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Are Swimming Pools Safe for Children with Asthma?

In this prospective birth cohort study, swimming did not increase risk for asthma or atopy.

Swimming has been recommended for patients with asthma because the warm humidified air might lessen exercise-induced bronchoconstriction, but several studies suggest that exposure to chlorine byproducts (especially trichloramine) might actually be asthmogenic. Researchers followed 5738 children in the U.K. from birth to age 10 years and prospectively collected data by questionnaire on swimming and respiratory status. Lung function, bronchial hyperresponsiveness, and skin tests were measured at age 7 to 8 years.

After adjustment for confounding variables, swimming frequency did not increase the prevalence of asthma, eczema, atopy, or rhinoconjunctivitis symptoms. On the contrary, swimming was associated with increased lung function and decreased prevalence of current asthma symptoms at age 10 years in children with previous wheezing. Swimming had a protective effect in children who wheezed before age 3.5 years.

Comment: In an accompanying pro/con exchange, editorialists debate these findings in light of studies showing increased rates of atopy and allergic disease in recreational swimmers, higher rates of occupational asthma in indoor swimming-pool workers, and increased bronchial hyperresponsiveness and asthmalike symptoms in competitive swimmers. The study results are reassuring for recreational swimmers. I believe that we should encourage all patients with asthma to exercise regularly but still caution them that prolonged exposure to chlorine products (e.g., in elite swimmers) could cause lung injury.

— David J. Amrol, MD

David J. Amrol, MD, is an Associate Professor of Clinical Internal Medicine and Director of the Division of Allergy and Immunology at the University of South Carolina School of Medicine in Columbia.

Published in Journal Watch Pediatrics and Adolescent Medicine March 23, 2011

Citation(s):

Font-Ribera L et al. Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort. Am J Respir Crit Care Med 2011 Mar 1; 183:582.

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Piacentini GL and Baraldi E. Pro: Swimming in chlorinated pools and risk of asthma: We can now carry on sending our children to swimming pools! Am J Respir Crit Care Med 2011 Mar 1; 183:569.

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• Medline abstract (Free)

Bernard A et al. Con: Respiratory risks associated with chlorinated swimming pools: A complex pattern of exposure and effects. Am J Respir Crit Care Med 2011 Mar 1; 183:570.

• Original article (Subscription may be required)
• Medline abstract (Free)

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• Are Swimming Pools Safe for Children with Asthma?
  Antonio Carlos Fonseca Silveira, CREI-PMSV, 28 Mar 2011 2:16 PM EST
  Specialty: Pediatric Emergency Med
  Indeed, pediatricians should encourage our young patients to take up sport. As mentioned in the article, swimming is undoubtedly the... [more]

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