Diapositiva 1

1
Giorgio Piacentini
Pediatric Department University of Verona Italy
2
(No Transcript)
3
Patterns of Allergic Reactivity and Disease in
Olympic Athletes
Katelaris Clin J Sport Med 200616401
A survey case series of Australian Olympic and
Paralympic athletes.
Presence of Asthma and Sporting Category
Indoor vs outdoor
1.5 plt0.01
977 athletes (725 Olympic, 252 Paralympic) from
34 different sports
Aquatic vs nonaquatic
1.5 plt0.007
Endurance vs others
A questionnaire seeking information on the
presence of allergic disorders, symptoms, family
history, and medication use was administered.
Skin-prick tests (SPT) for sensitivity to
common aeroallergens was performed.
1.4 plt0.03
Swimmers vs nonswimmers
2.5 plt0.001
0 1 2 3
O.R.
4
Patterns of Allergic Reactivity and Disease in
Olympic Athletes
Katelaris Clin J Sport Med 200616401
A survey case series of Australian Olympic and
Paralympic athletes.
Presence of Asthma and Sporting Category
Indoor vs outdoor
1.5 plt0.01
977 athletes (725 Olympic, 252 Paralympic) from
34 different sports
Aquatic vs nonaquatic
1.5 plt0.007
Swimmers were more likely to be atopic and to
have allergic symptoms than
other sporting groups
Endurance vs others
A questionnaire seeking information on the
presence of allergic disorders, symptoms, family
history, and medication use was administered.
Skin-prick tests (SPT) for sensitivity to
common aeroallergens was performed.
1.4 plt0.03
Swimmers vs nonswimmers
2.5 plt0.001
0 1 2 3
O.R.
5
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6
"Coughing water" bronchial hyperreactivity
induced by swimming in a chlorinated pool.
Mustchin Thorax. 197934682
Indoor swimming pools, water chlorination and
respiratory health
NemeryEur Respir J 2002 19790
chlorination may affect the respiratory health
of either those who work as swimming attendants
or instructors, or those who use the pools as
customers, particularly children and the general
public, but also competitive swimmers.
7
Increased sensitization to aeroallergens in
competitive swimmers.
Szwick Lung. 1990168111
14 competitive swimmers 14 matched control
subjects

11
11
9
clinically manifest allergies, subclinical
sensitization to aeroallergens, BHR to Mch.
5
4
3
Sensitization to aeroallergens
Conjunctival or respiratory symptoms
BHR to Mch
8
Increased sensitization to aeroallergens in
competitive swimmers.
Szwick Lung. 1990168111
14 competitive swimmers 14 matched control
subjects

11
11
9
clinically manifest allergies, subclinical
sensitization to aeroallergens, BHR to Mch.
This higher incidence of allergic diseases and
subclinical sensitization to
aeroallergens and bronchial hyperresponsiveness
in competitive swimmers compared with
control subjects could be
due to repeated exposure to chlorine
in swimming
pools
5
4
3
Sensitization to aeroallergens
Conjunctival or respiratory symptoms
BHR to Mch
9
Exposure to trichloramine and respiratory
symptoms in indoor swimming pool workers
Jacobs Eur Respir J 2007 29 690698
624 pool workers 38 swimming facilities
Method for water disinfection

