Swimming Causes Asthma

Discussion in 'General Fitness' started by Larry Weisentha, Dec 12, 2003.

  1. The association of swimming with asthma has been long known.

    But it has been a chicken/egg situation. The official "line" of USA Swimming (which has, shamefully,
    turned its back on the problem) is that swimming is "good" for asthma (e.g. as discussed in the most
    recent issue of SPLASH). Past articles in Swimming World have also endorsed the idea that swimming
    (by being "good" for asthma) ATTRACTS asthmatics, rather than swimming CREATING asthmatics.

    But the evidence which indicts swimming as the CAUSE of MOST cases of asthma present in competitive
    swimmers is now overwhelming.

    It is time to stop making excuses for the sport and to focus attention on this problem. Families
    considering putting their kids in the sport must be informed in advance of the risks. Serious
    investments must be made in (available) pool decontamination technologies to replace inexpensive but
    toxic chlorination.

    http://www-rohan.sdsu.edu/dept/coachsci/swimming/chlorine/asthma.htm

    - Larry
     
    Tags:


  2. Larry Weisenthal wrote:

    > The association of swimming with asthma has been long known.
    >

    I suppose that is why many new pools are moving away from chroline then.

    --
    Chris Lambert (http://web.trout-fish.org.uk/) It has recently been discovered that research causes
    cancer in rats.
     
  3. Chris Lambert (http://web.trout-fish.org.uk/)

    >>It has recently been discovered that research causes cancer in rats.<<

    1. Cancer is on course to shortly overtake heart disease as the number one cause of death
    in the USA.

    2. Most cases of cancer are "optional" and not "mandatory."

    3. A not inconsequential amount of what we now know about the "optional" nature of cancer had
    its genesis in or was supported by the causation of cancer in sub-human animal models,
    including rats.
     
  4. Ross Bogue

    Ross Bogue Guest

    In <[email protected]> Larry Weisenthal wrote:
    > The association of swimming with asthma has been long known.

    I haven't studied your article carefully yet, but I fear it's not my favorite style of research
    presentation. The sensationalist tone and lack of hard data seems to indicate that it's intended for
    a general audience, not the usual readers of a research journal. Is this online journal a referreed
    publication?

    You summarized some interesting papers (Bernard, Aggazzoti, etc). Good! But you made a mistake
    including some others. One in particular stood out:

    ... The implicated swimming pool revealed a gas-chlorinated pool with corrosion of metal
    fixtures and etching of cement and a pH of 2.7.

    I have no idea what this is doing in an article about asthma. This looks too much like a common
    scare tactic. It is taking an isolated example of a very poorly maintained pool and pretending it
    has some connection with the topic of the article. That sort of poor scholarship is usually a sign
    that the rest of the article might not be entirely on the up-and-up.

    Maybe it would help if you pulled that paragraph?

    > But the evidence which indicts swimming as the CAUSE of MOST cases of asthma present in
    > competitive swimmers is now overwhelming.

    Maybe. I don't know. But a few limited studies and anecdotes do not establish anything as the "CAUSE
    of MOST" of anything. And the leap from "exercise-induced bronchospasm" to "MOST cases of asthma" is
    hardly intuitive. Is anyone looking into a larger study?

    I almost hate to bring it up, but I didn't see where you discussed the relative cost of alternative
    water treatment methods. What would be the costs involved? In this day when schools (my local high
    school, anyway) are looking for excuses to shut down pools, you shouldn't avoid that discussion.

    Ross
     
  5. To Ross,

    You raise some excellent points. I'll address them this weekend. Thank you for taking the time to
    read and consider.

    - Larry
     
  6. Ross Bogue raises appropriate questions.

    Firstly, some background.

