Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers

¹ Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, The Netherlands
² Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, The Netherlands; and Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands
³ Institute for Risk Assessment Sciences, Division Environmental Epidemiology, Utrecht University, The Netherlands; Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands; and University Medical Center Utrecht, Utrecht University, The Netherlands

^* To whom correspondence should be addressed. E-mail: j.h.jacobs{at}iras.uu.nl.

	Abstract

The association was studied between swimming pool characteristics and activities of employees and respiratory symptoms in employees. Trichloramine levels were measured to evaluate relationships with pool characteristics and to estimate long-term exposure levels.

Questionnaires were available from 624 pool workers and 38 swimming facilities. Chloramine levels were measured by area sampling over 2-hour periods and analyzed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyper-responsiveness (BHR) were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modeled with regression analysis. This model was used to estimate long-term average chloramine levels for each pool studied.

Employees with higher exposure reported upper respiratory symptoms with greater frequency. Upper respiratory symptoms were statistically significantly associated with cumulative chloramine levels (OR>1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared to a Dutch population sample (OR ranged from 1.4 to 7.2).

An excess risk for respiratory symptoms indicative of asthma was observed. Aggravation of existing respiratory disease or interactions between irritants and allergen exposures are the most likely explanations for the observed associations.