantity of trichloramine emitted from pool water depends on various factors, such as the shaking of the water, the number of swimmers, the concentration of chloramine precursors (especially urea…”
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Swimming pool, respiratory health, and childhood asthma: Should we change our beliefs?
Uyan, Z. S., Carraro, S., Piacentini, G., & Baraldi, E. (2009) · Pediatric Pulmonology · doi:10.1002/ppul.20947 · Cited by 69 · see citing works
Occurrence and Spatial and Temporal Variations of Disinfection By-Products in the Water and Air of Two Indoor Swimming Pools
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“[0–128] 37 12.”
Background
Airway cells after swimming outdoors or in the sea in nonasthmatic athletes.
Bonsignore, M., Morici, G., Riccobono, L., Profita, M., Bonanno, A., Paternó, A., Giorgi, R. D., Chimenti, L., Abate, P., Mirabella, F., et al. (2003) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000074581.08023.25 · Cited by 64 · see citing works
Nontuberculous Mycobacteria in Aerosol Droplets and Bulk Water Samples from Therapy Pools and Hot Tubs
Glazer, C., Martyny, J., Lee, B., Sanchez, T., Sells, T. M., Newman, L., Murphy, J. R., Heifets, L., & Rose, C. (2007) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459620701634403 · Cited by 61 · see citing works
“These results should be interpreted with caution due to the small sample size, but further study appears warranted, especially given recent trends away from halogen disinfection due to concerns about adverse health effects related to chlorine exposure.(4,5) Higher turnover rates (the number of times the entire pool vo…”
Result
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Aranđelović, M., Stanković, I., & Nikolić, M. (2007) · The Scientific World JOURNAL · doi:10.1100/tsw.2007.221 · Cited by 58 · see citing works
“There are many different opinions regarding the positive influence of swimming in patients with asthma; for example, that nitrogen trichloride, which is present in indoor chlorinated pools, has a very negative influence on breathing organs, and also the claim that there is recorded professional asthma in employees in…”
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Effects of swimming on spirometric parameters and bronchial hyperresponsiveness in children and adolescents with moderate persistent atopic asthma
Wicher, I. B., O, M. Â. G. D. O., Marmo, D. B., Santos, C. I. D. S., Toro, A. A. D. C., Mendes, R. T., Cielo, F. M. D. B. L., & Ribeiro, J. D. (2010) · Jornal de Pediatria · doi:10.2223/jped.2022 · Cited by 58 · see citing works
Allergic and non-allergic rhinitis in swimmers: clinical and cytological aspects
Gelardi, M., Ventura, M. T., Fiorella, R., Fiorella, M. L., Russo, C., Candreva, T., Carretta, A., & Passalacqua, G. (2010) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.066456 · Cited by 43 · see citing works
Acute Inhalation Injury With Evidence of Diffuse Bronchiolitis Following Chlorine Gas Exposure at a Swimming Pool
Parimon, T., Kanne, J. P., & Pierson, D. J. (2004) · Respiratory Care · doi:10.4187/respcare.04490291 · Cited by 44 · see citing works
“7 Of all organ systems, the respiratory system is the most adversely affected by chlorine gas exposure.”
Air Quality and Temperature Effects on Exercise‐Induced Bronchoconstriction
Rundell, K. W., Anderson, S. D., Sue‐Chu, M., Bougault, V., & Boulet, L. (2015) · Comprehensive physiology · doi:10.1002/j.2040-4603.2015.tb00611.x · Cited by 5 · see citing works
“These are often reported as being the cause of nasal and bronchial irritation and respiratory symptoms 232,243,262,266,302,357,365), and are also suspected contribute to the development of asthma and subsequent in some swimmers (114,373).”
Baby swimming increases the risk of recurrent respiratory tract infections and otitis media
Nystad, W., Njå, F., Magnus, P., & Nafstad, P. (2003) · Acta paediatrica · doi:10.1111/j.1651-2227.2003.tb00622.x · Cited by 49 · see citing works
“A recent study focused on the possible effects of chlorinebased products used to disinfect swimming water (3).”
Background
Haloacetic acids in swimming pool and spa water in the United States and China
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“Chlorination is the most common process for disinfection of public swimming pools [1–3].”
