Chlorine Toxicity: What Is Known

1. Exercising competitive swimmers absorb toxic levels of chlorine products in the course of a training session.
2. Training two or more times a day will not allow the toxins to be completely cleared from the body in most swimmers.
3. Children inhale more air per unit of body weight than adults.
4. Young children absorb relatively greater amounts of toxins than older swimmers and therefore, are at greater risk.
5. In hyper-chlorinated pools, even dental enamel can be eroded because of the increased acidity in swimmers in training.
6. Exercise intensity and number of sessions increase the toxic concentrations in competitive swimmers.
7. Greater toxin absorption occurs through the skin than through breathing. However, the breathing action alone is sufficient to cause hypersensitivity and "asthma-like" respiratory conditions in at least some swimmers.
8. Over chlorination is particularly hazardous to the health of swimmers.

Chlorine in tap water 'nearly doubles the risk of birth defects'

Pregnant women living in areas where tap water is heavily disinfected with chlorine nearly double their risk of having children with heart problems, a cleft palate or major brain defects, a new study has found.
Scientists say expectant mothers can expose themselves to the higher risk by drinking the water, taking a bath or shower, or even by standing close to a boiling kettle.
The danger comes from chemical by-products in chlorinated water known as trihalomethanes, or THMs, which can be absorbed through the skin. They can then pass into the womb.At risk: Scientists have now linked chlorinated water to specific birth defects
THMs form because of a chemical reaction between chlorine and natural substances in the water.
They exist in mains water across Britain – but are highest in areas where more chlorine is added because the water quality is poor.
Earlier studies linked chlorinated water to an increased risk of stillbirth, miscarriage, birth defects and bladder cancer. But this is the first time that the risk has been narrowed down to specific birth defects.
Although a major study in 2007 by Imperial College, London, into birth defects and THM levels in Britain uncovered ‘little evidence’ of a link, the new research appears to contradict its findings.
A research team led by Professor Jouni Jaakkola of the University of Birmingham analysed the birth registry details of nearly 400,000 babies born in Taiwan between 2001 and 2003. Levels of chlorine found in water there are similar to those found in the UK.
Scientists compared the number of birth defects recorded by doctors to the level of THMs in the drinking water in different areas.
The proportions of certain specific defects were much higher in areas where levels of THMs were above 20 micrograms per litre.
The brain condition anencephalus, usually found in 0.01 per cent of births, rose to 0.17 per cent in high-THM areas.
Hole-in-the-heart defects also nearly doubled from 0.015 per cent to 0.024 per cent.
The number of cleft palates rose from 0.029 per cent to 0.045 per cent in high-THM areas.
Overall, the risks of having children with these three defects increased by between 50 per cent and 100 per cent.
There was also a slightly raised risk of urinary tract defects and Down’s syndrome.
The study appears in Environmental Health journal next week.
The number of defects could be much higher as some are not detected until later in childhood.
THM levels across Britain vary widely even within one water company area. They range from 92 micrograms per litre in south Staffordshire to just five in Hartlepool.
Most areas have levels way above the ‘high’ range in the Taiwan study. High levels were recorded in South-West England, Yorkshire and North-East Essex.
Prof Jaakkola said THMs should be cut because the biological reasons for the defects were unknown.
He said: ‘Our findings don’t just add to the evidence that water chlorination may cause birth defects but suggest that exposure to chlorination by-products may be responsible for some specific and common defects.’
Barrie Clarke, spokesman for Water UK, reassured consumers that water companies’ work was in line with the best existing information on THMs.
But he added: ‘There will be no closed minds about this new information.’

The above extract is from the following link: http://www.dailymail.co.uk/health/article-1023340/Chlorine-tap-water-nearly-doubles-risk-birth-defects.html

Chlorine pools and child asthma - even open-air pools seem to increase the risk finds a Belgian study

Article Date: 18 Sep 2008 - 15:00 PDT

Warnings about adverse effects of chlorinated swimming pools, particularly where they affect children's airways, are becoming increasingly prominent in the scientific literature. The harmful impact of air breathed in close to the chlorinated water could even be one cause of the upsurge in child asthma recorded in the industrialised countries.
The 17th Congress of the European Respiratory Society (ERS), where this issue was the subject of several communications, has just added a new element to the discussions: children who use chlorinated open-air swimming pools have an increased risk of developing asthma.

Asthma is known to be one of the commonest chronic conditions, affecting over 300 million people worldwide, particularly those who are prone to allergies.
It has multiple causes, but it appears increasingly that chlorinated swimming pools are a factor linked with an increased risk of asthma onset.
Swimming instructors and poolside staff are in the front line, as reported recently in the European Respiratory Journal (ERJ) by a Netherlands team, but children and adolescents are also directly threatened.