100 80 60 40 20 0
Chloramine levels were measured by area sampling
over 2-h periods and analysed using ion
chromatography
76
Work-related and general respiratory symptoms,
and symptoms indicative of atopy and BHRwere
considered. Respiratory symptom prevalence
among pool workers was compared with symptoms in
a Dutch population sample
lt3
11
5
NaClO
NaClO
Combined
O3 NaClO
by salt electrolysis
10
Exposure to trichloramine and respiratory
symptoms in indoor swimming pool workers
Jacobs Eur Respir J 2007 29 690698
624 pool workers 38 swimming facilities
Sinusitis Chronic cold Sore
throat Blocked nose Cough Phlegm
2.4
3.4
Chloramine levels were measured by area sampling
over 2-h periods and analysed using ion
chromatography
Swimming instructors
2.4
2.0
Work-related and general respiratory symptoms,
and symptoms indicative of atopy and BHRwere
considered. Respiratory symptom prevalence
among pool workers was compared with symptoms in
a Dutch population sample
2.4
2.6
0 1 2 3 4
11
Exposure to trichloramine and respiratory
symptoms in indoor swimming pool workers
Jacobs Eur Respir J 2007 29 690698
624 pool workers 38 swimming facilities
Sinusitis Chronic cold Sore
throat Blocked nose Cough Phlegm
2.4
0.7
3.4
Chloramine levels were measured by area sampling
over 2-h periods and analysed using ion
chromatography
1.2
pool attendants
2.4
2.0
2.0
Work-related and general respiratory symptoms,
and symptoms indicative of atopy and BHRwere
considered. Respiratory symptom prevalence
among pool workers was compared with symptoms in
a Dutch population sample
1.4
Swimming instructors
2.4
2.3
2.6
2.0
0 1 2 3 4
12
Exposure to trichloramine and respiratory
symptoms in indoor swimming pool workers
Jacobs Eur Respir J 2007 29 690698
624 pool workers 38 swimming facilities
Sinusitis Chronic cold Sore
throat Blocked nose Cough Phlegm
2.4
combined the jobs of pool attendant and
instructor
0.7
3.4
1.2
Chloramine levels were measured by area sampling
over 2-h periods and analysed using ion
chromatography
3.5
2.4
2.0
pool attendants
3.2
2.0
1.4
Work-related and general respiratory symptoms,
and symptoms indicative of atopy and BHRwere
considered. Respiratory symptom prevalence
among pool workers was compared with symptoms in
a Dutch population sample
3.7
2.4
2.3
3.0
Swimming instructors
2.6
2.0
1.9
0 1 2 3 4
13
Exposure to trichloramine and respiratory
symptoms in indoor swimming pool workers
Jacobs Eur Respir J 2007 29 690698
624 pool workers 38 swimming facilities
Sinusitis Chronic cold Sore
throat Blocked nose Cough Phlegm
2.4
combined the jobs of pool attendant and
instructor
0.7
3.4
1.2
Chloramine levels were measured by area sampling
over 2-h periods and analysed using ion
chromatography
3.5
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.
2.4
2.0
pool attendants
3.2
2.0
1.4
Work-related and general respiratory symptoms,
and symptoms indicative of atopy and BHRwere
considered. Respiratory symptom prevalence
among pool workers was compared with symptoms in
a Dutch population sample
3.7
2.4
2.3
3.0
Swimming instructors
2.6
2.0
1.9
0 1 2 3 4
14
(No Transcript)
15
Ecological association between childhood asthma
andavailability of indoor chlorinated swimming
pools in Europe
Nickmilder Occup Environ Med 20076437
Relationships between the prevalences of
wheezing as reported by the International Study
of Asthma and Allergies in Childhood (ISAAC)
and the number of indoor chlorinated swimming
pools per inhabitant in the studied centres
Prevalence of ever asthma ()
Number of indoor chlorinated swimming pools per
100 000 inhabitants
16
Ecological association between childhood asthma
andavailability of indoor chlorinated swimming
pools in Europe
Nickmilder Occup Environ Med 20076437
Relationships between the prevalences of
wheezing as reported by the International Study
of Asthma and Allergies in Childhood (ISAAC)
and the number of indoor chlorinated swimming
pools per inhabitant in the studied centres
Prevalence of ever asthma ()
Number of indoor chlorinated swimming pools per
100 000 inhabitants
17
Ecological association between childhood asthma
andavailability of indoor chlorinated swimming
pools in Europe
Nickmilder Occup Environ Med 20076437
Relationships between the prevalences of
wheezing as reported by the International Study
of Asthma and Allergies in Childhood (ISAAC)
and the number of indoor chlorinated swimming
pools per inhabitant in the studied centres
Prevalence of ever asthma ()
Number of indoor chlorinated swimming pools per
100 000 inhabitants
18
Ecological association between childhood asthma
andavailability of indoor chlorinated swimming
pools in Europe
Nickmilder Occup Environ Med 20076437
Relationships between the prevalences of
wheezing as reported by the International Study
of Asthma and Allergies in Childhood (ISAAC)
and the number of indoor chlorinated swimming
pools per inhabitant in the studied centres
The difference in pool Ventilation according to
the climate might explain why the relationships
between asthma and pool availability appear
steeper in Northern Europe compared to Southern
Europe.
Prevalence of ever asthma ()
Number of indoor chlorinated swimming pools per
100 000 inhabitants
19
Ecological association between childhood asthma