Background
Acute Respiratory Distress Syndrome From Chlorine Inhalation During a Swimming Pool Accident: A Case Report and Review of the Literature
Babu, R., Cardenas, V., & Sharma, G. (2008) · Journal of Intensive Care Medicine · doi:10.1177/0885066608318471 · Cited by 48 · see citing works
“Despite the potential for late complications, long-term respiratory debilitation from chronic low-level chlorine exposure is rare.(19,25) Bronchial hyperresponsiveness is possible either with a prolonged low-level exposure or with a more serious one-time exposure.”
Background
Outbreaks of short-incubation ocular and respiratory illness following exposure to indoor swimming pools
Bowen, A. B., Kile, J. C., Otto, C., Kazerouni, N., Austin, C., Blount, B. C., Wong, H.-N., Beach, M. J., & Fry, A. M. (2007) · Environmental Health Perspectives · doi:10.1289/ehp.9555 · Cited by 40 · see citing works
Not only training but also exposure to chlorinated compounds generates a response to oxidative stimuli in swimmers
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Airway irritation among indoor swimming pool personnel: trichloramine exposure, exhaled NO and protein profiling of nasal lavage fluids
Fornander, L., Ghafouri, B., Lindahl, M. G., & Graff, P. (2012) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-012-0790-4 · Cited by 35 · see citing works
“However, people frequently being in the environment often experience airway, eye or dermatological problems (WHO 2006; Nemery et al. 2002).”
Background
Swimming facilities and work-related asthma
Rosenman, K. D., Millerick-May, M. L., Reilly, M. J., Flattery, J., Weinberg, J. L., Harrison, R., Lumia, M., Stephens, A. C., & Borjan, M. (2014) · Journal of Asthma · doi:10.3109/02770903.2014.950428 · Cited by 36 · see citing works
Health effects of exposure to chlorination by‐products in swimming pools
Couto, M., Bernard, A., Delgado, L., Drobnic, F., Kurowski, M. M., Moreira, A. M., Alves, R. R., Rukhadze, M., Seys, S., Wiszniewska, M., et al. (2021) · Allergy · doi:10.1111/all.15014 · Cited by 42 · see citing works
An outbreak of swimming-pool related respiratory symptoms: An elusive source of trichloramine in a municipal indoor swimming pool
Seys, S. F., Feyen, L., Keirsbilck, S., Adams, E., Dupont, L. J., & Nemery, B. (2015) · International Journal of Hygiene and Environmental Health · doi:10.1016/j.ijheh.2015.03.001 · Cited by 37 · see citing works
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Carraro, S., Pasquale, M. F., Frè, M. D., Rusconi, F., Bonetto, G., Zanconato, S., & Baraldi, E. (2006) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2006.07.016 · Cited by 29 · see citing works
Attendance at chlorinated indoor pools and risk of asthma in adult recreational swimmers
Ferrari, M., Schenk, K., Mantovani, W., Papadopoulou, C., Posenato, C., Ferrari, P., Poli, A., & Tardivo, S. (2011) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2010.12.006 · Cited by 28 · see citing works
Acute accidental exposure to chlorine gas: clinical presentation, pulmonary functions and outcomes.
Mohan, A., Kumar, S., Rao, M., Bollineni, S., & Manohar, I. (2010) · Indian journal of chest diseases & allied sciences · doi:10.5005/ijcdas-52-3-149 · Cited by 27
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Carew, C., & Cox, D. (2017) · Journal of Asthma · doi:10.1080/02770903.2017.1373806 · Cited by 26 · see citing works
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Wicher, I. B., Ribeiro, M. Â. G. D. O., Marmo, D. B., Santos, C. I. D. S., Toro, A. A. D. C., Mendes, R. T., Cielo, F. M. D. B. L., & Ribeiro, J. D. (2010) · Jornal de Pediatria · doi:10.1590/s0021-75572010000500006 · Cited by 32 · see citing works
Toxicological Effects of Secondary Air Pollutants
Xiang, W., Wang, W., Du, L., Zhao, B., Liu, X., Zhang, X., Li, Y., & Ge, M. (2023) · Chemical Research in Chinese Universities · doi:10.1007/s40242-023-3050-0 · Cited by 28 · see citing works
Cleaning Products-related Asthma
Rosenman, K. (2006) · Clinical Pulmonary Medicine · doi:10.1097/01.cpm.0000227253.84652.77 · Cited by 22 · see citing works
The effect of physical and chemical properties of swimming pool water and its close environment on the development of contact dermatitis in hydrotherapists
Pardo, A., Nevo, K., Vigiser, D., & Lazarov, A. (2007) · American Journal of Industrial Medicine · doi:10.1002/ajim.20423 · Cited by 27 · see citing works
Comprehensive assessment of the indoor air quality in a chlorinated Olympic-size swimming pool.
