Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2009 Apr;117(4):500-7.
doi: 10.1289/ehp.11513. Epub 2008 Sep 30.

Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations

Clifford P Weisel  1 , Susan D Richardson, Benoit Nemery, Gabriella Aggazzotti, Eugenio Baraldi, Ernest R Blatchley 3rd, Benjamin C Blount, Kai-Håkon Carlsen, Peyton A Eggleston, Fritz H Frimmel, Michael Goodman, Gilbert Gordon, Sergey A Grinshpun, Dirk Heederik, Manolis Kogevinas, Judy S LaKind, Mark J Nieuwenhuijsen, Fontaine C Piper, Syed A Sattar
Affiliations
Review

Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations

Clifford P Weisel et al. Environ Health Perspect. 2009 Apr.

Abstract

Objectives: Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children's exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue.

Data sources: A workshop was held in Leuven, Belgium, 21-23 August 2007, to evaluate the literature and to develop a research agenda to better understand children's exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs.

Synthesis: Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection.

Conclusions: Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.

Keywords: DBPs; aerosols; biologics; childhood asthma; disinfection by-products; epidemiology; study design; swimming pools.

PubMed Disclaimer

Comment in

References

    1. Aggazzotti G, Fantuzzi G, Righi E, Predieri G. Blood and breath analyses as biological indicators of THMs exposure in indoor swimming pools. Sci Total Environ. 1998;217:155–163. - PubMed
    1. Aggazzotti G, Predieri G. Survey of volatile halogenated organics (VHO) in Italy: levels of VHO in drinking waters, surface water and swimming pools. Water Res. 1986;20:959–963.
    1. American Thoracic Society and the European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide. Am J Respir Crit Care Med. 2005;171:912–930. - PubMed
    1. Armstrong B, Strachan D. Asthma and swimming pools: statistical issues [Letter] Occup Environ Med. 2004;61:475. - PMC - PubMed
    1. Asmussen L, Olson LM, Grant EN, Fagan J, Weiss KB. Reliability and validity of the Children’s Health Survey for Asthma. Pediatrics. 1999;104:e71. - PubMed

Publication types