andavailability of indoor chlorinated swimming
pools in Europe
Nickmilder Occup Environ Med 20076437
The prevalences of childhood asthma and the
number of indoor chlorinated swimming pools in
Europe are linked.
Relationships between the prevalences of
wheezing as reported by the International Study
of Asthma and Allergies in Childhood (ISAAC)
and the number of indoor chlorinated swimming
pools per inhabitant in the studied centres
Pool chlorine hypothesis the rise of
childhood asthma could result, at least partly,
from the increasing exposure of young children
to chlorination products in the air and water of
indoor swimming pools
Prevalence of ever asthma ()
Attendance at chlorinated swimming pools should
be included among possible risk factors of
childhood asthma and allergy
A need to evaluate the long term respiratory
effects of chlorination products that children
inhale in swimming pools
A need to regulate the concentrations of this
irritant and to ensure that indoor swimming pools
are properly ventilated
Number of indoor chlorinated swimming pools per
100 000 inhabitants
20
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
21
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
22
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
dose-dependent Increases in RRS that were
comparable in all treatment groups At low doses
of MCh, but at high doses (80 and 160 g/kg)
the responses were significantly higher after 400
and 800 ppm
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
23
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
dose-dependent Increases in RRS that were
comparable in all treatment groups At low doses
of MCh, but at high doses (80 and 160 g/kg)
the responses were significantly higher after 400
and 800 ppm
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
24
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
25
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
There was a significant increase in
responsiveness both for RRS and ERS
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
26
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
There was evidence in two independent experiments
of an increase in iNOS expression after
Chlorine exposure, but there was no clear dose
dependence of expression
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
27
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
There was a small amount of bronchial epithelial
staining with an anti3-NT antibody revealed by
Fast Red in mice exposed to 100 ppm chlorine
for 5 minutes
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
28
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
and substantially more in mice exposed to 800
ppm chlorine
induction of airway inflammation and AHR by
oxidative damage
?
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
29
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
and substantially more in mice exposed to 800
ppm chlorine
induction of airway inflammation and AHR by
oxidative damage
?
The staining was largely confined to the apical
border of the epithelial cell
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
30
Chlorine-induced Injury to the Airways in Mice
Martin AJRCCM 2003 168568574
Exposure to Cl2 gas occupational asthma
induction of airway inflammation and AHR by
oxidative damage
?
Chlorine exposure causes functional
and pathological changes in the
airways associated with oxidative
stress. Inducible nitric oxide synthase is
involved in the induction of changes in
responsiveness to
methacholine
The staining was largely confined to the apical
border of the epithelial cell
24 hours after a 5-minute exposure to
100 200 400 800
MCH assessed
ppm Cl2
2 and 7 days after 400 ppm Cl2
31
Schematic representation of asthma
pathophysiology
Holgate Trends in immunology 2007, 28 248
32
Changes in serum pneumoproteins caused by
shortterm exposures to nitrogen trichloride in
indoor chlorinated swimming pools
Carbonnelle Biomarkers 2002 7464
Effects of NCl3 on the pulmonary epithelium of
pool attendees by measuring the leakage into
serum of three pneumoproteins the alveolar
surfactant associated proteins A and B (SP-A and
SP-B) the bronchiolar 16 kDa Clara
cell protein (CC16).
29 recreational swimmers (16 children and 13
adults) before and after attending a
chlorinated pool
33
Changes in serum pneumoproteins caused by
shortterm exposures to nitrogen trichloride in
indoor chlorinated swimming pools
Carbonnelle Biomarkers 2002 7464
Effects of NCl3 on the pulmonary epithelium of
pool attendees by measuring the leakage into
serum of three pneumoproteins the alveolar
surfactant associated proteins A and B (SP-A and
SP-B) the bronchiolar 16 kDa Clara
cell protein (CC16).
Short-term exposure to NCl3 in the air of
indoor chlorinated pools can produce
permeability changes
of the deep lung that are undetected
by classical lung function tests.
29 recreational swimmers (16 children and 13
adults) before and after attending a
chlorinated pool
34
Respiratory health and baby swimming
Bernard Arch Dis Child 200691620
Possible effects of exposing babies to the
volatile chlorination products of indoor
pools that have been found to affect the lung
epithelium and to increase asthma risk
?
p0.01