Felgueiras, F., Mourão, Z., Morais, C., Santos, H., Gabriel, M., & Fernandes, E. D. O. (2019) · Environment International · doi:10.1016/j.envint.2019.105401 · Cited by 19 · see citing works
Airways Disorders and the Swimming Pool
Bougault, V., & Boulet, L. (2013) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2013.02.008 · Cited by 16 · see citing works
A smartphone-based portable analytical system for on-site quantification of hypochlorite and its scavenging capacity of antioxidants
Yang, X., Sun, M., Wang, T., Wong, M. W., & Huang, D. (2018) · Sensors and Actuators B Chemical · doi:10.1016/j.snb.2018.11.131 · Cited by 20 · see citing works
Airway inflammation in elite swimmers
PIACENTINI, G. L., Rigotti, E., Bodini, A., Peroni, D. G., & Boner, A. L. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.01.050 · Cited by 18 · see citing works
CuO-ZIF-8 modified electrode surface as a new electrochemical sensing platform for detection of free chlorine in aqueous solution
Jafari, S., Pourmortazavi, S. M., Ehsani, A., & Mirsadeghi, S. (2024) · Scientific Reports · doi:10.1038/s41598-024-69869-4 · Cited by 17
Sources, transmission and hospital-associated outbreaks of nontuberculous mycobacteria: a review.
Abbas, M., Khan, M. T., Iqbal, Z., Ali, A., Eddine, B. T., Yousaf, N., & Wei, D.-Q. (2024) · Future Microbiology · doi:10.2217/fmb-2023-0279 · Cited by 17
Indoor Air Pollution in Exercise Centers
Hajian, M., & Mohaghegh, S. (2014) · International Journal of Medical Toxicology and Forensic Medicine · doi:10.22037/ijmtfm.v5i1(winter).6442 · Cited by 14 · see citing works
“Chloramines are mainly responsible for smell and irritant properties of swimming-pool air (30).”
Background
Determination of nitrogen trichloride (NCl3) levels in the air of indoor chlorinated swimming pools: an impinger method proposal
Predieri, G., & Giacobazzi, P. (2011) · International Journal of Environmental & Analytical Chemistry · doi:10.1080/03067319.2010.496044 · Cited by 13 · see citing works
The Epidemiology of Work-Related Asthma
Smith, A. M. (2011) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2011.07.009 · Cited by 16 · see citing works
Potential negative effects of chlorinated swimming pool attendance on health of swimmers and associated staff
Zarzoso, M., Llana, S., & Pérez-Soriano, P. (2010) · Biology of Sport · doi:10.5604/20831862.927465 · Cited by 15 · see citing works
Accidental Chlorine Gas Intoxication: Evaluation of 39 Patients
Sever, M., Mordeniz, C., Sever, F., & Dokur, M. (2009) · Journal of Clinical Medicine Research · doi:10.4021/jocmr2009.12.1283 · Cited by 15
“The medical literature is replete, from household or swimming pool exposures to industrial or chemical transportation accident reports [2, 4, 6, 9, 12, 13-16].”