Asthma rates doubled

This is illustrated by young competitive swimmers, as seen in the study presented to the Congress by Vito Brusasco, Giovanni Rossi and their teams, of the University of Genoa and Gaslini Hospital in Italy. The authors studied thirty adolescents, with an average age of 14, who had not previously been diagnosed with asthma. They measured their level of sensitisation to typical airborne allergens and their degree of bronchial hyperreactivity; these two elements are generally considered predictors of asthma onset.

The results presented to the ERS Congress clearly demonstrate a risk to the young swimmers in regular training for competitions. The Italian team found that 73% of them were sensitised to airborne allergens, a level almost double that of the general population, and over half of them (17 subjects) suffered from bronchial hyperreactivity.

"We believe that repeated exposure to high concentrations of chlorine in the ten centimetres of air above the water's surface is damaging to the airways", the authors told the Congress. "It could favour allergen sensitisation and contribute to the development of bronchial hyperreactivity as well as the onset of asthma symptoms in children."

Open-air swimming pools now also suspected

It was a Belgian team that brought really astounding news to the Congress.
The received wisdom was that harmful levels of airborne chlorine were only found in covered swimming pools: it seemed logical that the enclosed air would be rich in lung-irritating gases, especially chloramines, produced by the chemical reaction between chlorine and various organic substances, including sweat, urine and saliva. Yet an original study presented to the ERS Congress by Marc Nickmilder, Alfred Bernard and Catherine Voisin, of the Catholic University of Louvain's Department of Toxicology, shows that this risk can also affect regular users of open-air pools.

The Louvain team examined 847 adolescents, aged 15 years on average, enrolled at three Belgian secondary schools. One school was chosen because the timetabled swimming lessons took place in a non-chlorinated pool, disinfected by means of a copper-silver ionisation system, which meant its pupils could be used as a control group.
The study was conducted on the basis of both questionnaires completed by parents and blood tests. The questionnaires elicited information on family antecedents for asthma or allergies, the adolescent's lifestyle and, above all, the number of hours spent in chlorinated and non-chlorinated, enclosed and open-air pools.
The blood tests sought to determine levels of immunoglobin E (IgE), an antibody associated with an increased risk of allergies and asthma.

Risk multiplied up to nine times

The conclusions revealed in Stockholm by Nickmilder leave little room for doubt. "Use of open-air swimming pools correlates strongly with atopy levels as measured by serum IgE concentration and considerably increases the asthma risk", the researcher explains.
The results presented to the Congress show that adolescents who, up to the time of the study, had spent a total of more than 500 hours in open-air swimming pools, had a risk of developing asthma three times higher than those who had never swum in a chlorinated pool.
"The relative risk is as much as nine times in subjects with high IgE, even where the parents have no asthmatic antecedents", Bernard emphasised at the Congress.

So this sounds an important warning, coming as it does at a time when young children are increasingly being taken to swimming pools. Following hard on the heels of a discovery by the same team that so-called "water-babies" had higher asthma rates than their peers at age ten, the latest revelations in Stockholm should lead to some serious reconsideration of the issues.
"We would recommend that open-air pools should not be too heavily chlorinated, especially if young children use them", the Belgian team told the Congress.

European Respiratory Society

The article above was extracted from the following link: http://www.medicalnewstoday.com/articles/82273.php

One in ten Australians are believed to have asthma, but at the past two Olympic Games between 16 and 20 per cent of the national swimming team have claimed to have it.

Swimming Australia this week confirmed around one third of the team have asthma.

The Age
November 23, 2007

The above "The Age" extract is from the following link: http://www.asthmaqld.org.au/content/?action=getfile&id=227

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NEWS Last Update: Thursday, May 29, 2003. 8:32am (AEST)
Study links chlorine to asthma epidemic

A new Belgian study is linking swimming pool chlorine to the asthma epidemic which is spreading in developed nations.
Researchers at Brussels' Catholic University of Louvain say when chlorinated water reacts with organic matter such as urine or sweat it creates trichloramine, a gassy, easily inhaled irritant.
Trichloramine is already known as a trigger for three proteins that destroy the cellular barrier protecting the lungs, making it more prone to an asthma attack.
The researchers have tested the blood of hundreds of young pool swimmers, finding higher than normal levels of the proteins.
The levels rose even when people merely sat beside the pool.
The scientists say the study suggests a move towards non-chlorine based disinfectants or improvements to water and air quality control in indoor pools.

BBC NEWS Thursday, 4 April, 2002, 00:02 GMT 01:02 UK
Fears over swimming pool chemicals

Chlorination is used to kill swimming pool bacteria

Scientists are calling for more research into levels of chemicals in swimming pools after it was found they were significantly higher than in tap water.
Earlier studies have suggested the chemicals could harm unborn children, and experts have moved to reassure pregnant women that swimming is safe

The study calls for chlorination levels to be reduced as a precaution.

