Investigating the Impact of Chlorine Exposure on the Respiratory Health of Young Female Swimmers Aged 10 to 15 Years
Subject Areas : Sport physiology
1 -
Keywords: Chlorine, Respiratory system, Swimming,
Abstract :
Chlorine and disinfectants commonly used in swimming pools to maintain water hygiene and prevent contagious diseases react with substances in the water or the swimmers' bodies to produce toxic gases to the respiratory tract. These gases accumulate significantly in the confined spaces of indoor pools, and their inhalation can lead to respiratory illnesses. Many pools use large amounts of chlorine to prevent diseases, which poses substantial health risks. Studies conducted to date indicate that prolonged exposure to chlorine gas can have adverse effects on swimmers' respiratory systems, including conditions such as asthma, shortness of breath, and chronic bronchitis. Given the vital role of the respiratory system in the human body and the widespread popularity of swimming as a sport, it becomes imperative to understand the impact of disinfectants on the body. This research is significant as it focuses on identifying the harmful effects of chlorine on the respiratory system of professional female swimmers aged 10 to 15 who have been consistently engaged in swimming over the past three years. The findings of this study will contribute to the development of safer swimming environments and the promotion of healthier sports practices.
References:
Agabiti N, Ancona C, Forastiere F, Di Napoli A, Lo PE, Corbo GM, et al(2001). Short-term respiratory effects of acute exposure to chlorine due to a swimming pool accident. Occup Environ Med;58:399-404
Aggazzotti G, Fantuzzi G, Righi E, Predieri G(1995). Environmental and biological monitoring of chloroform in
Iranmanesh M. (2010). Chlorine in pool water and asthma and allergy diseases. University of Tehran Press, pp. 74-82.
Aggazzotti G, Fantuzzi G, Righi E, Predieri G(1998). Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools. Sci Total Environ;217(1-2):155-63
Aggazzotti, G., Fantuzzi, G., Righi, E., & Predieri, G. (1998). Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools. Science of the Total Environment, 217, 155-163
Aiking, H., van Acker, M. B., Scholten, R. J., Feenstra, J. F., & Valkenburg, H. A. (1994). Swimming pool chlorination: a health hazard? Toxicology Letters, 72(1-3), 375-380.
Andreoli, T.E., Carpenter, C.C., (2010). Respiratory Diseases from "Cecil Textbook of Medicine." Translated by G.R. Derakhshan Dilami and colleagues. Tehran: Nasle Farda, pp. 132-145.
Bar-Or, O., & Inbar, O. (1992). Swimming and asthma. Benefits and deleterious effects. Sports Medicine, 14, 397-405.
Beech, J. A., Diaz, R., Ordaz, C., & Palomeque, B. (1980). Nitrates, chlorates, and trihalomethanes in swimming pool water. American Journal of Public Health, 70(1), 79-82.
Bernard, A., Carbonnelle, S., Michel, O., Higuet, S., de Burbure, C., Buchet, J-P., Hermans, C., Dumont, X., & Doyle, I. (2003). Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools. Occupational and Environmental Medicine, 60, 385-394.
Black J.M., Hawkins H., (2010). Respiratory Disorders. Translated by Z. Mahdavi. Tehran: Jameh Negar: Salami Publications, pp. 56-63.
Bonetto G, Corradi M, Carraro S, Zanconato S, Alinovi R, Folesani, et al. Longitudinal monitoring of lung injury in children after acute chlorine exposure in a swimming pool. Am J Respir Crit Care Med 2006;174:545-9.
Bernard Al, Uyan ZS, Carraro S, Piacentini G, Baraldi E(2009). Swimming pool, respiratory health, and childhood asthma: should we change our beliefs? Pediatr Pulmonol;44:31-7.
Bernard A, Carbonnelle S, Dumont X, Nickmilder M (2007) Infant Swimming Practice, Pulmonary Epithelium Integrity, and the Risk of Allergic and Respiratory Diseases Later in Childhood. Pediatrics 119(6): 1095–103
Cammann K, Hubner K(1995). Trihalomethane concentrations in swimmers' and bath attendants' blood and urine after swimming or working in indoor swimming pools. Arch Environ Health;50(1):61-5. http://dx.doi.org/10.1080/00039896..9955013
Cammann, K., & Hubner, K. (1995). Trihalomethane concentrations in swimmers' and bath attendants' blood and urine after swimming or working in indoor swimming pools. Archives of Environmental Health, 50(1), 61-65.
