Clifford, P. W., Richardson, S. D., Nemery, B., Aggazzotti, G., Baraldi, E., Blatchley, E. R., Blount, B. C., Carlsen, K., Eggleston, P. A., Frimmel, F. H., Goodman, M., Gordon, G., Grinshpun, S. A., Heederik, D., Kogevinas, M., LaKind, J. S., Nieuwenhuijsen, M. J., Piper, F. C., & Sattar S. A. (2009). Childhood asthma and environmental exposures at swimming pools: State of the science and research recommendations. Environmental Health Perspectives, 117, 500-507.

Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. This review describes the state of the science on methods for understanding children’s exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma. A research agenda to improve our understanding of this issue is recommended.

A workshop was held in Leuven, Belgium, 21–23 August 2007, to evaluate the literature and to develop a research agenda to better understand children’s exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs.

Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and actions are necessary. If there is no relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection.

Implication. Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in very young persons. It was recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.

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