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Infant swimming in chlorinated pools and the risks of bronchiolitis, asthma and allergy

C Voisin, A Sardella, F Marcucci, A Bernard
European Respiratory Journal 2010 36: 41-47; DOI: 10.1183/09031936.00118009
C Voisin
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A Sardella
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F Marcucci
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A Bernard
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  • For correspondence: Alfred.bernard@uclouvain.be
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Tables

  • Table 1– Characteristics of children who swam during infancy and their controls
    Swimming infantsControlsp-value
    Subjects n195235
    Males105 (53.9)124 (52.8)0.82
    School participation rate %54.9±19.458. 3±23.00.19
    Age yrs5.60±0.385.68±0.380.79
    BMI kg·m-220.9±3.820.6±3.50.39
    Parents
    Higher educational level154 (79.0)156 (66.4)0.004
    Asthma38 (19.5)25 (10.6)0.01
    Asthma and/or respiratory allergies86 (44.1)88 (37.4)0.16
    Early life
    Birthweight g3206±6393436±23960.30
    Breastfeeding161 (82.6)169 (71.9)0.01
    Day-care centre attendance127 (65.1)102 (43.4)<0.001
    Exposure to tobacco smoke
    During pregnancy31 (16.0)32 (13.6)0.51
    Parental smoking at home55 (28.2)74 (31.5)0.46
    CPA before age of 2 yrs h
    Indoor6 (0–21)
    Outdoor8 (0–31)
    Total22 (8–50)
    CPA over lifetime h
    Indoor53 (17–129)18 (0–48)<0.001
    Outdoor50 (4–146)0 (0–28)<0.001
    Total132 (52–202)35 (5–91)<0.001
    Environment and lifestyle
    Number of older siblings0.87±0.790.92±1.120.66
    House cleaning with bleach43 (22.1)66 (28.1)0.15
    Living <100 m from a busy road63 (32.3)79 (33.6)0.78
    Exposure to pets since birth85 (43.6)99 (42.1)0.76
    Aeroallergen-specific nasal IgE#
    House dust mite21 (12.2)22 (11.0)0.71
    Cat15 (8.7)14 (7.0)0.54
    Pollen27 (15.7)27 (13.5)0.55
    At least one aeroallergen42 (24.4)48 (24.0)0.92
    Respiratory symptoms and diseases¶
    Wheezing+36 (18.5)40 (17.0)0.70
    Asthma16 (8.2)15 (6.4)0.47
    Hay fever17 (8.7)27 (11.5)0.35
    Allergic rhinitis27 (13.9)25 (10.6)0.31
    Bronchiolitis71 (36.4)56 (23.8)0.004
    Bronchitis93 (47.7)111 (47.2)0.92
    Sinusitis28 (14.4)30 (12.8)0.63
    Pneumonia20 (10.3)28 (11.9)0.59
    • Data are presented as mean±sd, n (%) or median (interquartile range) unless otherwise indicated. BMI: body mass index; CPA: cumulative pool attendance; Ig: immunoglobulin. #: 172 children were tested in the swimming infant group and 200 in the other group; ¶: defined as doctor-diagnosed diseases at any time; +: episodes of wheezing during the last 12 months.

  • Table 2– Risk of bronchiolitis according to cumulative pool attendance (CPA) at indoor or outdoor chlorinated swimming pools during infancy#
    CPA categoryCPA hSubjects n/N (%)OR (95% CI)p-valueptrend
    UnadjustedAdjusted
    Indoor pool total¶
    0 h076/287 (26.5)1.0 (1.0–1.0)1.0 (1.0–1.0)
    >0–20 h6 (2–12)27/92 (29.4)1.15 (0.69–1.94)0.79 (0.44–1.42)0.44
    >20 h32 (25–45)24/51 (47.1)2.47 (1.34–4.54)2.02 (1.01–4.02)0.050.006
    Outdoor pool total¶
    0 h079/308 (25.7)1.0 (1.0–1.0)1.0 (1.0–1.0)
    >0–20 h9 (5–14)21/54 (38.9)1.85 (1.01–3.38)1.91 (0.99–3.68)0.05
    >20 h47 (30–84)27/68 (39.7)1.91 (1.1–3.3)1.59 (0.85–2.98)0.140.006
    Indoor pool alone
    0 h053/235 (22.6)1.0 (1.0–1.0)1.0 (1.0–1.0)
    >0–20 h6 (2–11)11/50 (22.0)0.9 (0.43–1.88)0.58 (0.25–1.32)0.19
    >20 h36 (24–66)12/23 (52.2)3.49 (1.46–8.34)3.49 (1.30–9.34)0.010.01
    Outdoor pool alone
    0 h059/235 (25.1)1.0 (1.0–1.0)1.0 (1.0–1.0)
    >0–20 h9 (4–12)9/27 (33.3)1.6 (0.68–3.76)1.69 (0.66–4.3)0.27
    >20 h50 (39–76)11/25 (44.0)2.51 (1.08–5.852.08 (0.81–5.34)0.130.03
    • CPA is presented as median (interquartile range). Odds ratios (ORs) were adjusted for sex, breastfeeding, day-care centre attendance, number of older siblings, parental asthma and/or respiratory allergies, maternal smoking during pregnancy, and, when the analysis was performed on all children, attendance of the other type of swimming. CI: confidence interval; N: number of subjects in group; ptrend: p-value for trend. #: before the age of 2 yrs; ¶: all children.

