Authors
Country
Country
Type of study
N (age, yrs)
NCl3 mg/m3
Main findings
Bernard et al. 2003 (51)
Belgium
Belgium
Cross-sectional
226 (8-12) 1,881 (7-14)
-
Dose-effect relation between CCPA and serum SP-A and SP-B (n=226). Correlations between the prevalence of asthma and the CCPA (n=1881).
Nystad et al. 2003 (68) Norway Norway Cross-sectional 2,862 children - Increased risk of recurrent respiratory tract infections in baby swimmers from atopic parents (aOR, 2.08, 95% CI: 1.08-4.031).
Lagerkvist et al. 2004 (70) Sweden Sweden Cross-sectional 57 (10-11) - Significant decrease of serum CC16 in children (n=20) regularly visiting indoor chlorinated-pools
Kohlhammer et al. 2006 (65)
Germany
Cross-sectional
Cross-sectional
2,606 (35-74)
-
Dose-related associations between the risk of hay fever and the current and school-age pool attendance.
Bernard et al. 2006 (52) Belgium Belgium Cross-sectional 341 (10-13) 0.25-0.54 Increased risk of asthma (doctor-diagnosed or EIB) with CCPA in children with serum IgE > 100 kIU/L (aOR for each 100-hr increase in CCPA = 1.79; 95% CI, 1.07-2.72).
Nickmilder and Bernard, 2007 (95)
Belgium
Belgium
Ecological
(13-14) (6-7)
_
In both age groups, the prevalence of ever asthma across Europe correlated with the availability of indoor chlorinated-pools.
Bernard et al. 2007 (9) Belgium Belgium Cross-sectional 341 (10-13) - Decrease of serum CC16 and higher risks of asthma and bronchitis in 43 children who swam in indoor chlorinated-pools during infancy
Bernard et al. 2008 (96) Belgium Belgium Cross-sectional 847 (13-18) - Use of outdoor pools was associated with higher risks of elevated FeNO, cat or HDM sensitization and asthma in subjects with serum IgE>25 kIU/L
Nystad et al. 2008 (97)
Norway
Norway
Prospective
30,870 (0.5-1.5)
-
Increased risk of wheeze (aOR, 1.24, 95% CI 1.11, 1.39) in baby swimmers from atopic mothers.
Schoefer et al. 2008 (98) Germany Germany Prospective 2,196 (6) - Baby swimmers had higher risk of asthma (aOR 2.15 95% CI 1.16-3.99) due potentially to reverse causation and respiratory infections in the 1st yr
Cotter and Ryan 2009 (56) Ireland Ireland Cross-sectional 97 (6-12) - Associations between CCPA and the risk of diagnosed asthma and wheezing in the last 12 months
Bernard et al. 2009 (53) Belgium Belgium Cross-sectional 847 (13-18) 0.30-0.50 Among atopic adolescents, aOR for asthma, hay fever or allergic rhinitis increased with CCPA but not with the Cu/Ag pool attendance.
Voisin et al. 2010 (69) Belgium Belgium Cross-sectional 430 (5-7) - Infant swimming in indoor or outdoor chlorinated-pools is associated with increased risks of bronchiolitis and later of allergic sensitization
Font-Ribera et al. 2011 (61)
UK
UK
Prospective
5,738 (7 and 10)
-
Swimming was associated with increased lung function and lower risk of asthma symptoms.
Ferrari et al. 2011 (57) Italy Italy Prospective 1,136 (18-55) - Higher risk of new-onset asthma associated with CCPA.
Jacobs et al. 2012 (62)
Netherlands
Netherlands
Cross-sectional
2,359 (6-13)
0.21
Association of HDM sensitization with frequent baby swimming and lower serum CC16 (n=419). No association with asthma.
Font-Ribera et al. 2013 (60)
Spain
Spain
Prospective
2,205 (0-1.17)
-
No association between indoor or outdoor swimming pool attendance during the 1st year of life and LRTI, wheezing, atopic eczema or otitis
Voisin et al. 2013, 2014 (66, 67)
Belgium
Belgium
Prospective
196 (5.7 and 7.7)
-
Swimming at indoor or outdoor chlorinated-pools before the age of 3 yrs was associated with higher risks of HDM sensitization and increased FeNO
Schuez-Havupalo et al. 2014 (99)
Finland
Finland
Prospective
1,827 (0-1.42)
-
Association between infant swimming and rhinovirus-associated wheezing among children with atopic eczema (n=635, p = 0.006).
Font-Ribera et al. 2014 (59) Spain Spain Cross-sectional 2,758 (6-12) - No associations between regular indoor pool attendance before 2 yrs and asthma, wheezing, eczema.
Bernard et al. 2015 (81) Belgium Belgium Cross-sectional 835 (13-18) - Associations of serum CC16/SP-D with CCPA, allergic sensitization (especially to HDM) and allergic diseases among sensitized adolescents
Andersson et al. 2015 (55)
Sweden
Sweden
Cross-sectional
1, 866 (11-12)
-
Asthma associated with indoor pool attendance (≥1 week) only among sensitized subjects (n= 1,652, aOR1.9, 95% CI 1.09-3.32).
Bernard et al. 2017 (100)
Belgium
Belgium
Prospective
121 (5.8, 7.8)
-
Low CC16 in NALF associated with CCPA predicts persistent sensitization to aeroallergens, especially to HDM
Cavaleiro-Rufo et al. 2018 (58) Portugal Portugal Cross-sectional 858 (7-12) - Indoor pool attendance associated with autonomic changes and baseline bronchoconstriction and before 3 yrs with functional asthma
Andersson et al. 2018 (54) Sweden Sweden Prospective 970 (16-17) 0.15 Early indoor pool attendance (< 3 yrs) associated with asthma onset. Risks are particularly high for atopics. Dose-response relationships with NCl3.