TY - JOUR
T1 - Childhood asthma and environmental exposures at swimming pools
T2 - State of the science and research recommendations
AU - Weisel, Clifford P.
AU - Richardson, Susan D.
AU - Nemery, Benoit
AU - Aggazzotti, Gabriella
AU - Baraldi, Eugenio
AU - Blatchley, Ernest R.
AU - Blount, Benjamin C.
AU - Carlsen, Kai Håkon
AU - Eggleston, Peyton A.
AU - Frimmel, Fritz H.
AU - Goodman, Michael
AU - Gordon, Gilbert
AU - Grinshpun, Sergey A.
AU - Heederik, Dirk
AU - Kogevinas, Manolis
AU - LaKind, Judy S.
AU - Nieuwenhuijsen, Mark J.
AU - Piper, Fontaine C.
AU - Sattar, Syed A.
PY - 2009
Y1 - 2009
N2 - Objectives: Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children's exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue. Data sources: A workshop was held in Leuven, Belgium, 21-23 August 2007, to evaluate the literature and to develop a research agenda to better understand children's exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs. Synthesis: Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection. Conclusions: Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.
AB - Objectives: Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children's exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue. Data sources: A workshop was held in Leuven, Belgium, 21-23 August 2007, to evaluate the literature and to develop a research agenda to better understand children's exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs. Synthesis: Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection. Conclusions: Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.
KW - Aerosols
KW - Biologics
KW - Childhood asthma
KW - DBPs
KW - Disinfection by-products
KW - Epidemiology
KW - Study design
KW - Swimming pools
UR - http://www.scopus.com/inward/record.url?scp=64049101425&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=64049101425&partnerID=8YFLogxK
U2 - 10.1289/ehp.11513
DO - 10.1289/ehp.11513
M3 - Review article
C2 - 19440486
AN - SCOPUS:64049101425
SN - 0091-6765
VL - 117
SP - 500
EP - 507
JO - Environmental health perspectives
JF - Environmental health perspectives
IS - 4
ER -