title: Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Institut National de Recherche et de Sécurité, INRS, Service d'Epidémiologie, Vandoeuvre-lès-Nancy, France.
authors.forename: N
authors.initials: N
authors.lastname: Massin
authors.forename: A B
authors.initials: AB
authors.lastname: Bohadana
authors.forename: P
authors.initials: P
authors.lastname: Wild
authors.forename: M
authors.initials: M
authors.lastname: Héry
authors.forename: J P
authors.initials: JP
authors.lastname: Toamain
authors.forename: G
authors.initials: G
authors.lastname: Hubert
mesh_terms: D000328:Adult; D001985:Bronchial Provocation Tests; D001991:Bronchitis / Q000139:chemically induced; D002712:Chlorides / Q000009:adverse effects* / Q000032:analysis; D005128:Eye Diseases / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D005541:Forced Expiratory Volume; D005602:France / Q000453:epidemiology; D006801:Humans; D007509:Irritants / Q000009:adverse effects* / Q000032:analysis; D008297:Male; D017672:Nitrogen Compounds / Q000009:adverse effects* / Q000032:analysis; D009668:Nose Diseases / Q000139:chemically induced / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D010612:Pharyngitis / Q000139:chemically induced / Q000453:epidemiology; D012044:Regression Analysis; D012120:Respiration Disorders / Q000139:chemically induced / Q000453:epidemiology; D012140:Respiratory Tract Diseases / Q000139:chemically induced* / Q000453:epidemiology; D013551:Swimming Pools; D014797:Vital Capacity
chemical_list: D002712:Chlorides; D007509:Irritants; D017672:Nitrogen Compounds; C037454:nitrogen chloride