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Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers

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

CORRESPONDENCE: J. H. Jacobs, Institute for Risk Assessment Sciences, Division Environmental Epidemiology, PO Box 80.178, 3508 TD Utrecht, The Netherlands. Fax: 31 302535077. E-mail: j.h.jacobs{at}iras.uu.nl

Keywords: Occupational asthma, swimming pools, trichloramines

Received: February 17, 2006
Accepted November 12, 2006

The association between swimming pool characteristics and activities of employees and respiratory symptoms in employees was studied. 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-h periods and analysed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyperresponsiveness were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modelled 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 (odds ratio (OR) >1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared with a Dutch population sample (OR ranged 1.4–7.2).

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