Cheng YC, Macera CA, Addy CL, Sy FS, Wieland D, et al. (2003) Effects of physical activity on exercise tests and respiratory function. Br J Sports Med 37: 521–8.
Cassan D, Mercier B, Castex F, Rambaud A (2009) Effects of medium-pressure UV lamps radiation on water quality in a chlorinated indoor swimming pool. Chemosphere 62(9): 1507
Carbonnelle S, Francaux M, Doyle I, Dumont X, de Burbure C, et al. (2005) Changes in serum pneumoproteins caused by short-term exposures to nitrogen trichloride in indoor chlorinated swimming pools. Biomarkers 7(6): 464
Committee on Medical and Biological Effects of Environmental Pollutants, National Research Council (1976) Chlorine and hydrogen chloride. 116–23, National Academy of Sciences, Washington DC.
C Ondolo, S Aversa, et al., Jun 2009, Nasal and Lung function in competitive swimmers Acta Otorhinolaryngol Ital; 29(3): 137–143.
Drobnic F (2009) Health impact of compounds used in swimming pool water treatment: state of the question. Apunts Med Esport 161: 42–7.
Erdinger L, Kuhn KP, Kirsch F, Feldhues R, Frobel T, Nohynek B, et al(2004). Pathways of trihalomethane uptake in swimming pools. Int J Hyg Environ Health;207(6):571-5.
Font-Ribera L, Kogevinas M, Zock J-P, Nieuwenhuijsen MJ, Heederik D (2009) Swimming pool attendance and risk of asthma and allergic symptoms in children. Eur Respir J 34(6): 1304–10.
Fantuzzi G, Righi E, Predieri G, Giacobazzi P, Mastroianni K, Aggazzotti G(2010). Prevalence of ocular, respiratory, and cutaneous symptoms in indoor swimming pool workers and exposure to disinfection by-products (DBPs). Int J Environ Res Public Health;7(4):1379-91
Gilchrist HL, Matz PB (1933) The residual effects of warfare gases: the use of chlorine gas, with the report of cases. Med Bull Vet Admin 6, 229–70.
Goodman M, & Hays S(2008). Asthma and swimming: a meta-analysis. J Asthma;45:639-47.
G. Baraldi, Environmental Health Perspectives, Swimming pools, and childhood asthma: suggestive but inconclusive association. 117, 500-507.
Janson Media, Kogevinas M, Zock J-P, Go´mez FP, Barreiro E, et al. (2010). Short-Term Changes in Respiratory Biomarkers after Swimming in a Chlorinated Pool, Environ Health Perspect, 118(11):1538-1544.
Kilburn KH, Warshaw RH (1993) Effects on neurobehavioral performance of chronic exposure to chemically contaminated well water. Int’l Toxicol Ind Health 39, 391–404.
Kim B., et al. (2010). Respiratory Physiology Section from "Medical Physiology" by Ganong. Translated by R. Badenzadeh. Tehran: Sina Teb Publications: Jahan Adib Books, 2011, pp. 150-155.
Kim H, Shim J, Lee S(2002). Formation of disinfection by-products in chlorinated swimming pool water. Chemosphere;46(1):123-30. http://dx.doi.org/10.1016/S0045-6535(00)00581-6
Kilburn KH (1996) Effects of a hydrochloric acid spill on neurobehavioral and pulmonary function. J Occup Environ Med 38, 1019–25.
Kogevinas M, Villanueva MC, Font-Ribera L, Liviac D, Bustamante M, et al. (2010) Genotoxic Effects in Swimmers Exposed to Disinfection By-products in Indoor Swimming Pools. Environ Health Perspect 118(11): 1531–7. Figure 2. Changes in FVC pre and post-intervention. doi:10.1371/journal.pone.0068447.g002 Respiratory Health in Ozone and chlorine pools plus one
Kim H, Shim J, Lee S (2002) Formation of disinfection by-products in chlorinated swimming pool water. Chemosphere 46(1): 123–30
Lees-Haley PR, Brown RS (1992) Bias in perception and reporting following a perceived toxic exposure. Percep Motor Skills 75, 531–44.
Levy JM, Hessel SJ, Nykamp PW, Stegman CJ, Crowe JK, Spiegel RM, Horsley WW, Cook GC (1986) Detection of the cerebral lesions of chlorine intoxication by magnetic resonance imaging. Magnetic Resonance Imaging 4, 51–2.
