Swimming Causes Asthma - Page 2

The evidence is compelling that swimming creates many more new cases than it "attracts" old cases.

Virtually all swim coaches would not argue with my own observation that relatively few kids join
swim teams and take inhalers to practice on the first day, but that, years down the road, many kids
have now acquired inhalers. And anecdotal observations (described previously) and now published
research show that asthma typically resolves or at least improves upon cessation of swimming in
chlorinated pools.

Pre-existing asthmatics (who had asthma prior to taking up swimming) have their airway disease
triggered by other (non-chlorine) allergens. These pre-existing asthmatics should not be discouraged
from swimming (quite the contrary) but, as with all new swimmers, should be encouraged to swim in a
safe environment.

But you miss the entire point of the editorial Dr. Rushall and I certainly do not condemn swimming
as an activity. In point of fact, we suggest substitution of the term "chlorine-associated asthma"
for "swimmer's asthma."

We are critical of the fact that USA Swimming (and similar organizations in other countries) which
has the responsibility for putting literally hundreds of thousands of swimmers at risk and, in the
process, creating literally tens of thousands of new, steroid-dependent childhood asthmatics, has
completely turned its back on the issue and, worse, denies the existence of this issue. It is time
for the competitive swimming establishment to squarely address this issue and support the rather
simple and inexpensive research efforts (basically surveys) which are required to define the
magnitude of the problem.

In addition to the acute morbidity of asthma are the potential long term consequences of the use of
inhaled steroids (often the only effective means of controlling asthma), which include osteoporosis
(for which swimmers are at greater risk, compared to land athletes), cataracts, and other potential
problems, such as diabetes.

We also point out ways in which safety may be improved. Flush deck pool designs promote better air
circulation than deep-walled and guttered pool designs. High volume, pool deck fans (e.g. as used in
the new competition pool in Commerce, CA) are an inexpensive way of improving dispersion of heavily-
chlorinated air. There are also alternatives to chlorination, as also discussed in our editorial.
Finally, in many cases, there may be a choice of swim teams to join; safety of the pool facility is
a factor which should enter into this decision.

- Larry

With regard to the suggestion of organizing a symposium, yes, of course, this is precisely the sort
of thing which does need to be done.

Given that I am (remember) only a swimming "hobbyist," with a day job, it's going to take the
efforts of someone else to do the work which would be required to organize this. We all do what we
can. The real pioneer in this, who will deserve the credit if/when this issue is ever addressed and
solved, will be David Berkoff, who was the first to try and bring the issue to light.

>>The costs of treating asthma would be borne by the swimmers' families,
not the parks and schools that own the pools. The relevant question is "Do we upgrade this already-too-
expensive pool, or do we close it down and divert any money into the football program?" Remember
that the school is currently $2 million in the red (yes, my local school is), and that the board
members' children are in football, not swimming.<<

Correction of the problem will be a very long term job.

Some things are simple and cheap; others are more complicated.

- Avoid overchlorination

- Improve ventilation...invest in high volume deck fans, which could be used at least during the
course of 2 hour high intensity workouts for the competitive swimmers who bear most of the risk.

- use altenative methods of pool decontamination

- design pool with a flush deck water level design, rather than with deep gutters and high walls,
which serves to trap chlorinated air right at the surface of the water.

And so on.

Of equal importance in simply informing and advising parents of the association and of the risks, so
that they may make educated risk/benefit assessments and so that they may make choices regarding
pools and programs.

"Rumor mongering" ?!!

Only one e.g.....

1: J Allergy Clin Immunol. 2002 Jun;109(6):962-8.

Effect of continuing or finishing high-level sports on airway inflammation, bronchial
hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers.

Helenius I, Rytila P, Sarna S, Lumme A, Helenius M, Remes V, Haahtela T.

Division of Allergy, Helsinki University Central Hospital, and the Department of Public Health,
University of Helsinki, Finland.