Many antenatal classes involve regular swimming sessions, as this can provide much-needed exercise without overstressing the joints.

Chemicals such as chlorine are added to pools in higher concentrations than in tapwater in order to kill off potentially harmful bacteria.

A small snapshot survey tested water from eight pools in the London area, and published in the journal Occupational and Environmental Medicine.

It found, as expected, that levels of these by-products, called trihalomethanes, was much higher in pool water than in tap water.

Dust reaction

They are formed when chlorine comes into contact with "organic material" such as dust, sweat or skin.

Chloroform, the most common of these trihalomethanes - and classed as a potential cancer-causing agent - was measured at more than 20 times the level found in tapwater.

The medical benefits of swimming far outweigh any problems caused by chemicals

Ralph Riley, National Pool Water Treatment Advisory Group
Separate studies have also linked trihalomethanes to miscarriage and foetal malformations.

The researchers, from Imperial College of Science and Technology in London, said earlier studies suggested that uptake of such chemicals could be as much as 141 times greater in a one hour swim as in a 10 minute shower.

Swimmers could be absorbing the chemicals through the skin, inhaling them as they evaporated, or swallowing water.

However, the study did not make any direct link between swimming and health problems in either pregnant women or their unborn children.

Safety pledge

Nevertheless, other experts moved swiftly to reaffirm the safety of swimming.

Ralph Riley, the chairman of the National Pool Water Treatment Advisory Group, said that the chemicals were needed to protect swimmers from infections - and that techniques had been refined over past decades.

He said: "The medical benefits of swimming far outweigh any problems caused by chemicals.

"I don't think it's healthy at all, what these researchers are doing.

"Of course it's to be expected that the levels of these chemicals is higher in pool water than tap water.

It does highlight an area of potential risk to pregnant women and offers a simple solution

Belinda Phipps, National Childbirth Trust
"All the medical experts who have been looking at this say that these levels are safe."

Belinda Phipps, from the National Childbirth Trust, supported the call for reducing the chlorine content of swimming pool water.

"For a vast number of pregnant women in the UK, swimming and aqua exercise programmes are a very enjoyable and beneficial part of their pregnancy.

"As such it is critically important to stress that this paper does not attempt to link swimming in indoor pools to miscarriage or birth defects.

"It does, however, highlight an area of potential risk to pregnant women and offers a simple solution to limit chemical levels in swimming pool water by reducing the amount of chlorine used - a measure which the NCT would strongly support."

She added: "All too often in this kind of situation, it is the mother that is made to feel guilty and change her practices.

"The burden of responsibility here lies with appropriate regulatory bodies and not with pregnant women to restrict their habits and lifestyle because of preventable and unnecessary factors such as this."

BBC NEWS Tuesday, 30 April, 2002, 17:05 GMT 18:05 UK
Pool staff in asthma link

Changing the water and air in swimming pools more regularly could help

People working in indoor swimming pools could be at risk of developing asthma, researchers suggest.
A study by Birmingham doctors suggests chemicals called chloramines could cause occupational asthma.

The paper, published in the European Respiratory Journal (ERJ), suggests regular swimmers could also be at risk.

It concentrates on just three cases, but the researchers, from Birmingham's Heartlands Hospital, said it opened the door for other studies in the area.

There's nothing in this report to show that asthma has been caused by swimming pools

Ralph Riley, National Pool Water Treatment Advisory Group
Chloramines are produced when chlorine reacts with polluting proteins from swimmers that enter the water from swimmers' bodies from sweat and urine - they cause the characteristic smell of pools.

Chlorine-based chemicals are used to ensure the water is disinfected so infections cannot be passed between swimmers.

The researchers say the amount of chloramines present in the air depends on factors such as swimmers' personal hygiene and the how often the water is changed.

Although there are various kinds of the chemical, nitrogen trichloride is the most common, and the kind the researchers believe causes asthma in indoor swimming pools.

Asthma and work link

The team monitored two lifeguards and a swimming teacher who worked at different pools.

All three had worked in swimming pools for some years before developing asthmatic symptoms.

However, all had begun to suffer cough and wheezing symptoms at work which improved when they were on holiday.

The three were asked to measure their peak expiratory flow (PEF), the maximum volume of air that they were able to force out of their lungs in a second, every two hours for two weeks.

Tests were also carried out using nitrogen trichloride.

In two of the three cases, the researchers found a significant relation between the subjects' asthma and their work.

In the third case, the person was not able to carry out the PEF checks in full because they suffered from wheezing within half an hour of arriving at the pool and had to use an inhaler.

In all three, the nitrogen trichloride tests produced an immediate asthmatic reaction.

None had a reaction to chlorine itself.