Lourencetti C, Grimalt JO, Marco E, Fernandez P, Font-Ribera L, Villanueva CM, Kogevinas M(2012). Trihalomethanes in chlorine and bromine disinfected swimming pools: Airwater distributions and human exposure. Environ Int; 45:59-67.
Le´vesque B, Duchesne J-F, Gingras S, Lavoie R, Prud’Homme D, et al. (2006) The determinants of the prevalence of health complaints among young competitive swimmers. Int Arch Occup Environ Health 80(1): 32–9.
Longo D.L., et al. (2012). Respiratory System from "Harrison's Principles of Internal Medicine." Translated by M. Ghorbani and colleagues. Tehran: Nasle Farda, pp. 78-84.
Massin N, Bohadana AB, Wild P, Héry M, Toamain JP, Hubert G(1998). Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools. Occup Environ Med;55(4):258-63.
Misami, H., Amiri, F. (2013). Investigating the Effects of Pollutants in Swimming Pool Water on Swimmers' Health and Proposing Solutions to Mitigate Them. 10th National Conference on Environmental Health, Hamedan, p. 68.
Miller JA, Cohen GS, Warshaw RH, Thornton JC, Kilburn KH (1989) Choice (CRT) and simple reaction times (SRT) compared in laboratory technicians: factors influencing reaction times and a predictive model. Am J Ind Med 15, 687–97.
Miller A, Thornton JC, Warshaw R, Bernstein J, Selikoff IJ, Teirstein AS (1986) Mean and instantaneous expiratory flows, FVC and FEV1: prediction equations from a probability sample of Michigan, a large industrial state. Bull Eur Physiolopathol Respir 22, 589–97.
Martinez TT, Long C. Explosion risk from swimming pool chlorinators and review of chlorine toxicity. J Toxicol Clin Toxicol 1995;33:349-54.
Manvlyz A, Maikell b.Changes in serum pneumoproteins caused by short-term exposures to nitrogen trichloride in indoor chlorinated swimming pools
Nelemans, P. J., Rampen, F. H., Groenendal, H., Kiemeney, L. A., Ruiter, D. J., & Verbeek, A. L. (1994). Swimming and the risk of cutaneous melanoma. Melanoma Research, 4, 281-286. Reuters Health, (March 21, 2001). Bronchospasm in competitive swimmers.
Pourlatifi, A., Meshkibaf-Moghadam, Z. (2008). The Pattern of Public Swimming Pools (Standards). 1st Edition, Tehran: Lifeguard Federation, pp. 42-50.
Parimon T, Kanne JP, Pierson DJ(2004). Acute inhalation injury with evidence of diffuse bronchiolitis following chlorine gas exposure at a swimming pool. Respir Care;49:291-4.
Romberg K, Bjermer L, Tufvesson E (2011) Exercise but not mannitol provocation increases urinary Clara cell protein (CC16) in elite swimmers. Respir Med 105(1): 31–6.
Richardson SD, DeMarini DD, Kogevinas M, Fernandez P, Marco E, et al. (2010) What’s in the Pool? A Comprehensive Identification of Disinfection Byproducts and Assessment of Mutagenicity of Chlorinated and Brominated Swimming Pool Water. Environ Health Perspect 118(11): 1523–30.
Spivey A(2009). Widening the pool of factors: studies needed to assess asthma swimming link. Environ Health Perspect;117:A162.
Smith Mf, Fisk MZ, Steigerwald MD, Smoliga JM, Rundell KW(2010). Asthma in swimmers: A review of the current literature. Phys Sportsmed;38(4):28-34
Taheri Hosseinzadeh, H., Ebrahimizadeh, M., Bidaskan, A. (2008). Basic Human Anatomy. Mashhad University of Higher Education, Jahad Daneshgahi.
Thickett KM, McCoach JS, Gerber JM, Sadhra S, Burge PS.(2002). Occupational asthma is caused by chloramines in indoor swimming pool air. Eur Respir J;19(5):827-32.
Tager IB, Balmes J, Lurmann F, Ngo L, Alcorn S, et al. (2005) Chronic Exposure to Ambient Ozone and Lung Function in Young Adults. Epidemiology 16(6): 751–9
Voisin C, Sardella A, Marcucci F, Bernard A (2010) Infant swimming in chlorinated pools and the risks of bronchiolitis, asthma and allergy. Eur Respir J 36(1): 41–7.
