title: Short-term changes in respiratory biomarkers after swimming in a chlorinated pool.
abstract: BACKGROUND
  Swimming in chlorinated pools involves exposure to disinfection by-products (DBPs) and has been associated with impaired respiratory health.
  
  
  OBJECTIVE
  We evaluated short-term changes in several respiratory biomarkers to explore mechanisms of potential lung damage related to swimming pool exposure.
  
  
  METHODS
  We measured lung function and biomarkers of airway inflammation [fractional exhaled nitric oxide (FeNO), eight cytokines, and vascular endothelial growth factor (VEGF) in exhaled breath condensate], oxidative stress (8-isoprostane in exhaled breath condensate), and lung permeability [surfactant protein D (SP-D) and the Clara cell secretory protein (CC16) in serum] in 48 healthy nonsmoking adults before and after they swam for 40 min in a chlorinated indoor swimming pool. We measured trihalomethanes in exhaled breath as a marker of individual exposure to DBPs. Energy expenditure during swimming, atopy, and CC16 genotype (rs3741240) were also determined.
  
  
  RESULTS
  Median serum CC16 levels increased from 6.01 to 6.21 microg/L (average increase, 3.3%; paired Wilcoxon test p = 0.03), regardless of atopic status and CC16 genotype. This increase was explained both by energy expenditure and different markers of DBP exposure in multivariate models. FeNO was unchanged overall but tended to decrease among atopics. We found no significant changes in lung function, SP-D, 8-isoprostane, eight cytokines, or VEGF.
  
  
  CONCLUSIONS
  We detected a slight increase in serum CC16, a marker of lung epithelium permeability, in healthy adults after they swam in an indoor chlorinated pool. Exercise and DBP exposure explained this association, without involving inflammatory mechanisms. Further research is needed to confirm the results, establish the clinical relevance of short-term serum CC16 changes, and evaluate the long-term health impacts.
authors.affiliation: Centre for Research in Environmental Epidemiology, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Font-Ribera
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
authors.forename: Jan-Paul
authors.initials: JP
authors.lastname: Zock
authors.forename: Federico P
authors.initials: FP
authors.lastname: Gómez
authors.forename: Esther
authors.initials: E
authors.lastname: Barreiro
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Nieuwenhuijsen
authors.forename: Pilar
authors.initials: P
authors.lastname: Fernandez
authors.forename: Carolina
authors.initials: C
authors.lastname: Lourencetti
authors.forename: Maitane
authors.initials: M
authors.lastname: Pérez-Olabarría
authors.forename: Mariona
authors.initials: M
authors.lastname: Bustamante
authors.forename: Ricard
authors.initials: R
authors.lastname: Marcos
authors.forename: Joan O
authors.initials: JO
authors.lastname: Grimalt
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Villanueva
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis / Q000097:blood / Q000378:metabolism; D001944:Breath Tests; D017606:Chlorine Compounds / Q000032:analysis / Q000633:toxicity*; D015237:Dinoprost / Q000031:analogs & derivatives / Q000032:analysis; D004202:Disinfectants / Q000032:analysis / Q000633:toxicity*; D005260:Female; D054879:Halogenation; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis*; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000139:chemically induced / Q000378:metabolism*; D037663:Pulmonary Surfactant-Associated Protein D / Q000097:blood; D012129:Respiratory Function Tests; D013551:Swimming Pools / Q000706:statistics & numerical data; D014598:Uteroglobin / Q000097:blood; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*; D014877:Water Pollution, Chemical / Q000706:statistics & numerical data
chemical_list: D015415:Biomarkers; D017606:Chlorine Compounds; D004202:Disinfectants; D037663:Pulmonary Surfactant-Associated Protein D; C556389:SCGB1A1 protein, human; D042461:Vascular Endothelial Growth Factor A; D014874:Water Pollutants, Chemical; C075750:8-epi-prostaglandin F2alpha; D014598:Uteroglobin; D015237:Dinoprost