    I first raised the issue of asthma on this newsgroup about 5 years ago. At that time, approximately
    8 of 25 kids on the Golden West Swim Club senior team were on inhalers for asthma. Then the pool was
    changed from a chlorination system to an ozonization system. All 8 asthmatic swimmers were able to
    discontinue their inhalers. I reported this on this newsgroup and received a private e-mail from the
    assistant coach of the Santa Barbara Swim Club, which trained out of both a chlorinated pool (on the
    beach in downtown Santa Barbara) and at an ozonated pool (at UC Santa Barbara). The coach told me
    that, like on most clubs, there were many swimmers in the chlorinated pool on inhalers, but none in
    the ozonated pool. I also received an e-mail from a swim parent in New England, who reported the
    opposite to our Golden West Swim Club experience. The New England team changed from a chlorine-free
    disinfection system to a chlorine-based system. Where asthma had been previously unknown on the team
    prior to chlorination, asthma became a serious problem thereafter. I also received an e-mail from
    former US Olympic Silver and Gold medalist, David Berkoff. Berkoff had also been concerned about the
    health hazards to competitive swimmers of swimming in chlorinated pools. He participated in a
    research project which resulted in a peer-reviewed publication (quoted in our editorial). Berkoff
    put great effort into trying to get USA Swimming to take the issue seriously and to support further
    research. He was very disappointed when these efforts were not successful.

    Also at this time, an international caliber swimmer (Pan Pac medalist) joined the Golden West Swim
    Club. This swimmer had a long history of serious, intractable, steroid-dependent asthma. I told the
    swimmer's parents that there was every likelihood that the swimmer's asthma would disappear, once
    she began training in the GWSC ozonated pool. I was correct. Within two months, the swimmer was off
    all medications.

    Two years ago, my older daughter, who at the time had been a competitive swimmer for 10 years,
    developed asthma while training at the University of California Irvine pool, which was an outdoor
    pool with very high walls (which trap chlorinated air at the water's surface well below deck level,
    particularly on cold mornings). This required treatment with inhaled glucocorticoids and
    bronchodilators. She developed continual and nearly intractable coughing and wheezing (which
    resulted in literally thousands of dollars in related medical expenses). She spent 6 months last
    year in England, training in an indoor, chlorinated pool, where the asthma worsened further. She had
    several very severe acute episodes and, in addition to bronchodilators, carried an emergency
    epinephrine syringe at all times in her swim bag. This was "real" (not just exercise-induced)
    asthma, with elevated serum IgE and eosinophilia. In late January, 2003, while on a three week
    training trip with her British team to Australia, she developed a severe shoulder injury which kept
    her out of the water for 6 months. Her asthma completely disappeared and she discontinued all
    medications. Since September, she has resumed full time training in an indoor pool as a college
    freshman varsity swimmer. Her asthma has recently begun to recur.

    These anecdotes are familiar to anyone closely involved with competitive swimming; were they only
    anecdotes, the situation would, perhaps, merit the benign neglect of USA Swimming. But these are not
    isolated anecdotes, as our editorial notes and which swim coaches would not dispute.

    Bogue raises several questions.

    First, the paper was an invited editorial and was reviewed only by the journal editorial staff and
    was not peer-reviewed.

    Second, the writing style was intentionally confrontational. The paper was an editorial and not a
    review. It was squarely addressing the same concerns raised by US Olympic medalist David Berkoff
    15 years ago, which have continued to be ignored by the governing bodies of national and
    international swimming.
    Dr. Rushall and I feel that the short and long term health of literally tens of thousands of
    children is being jeopardized needlessly (as there are available decontamination alternatives,
    discussed in the editorial, which are not being explored with the deserved urgency).

    With regard to the so-called lack of factual data, the following are the important points:

    Firstly, it is precisely because of the publication of the recent (since year
    2000) published studies that the editorial is particularly timely. In particular, the year 2002
    study from Finland is of compelling importance. The authors documented a high level of asthma
    in competitive swimmers. This confirmed may previous studies which are disputed by no one.
    However, in the Finnish study, the authors followed the swimmers for several years after
    enrollment into the study. Swimmers who continued to train had a progressively increasing
    level of asthma. In athletes who discontinued swimming, asthma spontaneously disappeared in
    the majority.

    These findings, in the context of all the pre-existing information, including the near universal
    experience of professional coaches, makes an overwhelmingly case to support our point of view, that
    the lack of attention to this serious problem is "deplorable."

