title: Swimming-induced pulmonary edema in triathletes.
abstract: BACKGROUND
  Pulmonary edema related to water immersion has been reported in military trainees and scuba and breath-hold divers, but rarely in the community. To date, no risk factors for this phenomenon have been identified by epidemiological methods. Recently, sporadic reports of swimming-induced pulmonary edema (SIPE) have emerged in the triathlon community. We surveyed the population of a national North American triathlon organization (USA Triathlon) to determine prevalence of and risk factors for symptoms compatible with SIPE.
  
  
  METHODS
  We surveyed the population of USA Triathlon through the organization's monthly newsletter distribution channel. We evaluated prevalence of symptoms compatible with pulmonary edema, and then followed up with a case-control study that included additional cases we had identified previously, to identify risk factors for this condition among triathletes.
  
  
  RESULTS
  Symptom history compatible with SIPE was identified in 1.4% of the population. Associated factors identified in multivariable analysis included history of hypertension, course length of half-Ironman distance or greater, female gender and use of fish oil supplements. Of the 31 cases reported, only 4 occurred in the absence of any associated factors.
  
  
  CONCLUSIONS
  The identification of hypertension and fish oil in particular as risk factors raise questions about the role of cardiac diastolic function in the setting of water-immersion cardiac preload, as well as the hematologic effects of fish oil. Mechanistic studies of these risk factors in a directly observed prospective cohort are indicated.
authors.affiliation: Department of Biomedical Sciences, Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, El Paso, TX 79905, USA. charles.miller@ttuhsc.edu
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: Katherine
authors.initials: K
authors.lastname: Calder-Becker
authors.forename: Francois
authors.initials: F
authors.lastname: Modave
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D056352:Athletes; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013550:Swimming; D055815:Young Adult