  • Table 3– Risk of bronchiolitis with increasing cumulative pool attendance (CPA) at indoor and/or outdoor chlorinated pools during infancy# by risk-factor category
    0-h CPA>0–20-h CPA>20-h CPAptrend
    Subjects n/N (%)OR (95% CI)Subjects n/N (%)OR (95% CI)p-valueSubjects n/N (%)OR (95% CI)p-value
    Total56/235 (23.8)1.0 (1.0–1.0)29/95(30.5)1.24 (0.69–2.23)0.4642/100 (42.0)2.25 (1.32–3.85)0.003<0.001
    Schools with >50% response rate35/146 (24.0)1.0 (1.0–1.0)17/59(28.8)1.24 (0.57–2.7)0.5923/58 (39.7)2.25 (1.10–4.59)0.030.03
    High parental educational level36/156 (23.1)1.0 (1.0–1.0)22/72(30.6)1.31 (0.67–2.57)0.4334/82 (41.5)2.26 (1.22–4.18)0.0090.003
    Parents with no asthma/respiratory allergies17/115 (14.8)1.0 (1.0–1.0)13/38 (34.2)4.31 (1.55–12.0)0.00518/45 (40.0)4.45 (1.82–10.9)0.0010.001
    No breastfeeding19/66 (28.8)1.0 (1.0–1.0)7/12 (58.3)1.06 (0.55–2.06)0.8612/22 (54.6)2.10 (1.11–3.98)0.020.008
    No day-care centre attendance21/133 (15.8)1.0 (1.0–1.0)9/32 (28.1)2.35 (0.87–6.38)0.0915/36 (41.7)4.44 (1.88–10.5)0.007<0.001
    No maternal smoking during pregnancy46/203 (22.7)1.0 (1.0–1.0)21/77 (27.3)1.27 (0.65–2.49)0.4834/87 (39.1)2.16 (1.20–3.90)0.010.005
    No exposure to parental smoking38/161 (23.6)1.0 (1.0–1.0)19/65 (29.2)1.16 (0.57–2.35)0.6132/75 (42.7)2.21 (1.18–4.17)0.010.004
    No older siblings16/99 (16.2)1.0 (1.0–1.0)13/45 (28.9)2.26 (0.87–5.88)0.0916/47 (34.0)2.72 (1.13–6.56)0.030.01
    No use of bleach for house cleaning48/201 (23.9)1.0 (1.0–1.0)28/87 (32.2)1.37 (0.75–2.51)0.3036/87 (41.4)2.22 (1.25–3.95)0.0070.003
    • Odds ratios (ORs) were adjusted for breastfeeding, sex, number of older siblings, area of residence, day-care centre attendance, maternal smoking during pregnancy and parental antecedents of atopic disease (except when the factor was excluded). A high level of education means that the father and/or mother graduated from a university or high school. N: number of subjects in group; CI: confidence interval; ptrend: p-value for trend. #: before the age of 2 yrs.

  • Table 4– Risk of respiratory diseases and sensitisation to aeroallergens associated with bronchiolitis in swimming infants and their controls
    ControlsSwimming infants
    Bronchiolitis n (%)OR (95% CI)p-valueBronchiolitis n (%)OR (95% CI)p-value
    NoYesUnadjustedAdjustedNoYesUnadjustedAdjusted
    Subjects n1795612471
    Wheezing28 (15.6)12 (21.4)1.47 (0.69–3.13)1.29 (0.47–3.54)0.6218 (14.5)18 (25.4)2.00 (0.96–4.16)2.49 (1.13–5.49)0.03
    Asthma11 (6.2)4 (7.1)1.18 (0.36–3.85)0.91 (0.23–3.70)0.905 (4.0)11 (15.5)4.36 (1.45–13.1)8.27 (2.30–29.6)0.001
    Allergic rhinitis16 (8.9)9 (16.1)1.95 (0.81–4.70)2.08 (0.79–5.40)0.1413 (10.5)14 (19.7.)2.10 (0.92–4.76)4.65 (1.42–15.2)0.01
    Hay fever19 (10.6)12 (21.4)1.40 (0.58–3.41)0.96 (0.34–2.70)0.946 (4.8)11 (15.5)3.61 (1.27–10.2)4.70 (1.52–14.5)0.007
    Nasal IgE
    Pollen#24 (15.7)3 (6.4)0.39 (0.11–1.38)0.57 (0.15–2.10)0.4014 (12.8)13 (20.6)1.86 (0.80–4.30)2.63 (1.01–6.80)0.05
    HDM#15 (9.8)7 (14.9)1.62 (0.62–4.25)2.05 (0.62–6.75)0.249 (8.3)21 (33.3 )2.59 (1.02–6.55)2.86 (1.07–7.80)0.04
    Cat#11 (7.2)3 (6.4)0.89 (0.24–3.32)0.90 (0.20–4.18)0.908 (7.3)7 (11.1)1.56 (0.54–5.54)1.26 (0.40–3.96)0.69
    • Outcomes are defined in table 1. Bronchiolitis was diagnosed at a mean±sd age of 9.6±5.9 months in infant swimmers and 9.3±5.5 months in controls. The prevalences of respiratory diseases and sensitisation to aeroallergens among children who never developed bronchiolitis did not differ significantly between swimming infants and their controls (p>0.07 for all; Chi-squared test). OR: odds ratio; CI: confidence interval; Ig: immunoglobulin; HDM: house dust mite. #: a total of 153 and 47 controls and 109 and 63 swimming infants, respectively, who did not or did develop bronchiolitis, were tested.

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Infant swimming in chlorinated pools and the risks of bronchiolitis, asthma and allergy
C Voisin, A Sardella, F Marcucci, A Bernard
European Respiratory Journal Jul 2010, 36 (1) 41-47; DOI: 10.1183/09031936.00118009

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Infant swimming in chlorinated pools and the risks of bronchiolitis, asthma and allergy
C Voisin, A Sardella, F Marcucci, A Bernard
European Respiratory Journal Jul 2010, 36 (1) 41-47; DOI: 10.1183/09031936.00118009
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