BackgroundInfluential
Performance indicators for aquatic centres in Canada: Identification and selection using fuzzy based methods
Saleem, S., Haider, H., Hu, G., Hewage, K., & Sadiq, R. (2020) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2020.141619 · Cited by 17 · see citing works
Effect of Sameera Pannaga Rasa (arsenomercurial formulation) in the management of Tamaka Shwasa (bronchial asthma) - Randomized double blind clinical study
Mashru, M., Galib, R., Shukla, V., Ravishankar, B., & Prajapati, P. (2013) · Ayu · doi:10.4103/0974-8520.127692 · Cited by 14
“Common risk factors for asthma include exposure to allergens (such as those for house dust mites, animal with fur, cockroaches, pollens and mold),[6] occupational irritants,[7] tobacco smoke,[8] respiratory (viral) infections,[9] chemical irritants,[7] food allergies such as milk, peanuts and eggs[10] and psychologica…”
Background
Occupational and Environmental Lung Diseases: Tarlo/Occupational and Environmental Lung Diseases
Tarlo, S., Cullinan, P., & Nemery, B. (2010) · doi:10.1002/9780470710425 · Cited by 13
Self-citation
The effect of exposure to chlorine on pulmonary function tests and respiratory and allergic symptoms in Iranian lifeguards
Boskabady, M., Esmaeilizadeh, M., & Boskabady, M. (2014) · Toxicology and industrial health · doi:10.1177/0748233712454465 · Cited by 12 · see citing works
“In addition, the exposure to chlorine can induce bronchial hyperresponsiveness and asthma-like and allergic symptoms (Fjellbirkeland et al., 1995; Helenius et al., 1998; Nemery et al., 2002; Zwick et al., 1990), which also support the finding of the present study.”
BackgroundResult
Incidence of asthma symptoms and decreased pulmonary function in young amateur swimmers.
Fiks, I., Carlos, L., Santos, A., Antunes, T., Gonçalves, R., Ricardo, C., de Carvalho, F., Roberto, C., & Carvalho, R. (2009) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37132009000300003 · Cited by 8 · see citing works
“Curiously, counter to the idea that individuals with asthma tend to choose swimming precisely because of their respiratory problem,( 9 ) most of the subjects interviewed in the present study reported that the choice was based exclusively on personal preference for the sport.”
Background
A Review of Chlorine in Indoor Swimming Pools and its Increased Risk of Adverse Health Effects
Angione, S., McClenaghan, H., & LaPlante, A. (2011) · Revue interdisciplinaire des sciences de la santé - Interdisciplinary Journal of Health Sciences · doi:10.18192/riss-ijhs.v2i1.1526 · Cited by 7 · see citing works
“Reactive Airways Dysfunction Syndrome (RADS) and hyperventilation are linked to serious effects from prolonged chlorine exposure (Nemery et al., 2002).”
BackgroundInfluential
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“The excessive use of hypochlorite (OCl¯) as a disinfectant can lead to serious health issues, including severe respiratory problems, hypoxemia, pneumonia, bronchitis, pulmonary edema, and acute respiratory distress syndrome as well as skin irritations [2–4].”
Continuous performance improvement of aquatic centres: A Taguchi-based optimization approach towards sustainability
Saleem, S., Haider, H., Hu, G., Hewage, K., & Sadiq, R. (2022) · Journal of Building Engineering · doi:10.1016/j.jobe.2022.104576 · Cited by 6 · see citing works
Performance benchmarking model for sustainability of aquatic centres in cold regions: Development and implementation
Saleem, S., Haider, H., Hewage, K., & Sadiq, R. (2020) · Sustainable Production and Consumption · doi:10.1016/j.spc.2020.12.020 · Cited by 7 · see citing works
Vocal Cord Dysfunction after an Inhalation Exposure
Brooks, S. M. (2017) · Journal of Allergy & Therapy · doi:10.4172/2155-6121.1000261 · Cited by 8 · see citing works
“Respiratory disorders were claimed for swimming pool participants [75,76].”
Background
Respiratory Health in Home and Leisure Pursuits
Ho, L. A., & Kuschner, W. G. (2012) · Clinics in Chest Medicine · doi:10.1016/j.ccm.2012.08.001 · Cited by 7 · see citing works
Comparative study on the microbial quality in the swimming pools disinfected by the ozone-chlorine and chlorine processes in Tabriz, Iran
Firuzi, P., Hashemi, A. A., Kafil, H. S., Gholizadeh, P., & Aslani, H. (2020) · Environmental Monitoring and Assessment · doi:10.1007/s10661-020-08470-4 · Cited by 7 · see citing works
Intérêts d’une activité physique en piscine chez l’asthmatique
Bougault, V., Rasseneur, L., Doutreleau, S., & Oswald-Mammosser, M. (2005) · doi:10.1016/j.scispo.2004.10.003 · Cited by 4
Assessment of worker exposure to disinfection byproducts at indoor swimming pools in Québec
Tardif, R., Catto, C., Haddad, S., & Rodriguez, M. (2015) · doi:10.70010/wvxc7036
“At swimming pools, exposure to CAMs, and specifically to TCAMs, have been the focus of attention for managers and researchers with respect to the probable health impacts (KaydosDaniels et al., 2007; Kohlhammer et Heinrich, 2007; Nemery et al., 2002).”