10.4
a loss of the Clara cells lining the terminal
airways
8
p0.006
60.5
341 schoolchildren aged 1013 years
p0.025
23.3
36.9
Swimming baby (n43)
11.1
Other children (n298)
Asthma ()
Recurrent Bronchitis ()
Serum CC16
(mg/l)
35
Infant Swimming Practice, Pulmonary Epithelium
Integrity, and the Risk of Allergic and
Respiratory Diseases Later in Childhood
Bernard Pediatrics 2007 1191095
?
impact of infant swimming practice on allergic
status and respiratory health later in childhood

ns
31.9
341 schoolchildren aged 1013 years
30.2
ns
ns
19.1
14
14
Swimming baby (n43)
8.7
Other children (n298)
Allergy to HDM ()
FeNO (ppb)
Allergy to aeroall. ()
36
Infant Swimming Practice, Pulmonary Epithelium
Integrity, and the Risk of Allergic and
Respiratory Diseases Later in Childhood
Bernard Pediatrics 2007 1191095
?
P0.006
impact of infant swimming practice on allergic
status and respiratory health later in childhood

60.5
36.9
341 schoolchildren aged 1013 years
p0.03
ns
plt0.05
Swimming baby (n43)
14
10.2
9.3
8.9
Other children (n298)
4.4
3.7
Recurrent Bronchitis ()
Chest tightness ()
EIB ()
Wheezing ()
37
Infant Swimming Practice, Pulmonary Epithelium
Integrity, and the Risk of Allergic and
Respiratory Diseases Later in Childhood
Bernard Pediatrics 2007 1191095
?
impact of infant swimming practice on allergic
status and respiratory health later in childhood
asthma and recurrent bronchitis alone had no
influence on the serum levels of
pneumoproteins. Highly significant decrease of
serum CC16 associated with infant swimming
activity (P .001). The levels of serum CC16
were the lowest inthe infant swimming group who
were asthmatic or with recurrent bronchitis.
341 schoolchildren aged 1013 years
Swimming baby (n43)
Other children (n298)
38
Infant Swimming Practice, Pulmonary Epithelium
Integrity, and the Risk of Allergic and
Respiratory Diseases Later in Childhood
Bernard Pediatrics 2007 1191095
?
impact of infant swimming practice on allergic
status and respiratory health later in childhood
Swimming baby practice in chlorinated indoor
pools can be associated with distal airways
alterations predisposing children to the
development of asthma and
recurrent bronchitis
Caution before regularly taking babies to poorly
ventilated indoor pools where there is a
strong chlorine smell
Swimming baby (n43)
Other children (n298)
39
INFANT SWIMMING MAY RISK FUTURE RESPIRATORY
HEALTH The American Academy of Pediatrics
(AAP) has long recommended against infant
swimming lessons due to the false sense of safety
that this practice gives regarding the risk of
drowning. Now a new study may add another
reason to avoid infant swim lessons. Infant
Swimming Practice, Pulmonary Epithelium
Integrity, and Risk of Allergic and Respiratory
Diseases Later in Childhood, examined the role
indoor chlorinated pools play in the development
of asthma and reduced lung function. The study,
conducted in Belgium, found that trichloramine
a chlorine byproduct that gives indoor pools
their distinctive chlorine smell is one of
the most concentrated air pollutants to which
children of developed countries are regularly
exposed. The study asserts that this pollutant
along with other aerosolized chlorine-based
oxidants can be associated with airway changes
that predispose children to asthma and recurrent
bronchitis later in childhood. They encourage
more study and possible regulation of the air
quality in the indoor pool environment
                                                                                                                  
40
Criticism of Infant Swimming Practice Is
Political, Not Scientific
Reich Pediatrics 2007120926
Bernard et al did not state that infant swimming
causes asthma but, rather, that infant swimming
in indoor pools, along with other factors, is
associated with airway changes that may
predispose children to asthma. The conclusion
was qualified because the study was too small to
draw a conclusion. Certainly, there was no
increase in hospitalizations, emergency
department visits, or mortality.
There is a definitive need to assess the effects
of chlorination products on the respiratory tract
of very young children
41
Swimming pool attendance and exhaled nitric
oxide in children
Carraro JACI 2006118958
Which kind of airway inflammation?
100 hundred children regularly attending a
swimming pool for at least 6 months and for at
least 1 hour a week 141 not regularly
attending a swimming pool
42
Swimming pool attendance and exhaled nitric
oxide in children
Carraro JACI 2006118958
Which kind of airway inflammation?
100 hundred children regularly attending a
swimming pool for at least 6 months and for at
least 1 hour a week 141 not regularly
attending a swimming pool
FENO level, an exhaled biomarker of eosinophilic
airway inflammation, is similar in children who
regularly attend a swimming pool and in those
who do not.
43
Swimming pool attendance and exhaled nitric
oxide in children
Carraro JACI 2006118958
Which kind of airway inflammation?
100 hundred children regularly attending a
swimming pool for at least 6 months and for at
least 1 hour a week 141 not regularly
attending a swimming pool
Children regularly attending indoor swimming
pools for 1 to 2 hours a week
do not have increased FENO levels,
suggesting that intermittent exposure to
chlorine derivatives does
not induce eosinophilic airway
inflammation.
Further studies might be useful to evaluate
whether such exposure can induce
any other inflammatory responses
in the airways of recreational
swimmers
44
Airway inflammation in elite swimmers
Piacentini JACI 20071191559
Which kind of airway inflammation?
p0.033
5 elite athletes of the Italian National Swimming
Team