Weisgerber M, Webber K, Meurer J, Danduran M, Berger S, Flores G(2008). Moderate and vigorous exercise programs in children with asthma: safety, parental satisfaction, and asthma outcomes. Pediatr Pulmonol;43:1175-82.
Weisel CP, Richardson SD, Nemery B, Aggazzotti G, Baraldi E, Blatchley ER III, Blount BC, Carlsen KH, Eggleston PA, Frimmel FH, et al. (2009). Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations. Environ Health Perspect;117:500-7
Winternitz MC (1920) Collected studies on the pathology of war gas poisoning. The Department of Pathology and Bacteriology, Medical Science Section, Chemical Warfare Service. Yale University Press, New Haven, CT.
Agabiti N, Ancona C, Forastiere F, Di Napoli A, Lo PE, Corbo GM, et al(2001). Short-term respiratory effects of acute exposure to chlorine due to a swimming pool accident. Occup Environ Med;58:399-404
Aggazzotti G, Fantuzzi G, Righi E, Predieri G(1995). Environmental and biological monitoring of chloroform in
Iranmanesh M. (2010). Chlorine in pool water and asthma and allergy diseases. University of Tehran Press, pp. 74-82.
Aggazzotti G, Fantuzzi G, Righi E, Predieri G(1998). Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools. Sci Total Environ;217(1-2):155-63
Aggazzotti, G., Fantuzzi, G., Righi, E., & Predieri, G. (1998). Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools. Science of the Total Environment, 217, 155-163
Aiking, H., van Acker, M. B., Scholten, R. J., Feenstra, J. F., & Valkenburg, H. A. (1994). Swimming pool chlorination: a health hazard? Toxicology Letters, 72(1-3), 375-380.
Andreoli, T.E., Carpenter, C.C., (2010). Respiratory Diseases from "Cecil Textbook of Medicine." Translated by G.R. Derakhshan Dilami and colleagues. Tehran: Nasle Farda, pp. 132-145.
Bar-Or, O., & Inbar, O. (1992). Swimming and asthma. Benefits and deleterious effects. Sports Medicine, 14, 397-405.
Beech, J. A., Diaz, R., Ordaz, C., & Palomeque, B. (1980). Nitrates, chlorates, and trihalomethanes in swimming pool water. American Journal of Public Health, 70(1), 79-82.
Bernard, A., Carbonnelle, S., Michel, O., Higuet, S., de Burbure, C., Buchet, J-P., Hermans, C., Dumont, X., & Doyle, I. (2003). Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools. Occupational and Environmental Medicine, 60, 385-394.
Black J.M., Hawkins H., (2010). Respiratory Disorders. Translated by Z. Mahdavi. Tehran: Jameh Negar: Salami Publications, pp. 56-63.
Bonetto G, Corradi M, Carraro S, Zanconato S, Alinovi R, Folesani, et al. Longitudinal monitoring of lung injury in children after acute chlorine exposure in a swimming pool. Am J Respir Crit Care Med 2006;174:545-9.
Bernard Al, Uyan ZS, Carraro S, Piacentini G, Baraldi E(2009). Swimming pool, respiratory health, and childhood asthma: should we change our beliefs? Pediatr Pulmonol;44:31-7.
Bernard A, Carbonnelle S, Dumont X, Nickmilder M (2007) Infant Swimming Practice, Pulmonary Epithelium Integrity, and the Risk of Allergic and Respiratory Diseases Later in Childhood. Pediatrics 119(6): 1095–103
Cammann K, Hubner K(1995). Trihalomethane concentrations in swimmers' and bath attendants' blood and urine after swimming or working in indoor swimming pools. Arch Environ Health;50(1):61-5. http://dx.doi.org/10.1080/00039896..9955013
Cammann, K., & Hubner, K. (1995). Trihalomethane concentrations in swimmers' and bath attendants' blood and urine after swimming or working in indoor swimming pools. Archives of Environmental Health, 50(1), 61-65.
Cheng YC, Macera CA, Addy CL, Sy FS, Wieland D, et al. (2003) Effects of physical activity on exercise tests and respiratory function. Br J Sports Med 37: 521–8.
Cassan D, Mercier B, Castex F, Rambaud A (2009) Effects of medium-pressure UV lamps radiation on water quality in a chlorinated indoor swimming pool. Chemosphere 62(9): 1507
Carbonnelle S, Francaux M, Doyle I, Dumont X, de Burbure C, et al. (2005) Changes in serum pneumoproteins caused by short-term exposures to nitrogen trichloride in indoor chlorinated swimming pools. Biomarkers 7(6): 464
Committee on Medical and Biological Effects of Environmental Pollutants, National Research Council (1976) Chlorine and hydrogen chloride. 116–23, National Academy of Sciences, Washington DC.