Transcriptome and computational approaches highlighting the molecular regulation of Zacco platypus induced by mesocosm exposure to common disinfectant chlorine.
Suman, T., Kim, S., Yeom, D.-H., Jang, Y., Jeong, T., & Jeon, J. (2023) · Chemosphere · doi:10.1016/j.chemosphere.2023.137989 · Cited by 2
Clinical Presentations and Outcomes of Industrial Chlorine Gas Exposure Incidence in Oman
Khilji, M. F. (2020) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x20001375 · Cited by 2
Chemical Quality of Pool Water and Correlation Between Swimmers Behaviour with Dry Eyes Syndrome in Tws Swimming Pool Padangan, Bojonegoro
Pertiwi, E. D. (2018) · Jurnal kesehatan lingkungan · doi:10.20473/jkl.v10i4.2018.385-393 · Cited by 2
Upper Airway Mucosal Inflammation : Proteomic Studies after Exposure to Irritants and Microbial Agents
Fornander, L. (2015) · Linköping University Electronic Press eBooks · doi:10.3384/diss.diva-117343 · Cited by 1 · see citing works
Sustainability Management for Reducing the Health Hazards in the Indoor Swimming Pools of UAE
Jacob, J., & Cherian, J. P. (2015) · Asian Social Science · doi:10.5539/ass.v11n15p124 · Cited by 1 · see citing works
“In addition, due to cleaning process these workers are exposed to chemical reactions between amino-compounds and ammonia from swimmer’s urine and sweat and chlorine (Nemery et al., 2002 WHO, 2006) However, the Bernard et al., (2006) and Helenius et al., (2002) proved that female lifeguards (28”
Background
Sustainable micro irrigation management for trees and vines.
Goyal, M. (2014) · doi:10.1201/b17302 · Cited by 1
TiO2-based photocatalysts in indoor swimming pool air purification
Hanel, A., Korkosz, A., & Hupka, J. (2011) · doi:10.1201/b11336-15 · Cited by 1
Irritants, Irritancy and Irritant Induced Asthma
Brooks, S. M. (2018) · Journal of Allergy & Therapy · doi:10.4172/2155-6121.1000273 · Cited by 2 · see citing works
“Swimming pool use and asthma occur among individuals frequenting public swimming pools that use chlorine as a disinfectant [200-209].”
Background
Novel understanding in diagnosis and management of exercise-induced bronchoconstriction
Dickinson, J. W. (2026) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2026.2747863
A comprehensive review on advancements in three-dimensional electrochemical disinfection as cutting-edge approaches for bacterial inactivation in water treatment: mechanisms and influencing factors
Nasiri, A., Hashemi, M., & Ghanbari, S. (2026) · Applied Water Science · doi:10.1007/s13201-026-02953-4
Combined Locally Enhanced Electric Field Treatment and Copper for Effective Disinfection in a Circulating Water System
Mo, F. Y., Wang, W., Chuol, L. M., Jarin, M., Corley, J. W., & Xie, X. (2026) · ACS ES&T Engineering · doi:10.1021/acsestengg.5c01041
Diffusion simulation and risk assessment model establishment of chlorine gas leakage based on terrain conditions
Ren, X.-T., Xiaoling, M., Liu, J., Liu, R., Zhao, C.-Q., Wu, H., Wang, Z., Hai, C., & Zhang, X.-D. (2023) · Environmental Science and Pollution Research · doi:10.1007/s11356-023-26181-4
“Chlorine is a typical heavy gas due to the density is significantly greater than that of air (Nemery et al. 2002; Winder 2001).”