BACKGROUND: Mild eosinophilic airway inflammation and bronchial hyperresponsiveness-ie, mild asthma-
have been shown to affect a high proportion of endurance athletes. The persistence of airway
inflammation, bronchial hyperresponsiveness, and asthma in this population is not known, however,
inasmuch as follow-up studies of athletes' asthma have not been performed. OBJECTIVE: The purpose of
this study was to investigate effect of finishing high-level sports on airway inflammation,
bronchial hyperresponsiveness, and asthma. METHODS: Forty-two elite competitive swimmers, most of
them from the Finnish national team (37/42; 88%), were followed for 5 years in a prospective manner.
All of the swimmers completed questionnaires and underwent resting spirometry, histamine challenge
testing, and skin prick tests at baseline and at follow-up. Twenty-nine swimmers (69%) also gave
induced sputum samples on both occasions. Sixteen (38%) of the swimmers had continued their
competitive careers during follow-up (active swimmers), but 26 (62%) had stopped competing more than
3 months before the follow-up examination (past swimmers). RESULTS: Bronchial responsiveness was
increased in 7 (44%) of the 16 active swimmers at baseline and in 8 (50%) of the 16 active swimmers
at follow-up; it was increased in 8 (31%) of the 26 past swimmers at baseline and in 3 (12%) of the
26 past swimmers at follow-up (McNemar test, P =.025). The difference in the change in bronchial
hyperresponsiveness between the study groups was significant (likelihood ratio test, P =.023).
Current asthma (defined as bronchial hyperresponsiveness and exercise-induced bronchial symptoms
monthly) was observed in 5 (31%) of the active swimmers at baseline and in 7 (44%) of the active
swimmers at follow-up; of the past swimmers, it occurred in 6 (23%) at baseline and in 1 (4%) at follow-
up (McNemar test, P =.025). The difference in the change in current asthma between the study groups
was significant (likelihood ratio test, P
=.0040). The sputum differential cell counts of eosinophils and lymphocytes
increased significantly during the follow-up period in the active swimmers (Wilcoxon signed rank sum
test; P =.033 and P =.0029, respectively); in the past swimmers, the sputum differential cell counts
of eosinophils tended to decrease during the follow-up period (P =.17), whereas the differential
cell counts of lymphocytes did not change significantly. The changes in the sputum differential cell
counts of eosinophils between the study groups differed significantly (Mann-Whitney U test, P
=.019). CONCLUSION: In swimmers who had stopped high-level training, bronchial hyperresponsiveness
and asthma attenuated or even disappeared. Mild eosinophilic airway inflammation was aggravated
among highly trained swimmers who remained active during the 5-year follow-up. Our results suggest
that athletes' asthma is partly reversible and that it may develop during and subside after an
active sports career.

<<<<

44% of Finnish national team members developing asthma? And it disappears in all but one once they
stop swimming?

This is entirely consistent with the personal experience of, I'm certain, just about every
experienced coach in the sport (who is not lucky enough to train in a non-overchlorinated and well-
ventilated pool).

I'm waiting for Scott Lemley to jump into this. Scott has coached in a lot of pools. What is the
average percentage of brand new swimmers who show up every year taking inhalers to their first
practice? After having been in the sport and advancing to, let's say, a "sectional" level, what
percent are then on inhalers?

Coaches? You really think we are wrong about this?

- Larry

The evidence is NOT overwhelming - what you present below is merely anecdotal, and not even well
measured and documented. Perhaps your problem is USA specific. In Australia asthmatic kids are sent
by their doctors to the pool to swim laps. Most asthmatic kids at swimming training in Australia
were asthmatic before they started swimming.

Rather than sensationalising about the minor dangers of swimming, you might want to focus on the
major dangers of untreated asthma and / or badly maintained pools.