41.9
5 age-matched subjects not performing swimming
regularly
n.s.
15
12
FeNO EBC for LTB4 assay
5.5
FeNO (ppb)
LTB4 (pg/ml)
45
Longitudinal Monitoring of Lung Injury in
Children after Acute Chlorine Exposure in a
Swimming Pool
Airway inflammation in elite swimmers
Bonetto AJRCCM 2006 174545
Piacentini JACI 20071191559
Significantly higher serum CC16
p0.033
5 elite athletes of the Italian National Swimming
Team

41.9
5 age-matched subjects not performing swimming
regularly
15
12
FeNO EBC for LTB4 assay
5.5
FeNO (ppb)
LTB4 (pg/ml)
46
Longitudinal Monitoring of Lung Injury in
Children after Acute Chlorine Exposure in a
Swimming Pool
Airway inflammation in elite swimmers
Bonetto AJRCCM 2006 174545
Piacentini JACI 20071191559
Epithelial Lung Injury?
p0.033
5 elite athletes of the Italian National Swimming
Team

41.9
5 age-matched subjects not performing swimming
regularly
15
12
FeNO EBC for LTB4 assay
5.5
FeNO (ppb)
LTB4 (pg/ml)
47
Longitudinal Monitoring of Lung Injury in
Children after Acute Chlorine Exposure in a
Swimming Pool
Airway inflammation in elite swimmers
Bonetto AJRCCM 2006 174545
Piacentini JACI 20071191559
p0.033
5 elite athletes of the Italian National Swimming
Team

41.9
5 age-matched subjects not performing swimming
regularly
15
12
FeNO EBC for LTB4 assay
5.5
FeNO (ppb)
LTB4 (pg/ml)
48
Airway inflammation in elite swimmers
Longitudinal Monitoring of Lung Injury in
Children after Acute Chlorine Exposure in a
Swimming Pool
Piacentini JACI 20071191559
Bonetto AJRCCM 2006 174545
Substantial lung function impairment associated
with biochemical exhaled breath alterations,
represented mainly by an increase in LTB4 and a
reduction in FeNO. Although lung function and
exhaled NO improved within a few weeks, the
increased levels of exhaled LTB4 persisted for
several months, suggesting persistent
neutrophilic inflammation despite the lack of
respiratory symptoms and the normalization of
routine lung function test findings.
p0.033
5 elite athletes of the Italian National Swimming
Team

41.9
5 age-matched subjects not performing swimming
regularly
15
12
FeNO EBC for LTB4 assay
5.5
FeNO (ppb)
LTB4 (pg/ml)
49
Airway inflammation in elite swimmers
Piacentini JACI 20071191559
p0.033
5 elite athletes of the Italian National Swimming
Team

41.9
5 age-matched subjects not performing swimming
regularly
A potential role of chronic exposure
to a chlorine-rich atmosphere can favour the
development of airway neutrophilic inflammation
in elite swimmers.
15
12
FeNO EBC for LTB4 assay
5.5
FeNO (ppb)
LTB4 (pg/ml)
50
Health risks of early swimming pool attendance
Schoefer Int J Hyg Environ Health in press
Doctor diagnosed after the 1st year of life up to
age 6

Relationship between early swimming pool
attendance, especially baby swimming, and early
infections and allergic diseases
Asthma () Rhinitis ()
?
7.3
5.8
4.7
4.6
4.1
2192 children 6-year follow-up prospective
birth cohort study
14
2.6
2.1
Later or never
Between ages 1 and 3
1st year occasionally
1st year baby swimming
Age of first pool attendance
51
Health risks of early swimming pool attendance
Schoefer Int J Hyg Environ Health in press
Doctor diagnosed after the 1st year of life up to
age 6

