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Weisel, C. P., Richardson, S. D., Nemery, B., Aggazzotti, G., Baraldi, E., Blatchley Iii, E. R., Blount, B. C., Carlsen, K. H., Eggleston, P. A., Frimmel, F. H., Goodman, M., Gordon, G., Grinshpun, S. A., Heederik, D., Kogevinas, M., LaKind, J. S., Nieuwenhuijsen, M. J., Piper, F. C., Sattar, S. A

Childhood asthma and environmental exposures at swimming pools: State of the science and research recommendations

Environ Health Perspect, 2009, 117, 4, 500, 507, IF: 6.123,

OBJECTIVES: Recent studies have explored the potential for swimming pool disinfection byproducts (DBPs), which are respiratory irritants, to cause asthma in young children. We describe the state of the science on methods for understanding of children's exposure to DBPs and biologics at swimming pools and association 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 to 23 August 2007, to evaluate the literature and to develop a research agenda to a better understand children's exposures in the swimming pool environment and their potential association with new onset asthma. Participants, which included clinicians, epidemiologists, exposure scientists, pool operations experts, and analytical 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 epidemiological 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, particulary in exposure assessment and characterization of asthma in the very young. It was recommended that additional evaluations using a multi-disciplinary approach are needed to determine if a clear association exists.


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