    Of course additional research would be helpful. Berkoff tried to get USA Swimming to support such
    research 15 years ago, without success. Tens of thousands of children have since suffered the
    consequence of swimming-induced asthma in USA Swimming sponsored programs ever since then. It is
    inexcusable and reprehensible that USA Swimming would not only fail to take a proactive role in
    addressing and solving this problem, but instead would continue to provide false assurance (e.g. as
    in the current issue of Splash) that swimming has a mitigating, rather than a causal, effect
    relating to asthma.

    Regarding the cost of chlorination alternatives, these costs must be balanced against the medical
    expenses related to treating asthma, which are considerable, as my own family's experience
    documents.

    The following study further emphasizes this point:

    Med Klin (Munich). 1996 Oct 15;91(10):670-6.

    Cost of asthma therapy in relation to severity. An empirical study

    Graf von der Schulenburg JM, Greiner W, Molitor S, Kielhorn A.

    Institut fur Versicherungbetriebslehre, Universitat Hannover.

    BACKGROUND: The aim of asthma therapy, i.e. the permanent elimination of the patient's symptoms, is
    as a rule, achievable over the long-term only with the aid of anti-inflammatory drugs. As well as
    medical, this approach also has considerable economic implications. The comparatively low compliance
    among asthmatics makes treatment in this context all the more difficult. An alternative that
    presents itself is the use of combination preparations, a mixture of a long-term prophylactic and a
    therapeutic agent. PATIENTS AND METHODS: With the aid of standardised questionnaires, data were
    acquired from 216 patients and assigned to subgroups in accordance with the degree of severity of
    the asthma. The patients were treated in the offices of a total of 23 GPs and internists selected at
    random from a complete list of all relevant practices in Germany. The use of resources, i.e. all
    diagnostic and therapeutic measures, was recorded retrospectively for a period of 1 year. In this
    way, all those resources of relevance to the health insurance carriers used during the observation
    period were identified. In addition to direct costs, so-called indirect costs were also estimated,
    i.e. in the present study the productivity loss to the economy due to illness-related absence from
    work. RESULTS: The annual cost of treating adult asthmatics was calculated to be DM 3,339 for level
    1 severity, DM 5,260 for level 2 severity and DM 12,016 for level 3 severity. As the illness
    progresses in particular the direct cost of inpatient care and the indirect costs rise
    disproportionately. The yearly expenditure for women sufferers is about DM 800 more than for male
    sufferers. The direct cost of asthma treatment in children amounts to DM 2,950 for level 1, DM 3,225
    for level 2, and DM 4,811 for level 3, severity. Here, drug-related costs in particular, rise
    significantly as the disease progresses. CONCLUSION: One of the results of the present study is the
    fact that for asthma sufferers in general, there is a positive correlation between average total
    costs and degree of severity. It may thus be postulated that preventive medical treatment of asthma
    that slows the progression of the illness, together with appropriate patient instruction, would have
    a positive effect on the total expenditure per patient. If, for example, the appropriate use of
    drugs in combination with patient instruction improved the compliance of asthmatics, lower treatment
    costs and a better quality of life for the patient could be expected.

    >>>

    The above costs (much of which is related to the cost of prescription drugs) are undoubtedly lower
    in German than in the USA (and the above study was published 7 years ago, and must be adjusted for
    inflation and the introduction of newer and more expensive drugs and diagnostic tests).

    With regard to the seemingly unrelated issues of dental erosions and cancer, it was the intention of
    the authors to focus attention on the problem of training for hours per day in chlorinated pools,
    and it seemed appropriate to note that there were additional medical issues beyond asthma to be
    considered. In particular, the long term carcinogenic effect of intense exposure to chloramines
    deserves much more attention than previously received.

    It must further be noted that the long term consequences of treating childhood asthma include long
    term effects such as osteoporosis and cataracts. e.g.

    J Allergy Clin Immunol. 2003 Sep;112(3 Suppl):S1-40.

    Inhaled corticosteroids: past lessons and future issues.

    Allen DB, Bielory L, Derendorf H, Dluhy R, Colice GL, Szefler SJ.

    Division of Endocrinology, University of Wisconsin Children's Hospital, Madison 53792-4108, USA.