Chlorine an 'irritant'

Dr Sherwood Burge, who led the researchers told BBC News Online: "If you have asthma, which is worse when you go swimming, it could be linked to the water in the pool."

He added: "This shows that air in swimming pools is a possible cause of asthma."

Dr Burge said further studies needed to be done, looking at people who worked in swimming pools.

The researchers say their findings should not result in "extreme measures" such as preventing children swimming.

But they suggest disinfectants used in pools should be more carefully chosen and that air and water should be replaced as often as possible.

Professor Benoit Nemery, of the Department of Occupational Medicine of Leuven Hospital, writing in the ERJ, said the Birmingham study was significant, despite its size: "It serves as evidence that asthma caused by indoor swimming pools could be an occupational disease and there is reason to believe that cases are more common than they might seem."

Ralph Riley, head of the National Pool Water Treatment Advisory Group said: "We have known for a long time that chloramines can trigger, rather than cause asthma. There's nothing in this report to show that asthma has been caused by swimming pools."

He said water was constantly being cleaned, and that air was also changed four to six times per hour.

Mr Riley added the industry was constantly looking at ways of reducing the levels of chloramines whilst retaining the protection against infection in the water.

A spokeswoman for the National Asthma Campaign said: "We know that chlorine is an irritant and can trigger asthma but there is not enough evidence to state conclusively that it can cause asthma.

"This is an interesting study but more research is needed to prove there is a possible causal relationship."

Chlorination Research

BLOOD AND BREATH ANALYSES AS BIOLOGICAL INDICATORS OF EXPOSURE TO TRIHALOMETHANES IN INDOOR SWIMMING POOLS Aggazzotti, G., Fantuzzi, G., Righi, E., & Predieri, G. (1998)
Science of the Total Environment, 217, 155-163.

CHLORINE PRODUCT ABSORPTION IN SWIMMERS IS GREATEST VIA THE SKIN Lindstrom, A.B., Pleil, J.D., & Berkoff, D.C. (1997).
Alveolar breath sampling and analysis to assess trihalomethane exposures during competitive swimming training.
Environmental Health Perspectives, 105(6), 636-642

EXERCISING INCREASES THE TOXICITY OF A "SAFE" CHLORINATED POOL ATMOSPHERE Drobnic, F., Freixa, A., Casan, P., Sanchis, J., & Guardino, X. (1996).
Assessment of chlorine exposure in swimmers during training. Medicine and Science in Sports and Exercise, 28(2), 271-274.

AMOUNT OF EXERCISE IS RELATED TO CHLORINE-RELATED CONCENTRATIONS IN THE BODY Cammann, K., & Hubner, K. (1995).
Trihalomethane concentrations in swimmers' and bath attendants' blood and urine after swimming or working in indoor swimming pools.
Archives of Environmental Health, 50(1), 61-65

YOUNG SWIMMERS AT GREATEST HEALTH RISK IN CHLORINATED INDOOR POOLS Aiking, H., van Acker, M.B., Scholten, R.J., Feenstra, J.F., & Valkenburg, H.A. (1994).
Swimming pool chlorination: a health hazard?
Toxicology Letters, 72(1-3), 375-380.

CHLORINATOR TABLETS POSE HEALTH RISKS Wood, B.R., Colombo, J.L., Benson, B.E. (1987).
Chlorine inhalation toxicity from vapours generated by swimming pool chlorinator tablets.
Paediatrics, 79(3), 427-430.

DENTAL ENAMEL EROSION INCREASED IN COMPETITIVE SWIMMERS IN CHLORINATED POOLS Centerwall, B.S., Armstrong, C.W., Funkhouser, L.S., & Elzay, R.P. (1986).
Erosion of dental enamel among competitive swimmers at a gas-chlorinated swimming pool.
American Journal of Epidemiology, 123(4), 641-647.

BRONCHOSPASM IN COMPETITIVE SWIMMERS Reuters Health, March 21, 2001.
A study presented [03/20/2001] in New Orleans at the 57th Annual Meeting of the American Academy of Allergy, Asthma and Immunology, strongly suggested that swimming pool environments adversely affect the lung function of competitive swimmers.

ADDITIONAL REFERENCES
1. Beech, J.A., Diaz, R., Ordaz, C., & Palomeque, B. (1980).
Nitrates, chlorates and trihalomethanes in swimming pool water.
American Journal of Public Health, 70(1), 79-82.

2. Mustchin, C.P., & Pickering, C.A. (1979).
"Coughing water": bronchial hyper-reactivity induced by swimming in a chlorinated pool.
Thorax, 34(5), 682-683.

3. Decker, W.J., & Koch, H.F. (1978).
Chlorine poisoning at the swimming pool: an overlooked hazard.
Clinical Toxicology, 13(3), 377-381.

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