Background
Navigating a medical mystery in an elite athlete—severe dystonia induced by swimming
Millard-Stafford, M., & Cantwell, J. (2022) · Proceedings · doi:10.1080/08998280.2022.2090827
“Her medical history was otherwise unremarkable except for sporadic exercise-induced bronchospasm during indoor swim meets in pools with poor air quality and high trichloramine levels (known to cause respiratory symptoms).(1) Outdoor swim competitions and training sites became her preferred venue thereafter to prevent…”
Background
Swimming Pool Water in Mafraq City in Northern Jordan: Quality Evaluation
Al-harahsheh, S. (2021) · doi:10.46488/nept.2021.v20i01.009
“This is because inhaling moist air is less conductive to triggering exercise-induced asthma (Nemery et al. 2002).”
Background
CHAPITRE 3 Eau et santé
Bordé, C., Bach, J., & Bony, J. (2020) · Les eaux continentales · doi:10.1051/978-2-7598-0151-0.c008
“Des études récentes chez le personnel des piscines et chez des enfants d’âge scolaire suggèrent une possible relation entre l’exposition répétée aux sous-produits de chloration dans l’air des piscines et le risque d’asthme (Nemery et al., 2002 ; Bernard et al., 2003).”
Assessment of Changes in Sex Hormones, Cortisol and White Blood Cells during Menstrual Cycle in Female Asthmatic Students at NAU, Nnewi, Nigeria
Nkiruka, R., Solomon, N., Charles, C., Joseph, E., & Ifeoma, N. (2016) · Journal of Advances in Medicine and Medical Research · doi:10.9734/bjmmr/2016/27400
“Asthmatic flare-ups have been linked to high responsiveness of the airways which are triggered when victims are exposed to different substances such as smokes, dust, irritant odours, anxiety, stress and indoor allergens as was reported by some researchers [15-18].”
Background
Fate of chlorine in indoor swimming pools : a numerical modelling approach
Mahinpour, P. (2014) · cIRcle (University of British Columbia) · doi:10.14288/1.0074388
Adolescent Swimmers: Breathing Complaints and Prescription Asthma Medication Use and Misuse
Houlé, K., & Simonian, S. J. (2014) · Children s Health Care · doi:10.1080/02739615.2013.867787
“Chlorine is concentrated on the surface of pool water (Nemery et al., 2002) and as such, swimmers gliding along the surface of the water have an increased inhalation of these chemicals.”
Background
Determination of Physical Problems for Adult Patients with Asthma
Atiyah, H. (2013) · doi:10.33899/mjn.2013.162919
“Three major physical characteristics are associated with asthma, and people with the disease can manifest one, two or all three of them (Nemery et al., 2002; Basavanthappa, 2009).”
Background
Commentary 1 on “Airway inflammation in the elite athlete and type of sportAirway inflammation in the elite athlete and type of sport”
Orellana, J. N. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2007.042275
Commentary 3 on “Airway inflammation in the elite athlete and type of sportAirway inflammation in the elite athlete and type of sport”
Moreira, A. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2007.042309
Contrasting the effectiveness of chloramines reduction in indoor swimming pools disinfected by ozone versus UV
Chan, I., & Sidhu, B. (2015) · doi:10.47339/ephj.2015.115
Adaptation and sport
Chaitow, L., & DeLany, J. (2011) · Elsevier eBooks · doi:10.1016/b978-0-443-06815-7.00005-x

Authors: Nemery, B., Hoet, P. H. M., & Nowak, D.
Affiliations: KU Leuven (BE)
Ludwig-Maximilians-Universität München (DE)
Corresponding author: Nemery, B.
ORCID: Nemery, B.
Hoet, P.H.M.
Nowak, D.
Venue: European Respiratory Journal
Publisher: European Respiratory Society (ERS)
Published: 2002-05
Volume: 19
Issue: 5
Pages: 790-793
ISSN: 0903-1936 (ISSN-L)
1399-3003
DOI: 10.1183/09031936.02.00308602
OpenAlex: W2105741497
Cited by: 107
References: 37
Citations by year: 2026: 2 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 2 · 2015: 7 · 2014: 5 · 2013: 3 · 2012: 5
FWCI: 2.55
Type: journal article
Language: en
Open access: closed
Locations: European Respiratory Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
Keywords: indoor swimming pools, water chlorination, respiratory health, chlorine, chlorination by-products, indoor air pollution, asthma, exercise-induced asthma, competitive swimmers
MeSH terms: Asthma, Chlorine, Environmental Exposure, Humans, Swimming Pools, Water Supply, Occupational Exposure, Air Pollution, Indoor

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