    Inhaled corticosteroids play a pivotal role in the treatment of asthma. Inhalation permits effective
    delivery of the corticosteroid in high concentration to target sites within the lung while
    minimizing systemic exposure. Consequently, the safety profile of inhaled corticosteroids is
    markedly better than that of oral corticosteroid therapy. However, although it was first thought
    that direct delivery might eliminate systemic adverse effects, this has not been confirmed by
    clinical trials and experience. Inhaled corticosteroids are absorbed from the lungs into the
    systemic circulation, in which they can acutely decrease growth velocity in children, an effect that
    fortunately appears to be temporary and might have no effect on final adult height. In sufficient
    dosages, they also produce bone mineral loss leading to osteoporosis and might increase the risk of
    cataracts, glaucoma, skin atrophy, and vascular changes that increase the risk of ecchymoses.
    Effective evaluation of the severity and significance of these complications is challenging because
    highly sensitive tests do not reliably predict clinically significant events, and short-term
    observations do not predict long-term consequences. Also, compliance wanes with long-term treatment,
    and susceptibility to a particular adverse event can vary over time, even in the same individual,
    because of developmental or hormonal changes. This journal supplement will review what has been
    learned about the safety of inhaled cortico-steroids during the past decade, discussing some of the
    questions that remain and considering the characteristics of an "ideal" inhaled corticosteroid: one
    with high local activity in the lung and minimal or no adverse systemic effects.

    >>>

    It is important to emphasize that, by far, the highest risk group are children and teenagers in year
    around competitive swimming programs. These swimmers have a vastly greater exposure to chloramines
    than in the case of recreational and masters swimmers. Additionally, growing children have greater
    vulnerability to the long term health consequences of intense exposure to chlorinated pool water.

    It is past time for the competitive swimming community to address and solve this important issue.
    Hopefully, it will not take something like a class action lawsuit to initiate the needed actions,
    which, at a minimum, require disclosure of risks and informed consent from parents who expose their
    children to these risks.

    - Larry Weisenthal
     
  7. Pat

    Pat Guest

    "Larry Weisenthal" > The association of swimming with asthma has been long known.

    Is this only a chlorine problem? I swim in a bromine pool. I haven't had any bad effects from it,
    but then, I don't "train" like the competitive swimmers. Have you heard of this asthma problem with
    bromine pools?

    thanks,

    Pat in TX
     
  8. Colin Priest

    Colin Priest Guest

    Swimming attracts asthmatics. When was diagnosed with asthma my doctor's first comment was that I
    should take up swimming to treat it. My personal experience is that swimming controls my asthma
    better than any medication, but it just happens that I swim outdoors in a salt water pool. A couple
    of weeks ago I saw an interview with Samantha Riley on TV in which she said that swimming had kept
    her asthma under control and she told of some instances when she had stopped training and her asthma
    had subsequently become worse.

    Your article is dangerous. It could discourage asthmatics from swimming and benefiting from the
    resultant improvement in asthma symptoms, all without side-effects.

    "Larry Weisenthal" <[email protected]> wrote in message news:[email protected]
    m02.aol.com...
    > The association of swimming with asthma has been long known.
    >
    > But it has been a chicken/egg situation. The official "line" of USA
    Swimming
    > (which has, shamefully, turned its back on the problem) is that swimming
    is
    > "good" for asthma (e.g. as discussed in the most recent issue of SPLASH).
    Past
    > articles in Swimming World have also endorsed the idea that swimming (by
    being
    > "good" for asthma) ATTRACTS asthmatics, rather than swimming CREATING asthmatics.
    >
    > But the evidence which indicts swimming as the CAUSE of MOST cases of
    asthma
    > present in competitive swimmers is now overwhelming.
    >
    > It is time to stop making excuses for the sport and to focus attention on
    this
    > problem. Families considering putting their kids in the sport must be
    informed
    > in advance of the risks. Serious investments must be made in (available)
    pool
    > decontamination technologies to replace inexpensive but toxic
    chlorination.
    >
    > http://www-rohan.sdsu.edu/dept/coachsci/swimming/chlorine/asthma.htm
    >
    > - Larry
     
  9. >>Is this only a chlorine problem? I swim in a bromine pool. I haven't had any
    bad effects from it, but then, I don't "train" like the competitive swimmers. Have you heard of this
    asthma problem with bromine pools?<<

    That's an important question...would be so easy to answer so many important questions relating to
    the association between swimming and asthma, were USA Swimming simply to send out some well-designed
    questionnaires to its 250,000 or so member swimmers.