C Ondolo, S Aversa, et al., Jun 2009, Nasal and Lung function in competitive swimmers Acta Otorhinolaryngol Ital; 29(3): 137–143.
Drobnic F (2009) Health impact of compounds used in swimming pool water treatment: state of the question. Apunts Med Esport 161: 42–7.
Erdinger L, Kuhn KP, Kirsch F, Feldhues R, Frobel T, Nohynek B, et al(2004). Pathways of trihalomethane uptake in swimming pools. Int J Hyg Environ Health;207(6):571-5.
Font-Ribera L, Kogevinas M, Zock J-P, Nieuwenhuijsen MJ, Heederik D (2009) Swimming pool attendance and risk of asthma and allergic symptoms in children. Eur Respir J 34(6): 1304–10.
Fantuzzi G, Righi E, Predieri G, Giacobazzi P, Mastroianni K, Aggazzotti G(2010). Prevalence of ocular, respiratory, and cutaneous symptoms in indoor swimming pool workers and exposure to disinfection by-products (DBPs). Int J Environ Res Public Health;7(4):1379-91
Gilchrist HL, Matz PB (1933) The residual effects of warfare gases: the use of chlorine gas, with the report of cases. Med Bull Vet Admin 6, 229–70.
Goodman M, & Hays S(2008). Asthma and swimming: a meta-analysis. J Asthma;45:639-47.
G. Baraldi, Environmental Health Perspectives, Swimming pools, and childhood asthma: suggestive but inconclusive association. 117, 500-507.
Janson Media, Kogevinas M, Zock J-P, Go´mez FP, Barreiro E, et al. (2010). Short-Term Changes in Respiratory Biomarkers after Swimming in a Chlorinated Pool, Environ Health Perspect, 118(11):1538-1544.
Kilburn KH, Warshaw RH (1993) Effects on neurobehavioral performance of chronic exposure to chemically contaminated well water. Int’l Toxicol Ind Health 39, 391–404.
Kim B., et al. (2010). Respiratory Physiology Section from "Medical Physiology" by Ganong. Translated by R. Badenzadeh. Tehran: Sina Teb Publications: Jahan Adib Books, 2011, pp. 150-155.
Kim H, Shim J, Lee S(2002). Formation of disinfection by-products in chlorinated swimming pool water. Chemosphere;46(1):123-30. http://dx.doi.org/10.1016/S0045-6535(00)00581-6
Kilburn KH (1996) Effects of a hydrochloric acid spill on neurobehavioral and pulmonary function. J Occup Environ Med 38, 1019–25.
Kogevinas M, Villanueva MC, Font-Ribera L, Liviac D, Bustamante M, et al. (2010) Genotoxic Effects in Swimmers Exposed to Disinfection By-products in Indoor Swimming Pools. Environ Health Perspect 118(11): 1531–7. Figure 2. Changes in FVC pre and post-intervention. doi:10.1371/journal.pone.0068447.g002 Respiratory Health in Ozone and chlorine pools plus one
Kim H, Shim J, Lee S (2002) Formation of disinfection by-products in chlorinated swimming pool water. Chemosphere 46(1): 123–30
Lees-Haley PR, Brown RS (1992) Bias in perception and reporting following a perceived toxic exposure. Percep Motor Skills 75, 531–44.
Levy JM, Hessel SJ, Nykamp PW, Stegman CJ, Crowe JK, Spiegel RM, Horsley WW, Cook GC (1986) Detection of the cerebral lesions of chlorine intoxication by magnetic resonance imaging. Magnetic Resonance Imaging 4, 51–2.
Lourencetti C, Grimalt JO, Marco E, Fernandez P, Font-Ribera L, Villanueva CM, Kogevinas M(2012). Trihalomethanes in chlorine and bromine disinfected swimming pools: Airwater distributions and human exposure. Environ Int; 45:59-67.
Le´vesque B, Duchesne J-F, Gingras S, Lavoie R, Prud’Homme D, et al. (2006) The determinants of the prevalence of health complaints among young competitive swimmers. Int Arch Occup Environ Health 80(1): 32–9.
