Airway irritation among indoor swimming pool personnel: trichloramine exposure, exhaled NO and protein profiling of nasal lavage fluids.
OBJECTIVE
Occurrence of airway irritation among indoor swimming pool personnel was investigated. The aims of this study were to assess trichloramine exposure levels and exhaled nitric oxide in relation to the prevalence of airway symptoms in swimming pool facilities and to determine protein effects in the upper respiratory tract.


METHODS
The presence of airway symptoms related to work was examined in 146 individuals working at 46 indoor swimming pool facilities. Levels of trichloramine, as well as exhaled nitric oxide, were measured in five facilities with high prevalence of airway irritation and four facilities with no airway irritation among the personnel. Nasal lavage fluid was collected, and protein profiles were determined by a proteomic approach.


RESULTS
17 % of the swimming pool personnel reported airway symptoms related to work. The levels of trichloramine in the swimming pool facilities ranged from 0.04 to 0.36 mg/m(3). There was no covariance between trichloramine levels, exhaled nitric oxide and prevalence of airway symptoms. Protein profiling of the nasal lavage fluid showed that the levels alpha-1-antitrypsin and lactoferrin were significantly higher, and S100-A8 was significantly lower in swimming pool personnel.


CONCLUSIONS
This study confirms the occurrence of airway irritation among indoor swimming pool personnel. Our results indicate altered levels of innate immunity proteins in the upper airways that may pose as potential biomarkers. However, swimming pool facilities with high prevalence of airway irritation could not be explained by higher trichloramine exposure levels. Further studies are needed to clarify the environmental factors in indoor swimming pools that cause airway problems and affect the immune system.
Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Louise
L
Fornander
Bijar
B
Ghafouri
Mats
M
Lindahl
Pål
P
Graff
D000328:Adult; D000395:Air Pollutants, Occupational / Q000009:adverse effects* / Q000032:analysis; D015415:Biomarkers / Q000378:metabolism; D002712:Chlorides / Q000009:adverse effects* / Q000032:analysis; D003430:Cross-Sectional Studies; D015180:Electrophoresis, Gel, Two-Dimensional; D005260:Female; D006801:Humans; D015151:Immunoblotting; D008297:Male; D008875:Middle Aged; D017817:Nasal Lavage Fluid / Q000737:chemistry; D009569:Nitric Oxide / Q000378:metabolism; D017672:Nitrogen Compounds / Q000009:adverse effects* / Q000032:analysis; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D015995:Prevalence; D020543:Proteome / Q000378:metabolism; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D012307:Risk Factors; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D013548:Sweden / Q000453:epidemiology; D013551:Swimming Pools
D000395:Air Pollutants, Occupational; D015415:Biomarkers; D002712:Chlorides; D017672:Nitrogen Compounds; D020543:Proteome; D009569:Nitric Oxide; C037454:nitrogen chloride