"Larry Weisenthal" <runnswim@aol.comnet> wrote in message news:20031214220520.11589.00000605@mb-
m25.aol.com...
> The evidence is compelling that swimming creates many more new cases than
it
> "attracts" old cases.
>
> Virtually all swim coaches would not argue with my own observation that relatively few kids join
> swim teams and take inhalers to practice on the
first
> day, but that, years down the road, many kids have now acquired inhalers.
And
> anecdotal observations (described previously) and now published research
show
> that asthma typically resolves or at least improves upon cessation of
swimming
> in chlorinated pools.
>
> Pre-existing asthmatics (who had asthma prior to taking up swimming) have
their
> airway disease triggered by other (non-chlorine) allergens. These
pre-existing
> asthmatics should not be discouraged from swimming (quite the contrary)
but, as
> with all new swimmers, should be encouraged to swim in a safe environment.
>
> But you miss the entire point of the editorial Dr. Rushall and I
certainly do
> not condemn swimming as an activity. In point of fact, we suggest
substitution
> of the term "chlorine-associated asthma" for "swimmer's asthma."
>
> We are critical of the fact that USA Swimming (and similar organizations
in
> other countries) which has the responsibility for putting literally
hundreds of
> thousands of swimmers at risk and, in the process, creating literally tens
of
> thousands of new, steroid-dependent childhood asthmatics, has completely
turned
> its back on the issue and, worse, denies the existence of this issue. It
is
> time for the competitive swimming establishment to squarely address this
issue
> and support the rather simple and inexpensive research efforts (basically surveys) which are
> required to define the magnitude of the problem.
>
> In addition to the acute morbidity of asthma are the potential long term consequences of the use
> of inhaled steroids (often the only effective
means of
> controlling asthma), which include osteoporosis (for which swimmers are at greater risk, compared
> to land athletes), cataracts, and other potential problems, such as diabetes.
>
> We also point out ways in which safety may be improved. Flush deck pool designs promote better air
> circulation than deep-walled and guttered pool designs. High volume, pool deck fans (e.g. as used
> in the new competition
pool
> in Commerce, CA) are an inexpensive way of improving dispersion of heavily-chlorinated air. There
> are also alternatives to chlorination, as
also
> discussed in our editorial. Finally, in many cases, there may be a choice
of
> swim teams to join; safety of the pool facility is a factor which should
enter
> into this decision.
>
> - Larry

On 15 Dec,
"Colin Priest" <Colin_Priest@nospam.com> wrote:

> The evidence is NOT overwhelming - what you present below is merely anecdotal, and not even well
> measured and documented. Perhaps your problem is USA specific. In Australia asthmatic kids are
> sent by their doctors to the pool to swim laps. Most asthmatic kids at swimming training in
> Australia were asthmatic before they started swimming.
>
> Rather than sensationalising about the minor dangers of swimming, you might want to focus on the
> major dangers of untreated asthma and / or badly maintained pools.
>

That last phrase hits the nail on the head. Correctly maintained pools, with chloramines controlled
adequately are a much lesser problem that overused, overchlorinated pools with little attention to
hygene and the reduction of TDS. Is this a problem with USAnian pols?
--
BD add 1 to from address to reply [13435]

We could do a quick survey on the group. So far you seem to be the only poster who seems to know
someone who developed asthma *after* taking up swimming, while a number of posters have related
cases where swimming has improved and controlled their asthma.

Does anyone else on this group know someone who developed asthma after taking up swimming?

"Larry Weisenthal" <runnswim@aol.comnet> wrote in message news:20031215162747.03799.00001064@mb-
m07.aol.com...
> >>and who do you propose finance this research? we both know it would take
> much MUCH more to verify this than 250K questionnaires, of which you might get a return of 33%?<<
>
> The questionnaire would go a long way toward defining the scope and
magnitude
> of the problem.
>
> e.g.
>
> 1. Did you child have asthma before joining the swim team?
>
> 2. If so, did the asthma get better or worse. If on medications (inhalers and/or pills), was the
> child able to discontinue medications? If it got
worse,
> did the dose and/or number of required medications go up?
>
> 3. Has your child aquired asthma for the first time since joining the swim team?
>
> 4. If so, what medications does the child take to control the asthma?
(most
> importantly oral or inhaled steroids, which pose an undeniable, serious
hazard
> to long-term health).
>
> 5. What type of disinfection system is used in the pool where your child trains?
>
> Such a survey would, within a period of a year or less, either refute the suggestion that swimming-
> caused asthma is a serious problem or else
confirm
> that it is a serious problem.
>
> - Larry

those questions are far too leading for qualitative research.