    For what it's worth, the anecdote I gave of the New England swim club which switched from a non-
    chlorine disinfection system to a chlorine-based disinfection system (and went from basically no
    asthma to a lot of asthma) switched from bromination to chlorination. So it may be that bromination
    is safer, from an asthma perspective; but research (currently not being done, but relatively easy to
    do, as noted above) is needed.
     
  10. Ross Bogue

    Ross Bogue Guest

    In <[email protected]> Larry Weisenthal wrote:
    >
    > These anecdotes are familiar to anyone closely involved with competitive swimming; were they only
    > anecdotes, the situation would, perhaps, merit the benign neglect of USA Swimming. But these are
    > not isolated anecdotes, as our editorial notes and which swim coaches would not dispute.

    It sounds to me like you want USA Swimming, FINA, and perhaps some other bodies to collectively
    sponsor a symposium on the subject. You, Rushall, and others would present your findings, and the
    entire body would decide whether it deserves further study or whether to recommend a change in the
    current practice.

    Do you have any supporters in those groups who might propose such a symposium?

    >
    > Regarding the cost of chlorination alternatives, these costs must be balanced against the medical
    > expenses related to treating asthma, which are considerable, as my own family's experience
    > documents.

    Well, what are the costs?

    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.

    Ross
     
  11. Bill

    Bill Guest

    [email protected] (Larry Weisenthal) wrote in message news:<[email protected]>...

    > But the evidence which indicts swimming as the CAUSE of MOST cases of asthma present in
    > competitive swimmers is now overwhelming.
    >
    > It is time to stop making excuses for the sport and to focus attention on this problem. Families
    > considering putting their kids in the sport must be informed in advance of the risks. Serious
    > investments must be made in (available) pool decontamination technologies to replace inexpensive
    > but toxic chlorination.
    >
    > http://www-rohan.sdsu.edu/dept/coachsci/swimming/chlorine/asthma.htm
    >
    > - Larry

    I read about swimming and asthma a few years ago but not exactly in the "toxic" laden tone of this
    article. This article as it is, would do more harm than good. It is sensationalized rumor-mongering
    hiding behind bibliograhic references but actually is based on nothing more than a few casual
    observations. Anybody can put 2 and 2 together and come up with 5.

    I was an asthmatic as a young child and remember being rushed to the hospital a few times. However,
    by the time I turned 20, I had completely outgrown it. I am 40 now, and have been swimming in
    chlorinated pools 3-4x a week for about 1 to 1.5 hrs each session for the past 10 years. My hair is
    brittle and my skin reeks of chlorine all day long, but the asthma has stayed away. Thanks to
    swimming, I'm slim and trim. If I had read this article 10 years ago before I took up swimming, I'd
    be a couch potato with a 40-inch belly by now.

    Bill
     
  12. Diablo

    Diablo Guest

    "Larry Weisenthal" <[email protected]> wrote in message
    news:[email protected]...

    So it may be that bromination is
    > safer, from an asthma perspective; but research (currently not being done,
    but
    > relatively easy to do, as noted above) is needed.

    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%?

    and then what? who will stump up the money for renovation of the pools to meet the specified
    requirements? we're lacking pools of a high standard anyway, and struggle to find money for more.

    also, to suggest that people select their club on this basis is a little far fetched don't you
    think? as salient as your point may be, i very much doubt anyone would follow that advice.
     
  13. MSEagan

    MSEagan Guest

    I know of many cases where bromine facilities had to switch to chlorine because too many people
    developed severe contact dermatitis from the bromine. Chlorine worked fine. I also knew of at least
    one kid who had more asthma in bromine than in chlorine.

    Ozone would be nice, but then I am told that it only works as the water is filtered through the
    system but does not help with immediate disinfection, for example, if the person next to you has a
    runny nose with infected mucous and you happen to swallow it (yuck). Chlorine works on contact to
    kill this sort of thing.

