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


METHODS
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.


RESULTS
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.
Environmental and Occupational Health Sciences Institute, Robert Wood Johnson Medical School/University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey 08854, USA. weisel@eohsi.rutgers.edu
Clifford P
CP
Weisel
Susan D
SD
Richardson
Benoit
B
Nemery
Gabriella
G
Aggazzotti
Eugenio
E
Baraldi
Ernest R
ER
Blatchley
Benjamin C
BC
Blount
Kai-Håkon
KH
Carlsen
Peyton A
PA
Eggleston
Fritz H
FH
Frimmel
Michael
M
Goodman
Gilbert
G
Gordon
Sergey A
SA
Grinshpun
Dirk
D
Heederik
Manolis
M
Kogevinas
Judy S
JS
LaKind
Mark J
MJ
Nieuwenhuijsen
Fontaine C
FC
Piper
Syed A
SA
Sattar
D016902:Air Pollution, Indoor / Q000517:prevention & control; D001249:Asthma / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002700:Chloramines / Q000633:toxicity; D004202:Disinfectants / Q000633:toxicity; D004781:Environmental Exposure / Q000517:prevention & control; D006287:Health Planning Guidelines; D006801:Humans; D013551:Swimming Pools / Q000592:standards
D002700:Chloramines; D004202:Disinfectants