"Larry Weisenthal" <runnswim@aol.comnet> wrote in message news:20031215162747.03799.00001064@mb-
m07.aol.com...
> >>and who do you propose finance this research? we both know it would take
> much MUCH more to verify this than 250K questionnaires, of which you might get a return of 33%?<<
>
> The questionnaire would go a long way toward defining the scope and
magnitude
> of the problem.
>
> e.g.
>
> 1. Did you child have asthma before joining the swim team?
>
> 2. If so, did the asthma get better or worse. If on medications (inhalers and/or pills), was the
> child able to discontinue medications? If it got
worse,
> did the dose and/or number of required medications go up?
>
> 3. Has your child aquired asthma for the first time since joining the swim team?
>
> 4. If so, what medications does the child take to control the asthma?
(most
> importantly oral or inhaled steroids, which pose an undeniable, serious
hazard
> to long-term health).
>
> 5. What type of disinfection system is used in the pool where your child trains?
>
> Such a survey would, within a period of a year or less, either refute the suggestion that swimming-
> caused asthma is a serious problem or else
confirm
> that it is a serious problem.
>
> - Larry

"Larry Weisenthal" <runnswim@aol.comnet> wrote in message
news:20031215163924.03799.00001066@mb-m07.aol.com...

> Coaches? You really think we are wrong about this?

Firstly, you may be right, you may not be. You cannot conclusively say one way or the other until a
large sample, well controlled study is done on this.

I for one, have never noticed what you speak of (competitve swimmer up to national level for 10
years, coaching age group, collegiate and senior groups for 10 years). The research is interesting
and warrants further investigation, however, certain things bother me about the literature you've
produced in support: sample size for one, control of extraneous variables for another, and the fact
that Rushall again is crusading about something
(j/k on that one).

the second thing is that you seem so cut and dried about what needs to be done, when you must know,
in your heart of hearts it isn't going to happen. the cost and inconvenience alone is enough to
prevent it, let alone a lack of support from the medical community.

steve

Colin Priest wrote:
> We could do a quick survey on the group. So far you seem to be the only poster who seems to know
> someone who developed asthma *after* taking up swimming, while a number of posters have related
> cases where swimming has improved and controlled their asthma.
>
> Does anyone else on this group know someone who developed asthma after taking up swimming?

In a pool, no, but at open water triathlons, lots and lots and lots, including at the recent World's
ch. in New Zealand. At Lausanne, Switzerland, the Orca wet suit company did a brisk business because
we all were choking, not realizing it was the water. I use an inhaler at triathlons and nowhere
else. But this is besides the point; no chlorine in those lakes, just ordinary poison.

Ruth Kazez

>Does anyone else on this group know someone who developed asthma after taking up swimming?
>
>
Yes -two people. Both resigned, swim only ocasionally and have very rare or almost none asthma
episodes now.

Gosia

"exercise induced asthma" - another issue that the sensationalist "research" didn't bother to
control for

"rtk" <exk7remove@psu.edu> wrote in message news:3pqDb.6869$xH2.1212098@news1.news.adelphia.net...
>
>
> Colin Priest wrote:
> > We could do a quick survey on the group. So far you seem to be the only poster who seems to know
> > someone who developed asthma *after* taking up swimming, while a number of posters have related
> > cases where swimming
has
> > improved and controlled their asthma.
> >
> > Does anyone else on this group know someone who developed asthma after taking up swimming?
>
> In a pool, no, but at open water triathlons, lots and lots and lots, including at the recent
> World's ch. in New Zealand. At Lausanne, Switzerland, the Orca wet suit company did a brisk
> business because we all were choking, not realizing it was the water. I use an inhaler at
> triathlons and nowhere else. But this is besides the point; no chlorine in those lakes, just
> ordinary poison.
>
> Ruth Kazez

I wasn't referring to exercise induced asthma or we all would have it at times other than when we
swim in polluted waters. I don't know of anyone with chlorine induced asthma, but I don't know any
kids who swim and I don't know the medical problems of almost any adults who swim. So I'm just
scoring zeros all around. What I wrote was a digression. I will, however, ask one of the coaches
when I see one.