    Ventilation would certainly help, but what do we do about all those old facilties that many are
    stuck using? What really irks me is our local YWCA has the air SO hot and humid (and the water) and
    they refuse to open doors for ventilation. If there is some literature on this, I would like to pass
    it along to them in the hopes that maybe they will come to their senses. Marianne

    "Larry Weisenthal" <[email protected]> wrote in message news:[email protected]
    m25.aol.com...
    > >>Is this only a chlorine problem? I swim in a bromine pool. I haven't had
    any
    > bad effects from it, but then, I don't "train" like the competitive swimmers. Have you heard of
    > this asthma problem with bromine pools?<<
    >
    > That's an important question...would be so easy to answer so many
    important
    > questions relating to the association between swimming and asthma, were
    USA
    > Swimming simply to send out some well-designed questionnaires to its
    250,000 or
    > so member swimmers.
    >
    > For what it's worth, the anecdote I gave of the New England swim club
    which
    > switched from a non-chlorine disinfection system to a chlorine-based disinfection system (and went
    > from basically no asthma to a lot of asthma) switched from bromination to chlorination. So it may
    > be that bromination
    is
    > safer, from an asthma perspective; but research (currently not being done,
    but
    > relatively easy to do, as noted above) is needed.
     
  14. Brian D

    Brian D Guest

    On 15 Dec,
    "MSEagan" <[email protected]> wrote:

    > Ozone would be nice, but then I am told that it only works as the water is filtered through the
    > system but does not help with immediate disinfection, for example, if the person next to you has a
    > runny nose with infected mucous and you happen to swallow it (yuck). Chlorine works on contact to
    > kill this sort of thing.
    >
    Our main pool is mainly ozone disinfected in the circulation system (which is then filtered out) and
    is about 20 years old It uses a small chlorine dose for immediate disinfection (about 25% of the
    usual dose) of the bulk water to kill the above. More modern pools often use UV tubes as the main
    steriliser, but still use a small chlorine dose. All pools backwash their sand filters at least once
    a week which serves to dilute the combined chlorine and TDS in the pool, which can be a major
    problem if not kept in check.

    I personally find the perfumes/deodorants and shampoo used by swimmers a greater allergin. I have
    hay fever which has developed to asthma on a few occasions, non athletic, but when there have been
    high levels of the trigger allergins about. This has never been when swimming in any pool, which has
    always been beneficial to me.

    --
    BD add 1 to from address to reply [13435]
     
  15. >>Your article is dangerous. It could discourage asthmatics from swimming and
    benefiting from the resultant improvement in asthma symptoms, all without side-effects.<<

    The evidence is compelling that swimming in chlorinated pools creates many more new cases of steroid-
    dependent asthma than the truly minimal benefits (which could be achieved, in any event, through
    swimming in non-chlorinated pools). In addition to the immediate health hazards and expense of
    acquiring steroid-dependent asthma are the long term consequences of osteoporosis (to which swimmers
    are at greater risk than land athletes), cataracts, diabetes, etc., associated with the use of
    steroid inhalers, which are often the only medications which control asthma.

    The point is not to keep kids from swimming, it is, rather, to create a safe environment in which
    they may swim.

    For example, high pool walls with gutters trap chlorinated air. Flush deck pool designs disperse
    chlorinated air much more effectively. This is a particulary important consideration in outdoor
    pools in temperate climates, such as California and Arizona. High volume portable fans (e.g. as
    present in the brand new indoor competition pool in Commerce, CA) further disperse chlorinated air.

    There are also alternatives to chlorination, as discussed in the editorial.

    There are also choices between safer pools and more dangerous pools. Knowledge of the (severe) risks
    from training intensively in dangerous pools should enter into the decision of which team to join.
     
  16. 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
     
  17. 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.
     
  18. "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
     
  19. Colin Priest

    Colin Priest Guest

    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" <[email protected]> wrote in message news:[email protected]
    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
     
  20. Brian D

    Brian D Guest

    On 15 Dec,
    "Colin Priest" <[email protected]> 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]
     
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