title: Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers.
abstract: The association between swimming pool characteristics and activities of employees and respiratory symptoms in employees was studied. Trichloramine levels were measured to evaluate relationships with pool characteristics and to estimate long-term exposure levels. Questionnaires were available from 624 pool workers and 38 swimming facilities. Chloramine levels were measured by area sampling over 2-h periods and analysed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyperresponsiveness were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modelled with regression analysis. This model was used to estimate long-term average chloramine levels for each pool studied. Employees with higher exposure reported upper respiratory symptoms with greater frequency. Upper respiratory symptoms were statistically significantly associated with cumulative chloramine levels (odds ratio (OR) >1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared with a Dutch population sample (OR ranged 1.4-7.2). An excess risk for respiratory symptoms indicative of asthma was observed in swimming pool employees. Aggravation of existing respiratory disease or interactions between irritants and allergen exposures are the most likely explanations for the observed associations.
authors.affiliation: Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, The Netherlands. j.h.jacobs@iras.uu.nl
authors.forename: J H
authors.initials: JH
authors.lastname: Jacobs
authors.forename: S
authors.initials: S
authors.lastname: Spaan
authors.forename: G B G J
authors.initials: GB
authors.lastname: van Rooy
authors.forename: C
authors.initials: C
authors.lastname: Meliefste
authors.forename: V A C
authors.initials: VA
authors.lastname: Zaat
authors.forename: J M
authors.initials: JM
authors.lastname: Rooyackers
authors.forename: D
authors.initials: D
authors.lastname: Heederik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002712:Chlorides / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017672:Nitrogen Compounds / Q000009:adverse effects*; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects; D012120:Respiration Disorders / Q000139:chemically induced* / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D013551:Swimming Pools
chemical_list: D002712:Chlorides; D017672:Nitrogen Compounds; C037454:nitrogen chloride