Ruth Kazez

Colin Priest wrote:

> "exercise induced asthma" - another issue that the sensationalist "research" didn't bother to
> control for
>
> "rtk" <exk7remove@psu.edu> wrote in message news:3pqDb.6869$xH2.1212098@news1.news.adelphia.net...
>
>>
>>Colin Priest wrote:
>>
>>>We could do a quick survey on the group. So far you seem to be the only poster who seems to know
>>>someone who developed asthma *after* taking up swimming, while a number of posters have related
>>>cases where swimming
>
> has
>
>>>improved and controlled their asthma.
>>>
>>>Does anyone else on this group know someone who developed asthma after taking up swimming?
>>
>>In a pool, no, but at open water triathlons, lots and lots and lots, including at the recent
>>World's ch. in New Zealand. At Lausanne, Switzerland, the Orca wet suit company did a brisk
>>business because we all were choking, not realizing it was the water. I use an inhaler at
>>triathlons and nowhere else. But this is besides the point; no chlorine in those lakes, just
>>ordinary poison.
>>
>>Ruth Kazez
>>
>

On 15 Dec,
runnswim@aol.comnet (Larry Weisenthal) wrote:

> From: Brian D brian13434@lycos.co.uk
>
> > > That last phrase hits the nail on the head. Correctly maintained pools, with
> chloramines controlled adequately are a much lesser problem that overused, overchlorinated pools
> with little attention to hygene and the reduction of TDS. Is this a problem with USAnian pols?<<
>
> As I described previously, my daughter's severe asthma, clearly caused by swimming, as I believe
> are most cases among swimmers, became worse when she trained for 6 months in a major indoor
> training and competition pool in the UK, and resolved totally when she was subsequentally forced
> to discontinue swimming for 6 months because of a shoulder injury. Her case is, I believe,
> entirely representative, rather than being an anomaly.
>
Which pool was that?

I currently have two younger swimmers who since taking up swimming have been able to discontinue the
use of their inhalers. We use three pools for training, one ozone disinfected, with minimal chlorine
use, and two with chlorine (calcium hypochlorite) as the disinfectant.
--
BD add 1 to from address to reply [13435]

"Larry Weisenthal" <runnswim@aol.comnet> wrote in message
news:20031215234720.14167.00001075@mb-m28.aol.com...

> I'm still waiting for Scott Lemley's input; he's a coach who (1) has had
the
> breadth of experience to know if I'm making a mountain out of a molehill
and
> (2) really cares about kids.

if you're so adamant about the point you're trying to make, why should Lemley's experience persuade
you its a molehill, not a mountain?

are you implying i don't care about kids?

anyway, i thought i'd try this for you: i'll re-write those questions you quickly posted and copy
the questionnaire to my club, to all the groups who compete competitively. this should reach approx
200 swimmers, aged between 11 and 18, who are anywhere from local competition upto the OT
qualifiers. is this something you would like me to do?

Larry Weisenthal wrote in a message

". . . an organization which, every month, sends out 250,000 copies of a magazine which, just last
month, glibly reassured its members that swimming was good for asthma, while making no mention of
the strong probability that swimming causes steroid-dependent asthma.

So many questions could be answered so quickly -- if only someone cared enough to look for answers.

I'm still waiting for Scott Lemley's input; he's a coach who (1) has had the breadth of experience
to know if I'm making a mountain out of a molehill and
(2) really cares about kids."

I don't have a pool operator's license. However, as a coach who has worked at A LOT of indoor pools
and a couple outdoor facilities, I believe as Larry does, that the conditions under which swimmers
train need to be improved.

I always knew the caustic nature of the chlorinated water dried out your skin and ate up your hair.
I learned a couple decades ago that pool water also etches swimmers' teeth after a certain time.
About 10 years ago I learned more about the respiratory problems associated with this environment.

It's a horrible situation. It costs real money to switch a pool over from chlorine to bromine. I'm
not sure what's better, ozone or bromine. What's your suggestion, Larry?

Regards,

Scott