Relationship between early swimming pool
attendance, especially baby swimming, and early
infections and allergic diseases
Asthma () Rhinitis ()
?
7.3
5.8
In terms of developing atopic diseases there is
no verifiable detrimental effect of early
swimming.
4.7
4.6
4.1
2192 children 6-year follow-up prospective
birth cohort study
14
2.6
2.1
Later or never
Between ages 1 and 3
1st year occasionally
1st year baby swimming
Age of first pool attendance
52
Health risks of early swimming pool attendance
Schoefer Int J Hyg Environ Health in press
Doctor diagnosed after the 1st year of life up to
age 6

Relationship between early swimming pool
attendance, especially baby swimming, and early
infections and allergic diseases
Asthma () Rhinitis ()
?
7.3
One important difference between Belgium
and Germany is the difference of maximum
recommended levels for
combined chlorine. In Belgium the maximum
of 2 ppm, the level is 10 times higher
than German standards, where limits of water
concentrations of 0.30.6 mg/l for free
chlorine, 0.2 mg/l for bound chlorine have to
be maintained
5.8
4.7
4.6
4.1
2192 children 6-year follow-up prospective
birth cohort study
14
2.6
2.1
Later or never
Between ages 1 and 3
1st year occasionally
1st year baby swimming
Age of first pool attendance
53
Swimming and Persons with Mild Persistant Asthma
ArandelovicTheScientificWorldJournal 2007
11821188
effect of recreational swimming on lung function
and bronchial hyperresponsiveness (BHR) in
patients with mild persistent asthma
FEV1 (L/min)
?
4.0 3.8 3.6 3.4 3.2 0
plt0.01
65 mild persistent asthmatics group A (n
45) swimming (twice a week on a 1-h
basis for the following 6 months)
group B (n 20) control
3.65
3.55
plt0.05
3.33
3.29
T0 T1
T0 T1
54
Swimming and Persons with Mild Persistant Asthma
ArandelovicTheScientificWorldJournal 2007
11821188
effect of recreational swimming on lung function
and bronchial hyperresponsiveness (BHR) in
patients with mild persistent asthma
FEV1 (L/min)
?
4.0 3.8 3.6 3.4 3.2 0
plt0.001
65 mild persistent asthmatics group A (n
45) swimming (twice a week on a 1-h
basis for the following 6 months)
group B (n 20) control
3.65
3.55
3.33
3.29
T0 T1
T0 T1
55
Swimming and Persons with Mild Persistant Asthma
ArandelovicTheScientificWorldJournal 2007
11821188
effect of recreational swimming on lung function
and bronchial hyperresponsiveness (BHR) in
patients with mild persistent asthma
Hist. PD20
?
3.0 2.5 2.0 1.5 1.0 0
p lt 0.001
65 mild persistent asthmatics group A (n
45) swimming (twice a week on a 1-h
basis for the following 6 months)
group B (n 20) control
2.01
p lt 0.05
1.75
0.61
0.58
T0 T1
T0 T1
56
Swimming and Persons with Mild Persistant Asthma
ArandelovicTheScientificWorldJournal 2007
11821188
effect of recreational swimming on lung function
and bronchial hyperresponsiveness (BHR) in
patients with mild persistent asthma
Hist. PD20
?
3.0 2.5 2.0 1.5 1.0 0
plt0.001
65 mild persistent asthmatics group A (n
45) swimming (twice a week on a 1-h
basis for the following 6 months)
group B (n 20) control
2.01
1.75
0.61
0.58
T0 T1
T0 T1
57
Swimming and Persons with Mild Persistant Asthma
ArandelovicTheScientificWorldJournal 2007
11821188
effect of recreational swimming on lung function
and bronchial hyperresponsiveness (BHR) in
patients with mild persistent asthma
Hist. PD20
?
3.0 2.5 2.0 1.5 1.0 0
Engagement of patients with mild,
persistent asthma in recreational swimming
in nonchlorinated pools, combined with regular
medical treatment and education, leads to
better improvement of their parameters of
lung function and also to a more
significant decrease of their BHR compared to
patients treated with traditional medicine
plt0.001
65 mild persistent asthmatics group A (n
45) swimming (twice a week on a 1-h
basis for the following 6 months)
group B (n 20) control
2.01
1.75
0.61
0.58
58
Giorgio Piacentini
Pediatric Department University of Verona Italy
59
Giorgio Piacentini
Pediatric Department University of Verona Italy