Pulmonary epithelial integrity in children—relationship to ambient ozone exposure and swimming pool attendance
Open accessAbstract
Airway irritants such as ozone are known to impair lung function and induce airway inflammation. Clara cell protein (CC16) is a small anti-inflammatory protein secreted by the nonciliated bronchiolar Clara cells. CC16 in serum has been proposed as a noninvasive and sensitive marker of lung epithelial injury. In this study, we used lung function and serum CC16 concentration to examine the pulmonary responses to ambient O3 exposure and swimming pool attendance. The measurements were made on 57 children 10–11 years of age before and after outdoor exercise for 2 hr. Individual O3 exposure was estimated as the total exposure dose between 0700 hr until the second blood sample was obtained (mean O3 concentration/m3 × hours). The maximal 1-hr value was 118 μg/m3 (59 ppb), and the individual exposure dose ranged between 352 and 914 μg/m3hr. These O3 levels did not cause any significant changes in mean serum CC16 concentrations before or after outdoor exercise, nor was any decrease in lung function detected. However, children who regularly visited chlorinated indoor swimming pools had significantly lower CC16 levels in serum than did nonswimming children both before and after exercise (respectively, 57 ± 2.4 and 53 ± 1.7 μg/L vs. 8.2 ± 2.8 and 8.0 ± 2.6 μg/L; p < 0.002). These results indicate that repeated exposure to chlorination by-products in the air of indoor swimming pools has adverse effects on the Clara cell function in children. A possible relation between such damage to Clara cells and pulmonary morbidity (e.g., asthma) should be further investigated.
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Asthma risk is increased only in children with elevated serum IgE, whereas inflammatory effects associated with pool attendance seem to concern all pool attendees.
“Thus, whereas asthma risk was increased only in children with elevated serum IgE, inflammatory effects associated with pool attendance, such as the effects on the pulmonary epithelium (Bernard et al. 2003; Carbonnelle et al. 2002; Lagerkvist et al. 2004), seem to concern all pool attendees.”
From Chlorinated Pool Attendance, Atopy, and the Risk of Asthma during Childhood (2006) · cites this paper as Lagerkvist et al. 2004
The Results (page unavailable) report lower average serum CC16 levels in regular pool visitors than in nonvisitors, supporting an association with pulmonary epithelial effects. The paper does not test whether the effect concerns all attendees regardless of IgE; its Methods (page unavailable) also say children reporting pollen allergy or childhood asthma were excluded. The elevated-IgE asthma-risk comparison is not established by this source. (LLM, conf=0.84)
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- Authors
- Lagerkvist, B. J., Bernard, A., Blomberg, A., Bergstrom, E., Forsberg, B., Holmstrom, K., Karp, K., Lundstrom, N.-G., Segerstedt, B., Svensson, M., & Nordberg, G.
- Affiliations
- Umeå University (SE)
- UCLouvain (BE)
- 3Respiratory Medicine and Allergy, Department of Public Health and Clinical Medicine
- 4Paediatrics, Department of Clinical Sciences, and
- 5Clinical Physiology, Department of Surgical and Peri-operative Sciences, Umea University, Umea, Sweden
- 1Environmental and Occupational Medicine, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2004-09-13
- Volume
- 112
- Issue
- 17
- Pages
- 1768-1771
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC1253671
- OpenAlex
- W2046037691
- Cited by
- 96
- References
- 28
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 2 · 2021: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 4 · 2015: 7 · 2014: 5 · 2013: 5 · 2012: 9
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/licenses/by/4.0/ (vor, 4855 d)
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- Clara cell protein 16, chlorination by-products, children, lung function, outdoor exercise, airway irritants, asthma
- MeSH terms
- Air Pollutants, Child, Disinfectants, Environmental Exposure, Epithelial Cells, Female, Humans, Inflammation, Lung, Male, Oxidants, Photochemical, Ozone, Respiratory Function Tests, Swimming, Swimming Pools, Uteroglobin, Chlorine Compounds
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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