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FOR MEMBERS' USE ONLY

COMEAP STATEMENT ON SWIMMING POOLS AND ASTHMA.

ASTHMA AND EXPOSURE TO CHLORINE AND ASSOCIATED REACTION PRODUCTS AT SWIMMING POOLS.

1. Members were asked to examine a paper by Bernard et al entitled 'Lung Hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools', published in Occupational and Environmental Medicine 2003; 60:385-394. This was discussed at the COMEAP meeting on June 20th 2003.

2. Members concluded that the authors had reported a carefully conducted study that appeared to show an association between attendance at swimming pools and the prevalence of asthma. However, Members raised two technical issues which will be taken up in letters to Occupational and Environmental Medicine - the journal that published the paper in question.

i) The statistical methods used in the analysis focus on numbers of children though it may be that the more appropriate unit of analysis should be the number of schools studied. It was felt that if the analysis were to be recast with the number of schools as the key variable, then the level of statistical significance of the findings might be reduced.

ii) The changes in levels of biochemical markers studied: surfactant proteins (SP-A, SP-B) and the Clara cell markers (CC16) were felt by some members to be less certain indicators of increased epithelial permeability than the authors argued, as release of such proteins could represent a physiological rather than a pathological response.

3. However, the committee felt that the study was of interest and that further focussed research in this area was advisable to take further these preliminary findings. Members accepted that exposure to airway irritants such as chloramines could trigger the symptoms of asthma. It was argued that it was important to distinguish clearly between induction of asthma as a disease and the triggering of symptoms. The primary cause of most cases of asthma is unknown as are the reasons for the increase in asthma in the UK over the past twenty years. That exposure to chlorine and associated reaction products had played a significant part in causing this increase was felt to be unlikely.

4. Members added that swimming provided an important form of exercise and unless significantly affected, children suffering from asthma should not avoid this activity. Minor effects on airway function were likely to respond to the use of the subjects' reliever inhaler.

August 2003

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