Longo D.L., et al. (2012). Respiratory System from "Harrison's Principles of Internal Medicine." Translated by M. Ghorbani and colleagues. Tehran: Nasle Farda, pp. 78-84.
Massin N, Bohadana AB, Wild P, Héry M, Toamain JP, Hubert G(1998). Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools. Occup Environ Med;55(4):258-63.
Misami, H., Amiri, F. (2013). Investigating the Effects of Pollutants in Swimming Pool Water on Swimmers' Health and Proposing Solutions to Mitigate Them. 10th National Conference on Environmental Health, Hamedan, p. 68.
Miller JA, Cohen GS, Warshaw RH, Thornton JC, Kilburn KH (1989) Choice (CRT) and simple reaction times (SRT) compared in laboratory technicians: factors influencing reaction times and a predictive model. Am J Ind Med 15, 687–97.
Miller A, Thornton JC, Warshaw R, Bernstein J, Selikoff IJ, Teirstein AS (1986) Mean and instantaneous expiratory flows, FVC and FEV1: prediction equations from a probability sample of Michigan, a large industrial state. Bull Eur Physiolopathol Respir 22, 589–97.
Martinez TT, Long C. Explosion risk from swimming pool chlorinators and review of chlorine toxicity. J Toxicol Clin Toxicol 1995;33:349-54.
Manvlyz A, Maikell b.Changes in serum pneumoproteins caused by short-term exposures to nitrogen trichloride in indoor chlorinated swimming pools
Nelemans, P. J., Rampen, F. H., Groenendal, H., Kiemeney, L. A., Ruiter, D. J., & Verbeek, A. L. (1994). Swimming and the risk of cutaneous melanoma. Melanoma Research, 4, 281-286. Reuters Health, (March 21, 2001). Bronchospasm in competitive swimmers.
Pourlatifi, A., Meshkibaf-Moghadam, Z. (2008). The Pattern of Public Swimming Pools (Standards). 1st Edition, Tehran: Lifeguard Federation, pp. 42-50.
Parimon T, Kanne JP, Pierson DJ(2004). Acute inhalation injury with evidence of diffuse bronchiolitis following chlorine gas exposure at a swimming pool. Respir Care;49:291-4.
Romberg K, Bjermer L, Tufvesson E (2011) Exercise but not mannitol provocation increases urinary Clara cell protein (CC16) in elite swimmers. Respir Med 105(1): 31–6.
Richardson SD, DeMarini DD, Kogevinas M, Fernandez P, Marco E, et al. (2010) What’s in the Pool? A Comprehensive Identification of Disinfection Byproducts and Assessment of Mutagenicity of Chlorinated and Brominated Swimming Pool Water. Environ Health Perspect 118(11): 1523–30.
Spivey A(2009). Widening the pool of factors: studies needed to assess asthma swimming link. Environ Health Perspect;117:A162.
Smith Mf, Fisk MZ, Steigerwald MD, Smoliga JM, Rundell KW(2010). Asthma in swimmers: A review of the current literature. Phys Sportsmed;38(4):28-34
Taheri Hosseinzadeh, H., Ebrahimizadeh, M., Bidaskan, A. (2008). Basic Human Anatomy. Mashhad University of Higher Education, Jahad Daneshgahi.
Thickett KM, McCoach JS, Gerber JM, Sadhra S, Burge PS.(2002). Occupational asthma is caused by chloramines in indoor swimming pool air. Eur Respir J;19(5):827-32.
Tager IB, Balmes J, Lurmann F, Ngo L, Alcorn S, et al. (2005) Chronic Exposure to Ambient Ozone and Lung Function in Young Adults. Epidemiology 16(6): 751–9
Voisin C, Sardella A, Marcucci F, Bernard A (2010) Infant swimming in chlorinated pools and the risks of bronchiolitis, asthma and allergy. Eur Respir J 36(1): 41–7.
Weisgerber M, Webber K, Meurer J, Danduran M, Berger S, Flores G(2008). Moderate and vigorous exercise programs in children with asthma: safety, parental satisfaction, and asthma outcomes. Pediatr Pulmonol;43:1175-82.
Weisel CP, Richardson SD, Nemery B, Aggazzotti G, Baraldi E, Blatchley ER III, Blount BC, Carlsen KH, Eggleston PA, Frimmel FH, et al. (2009). Childhood asthma and environmental exposures at swimming pools: state of the science and research recommendations. Environ Health Perspect;117:500-7
Winternitz MC (1920) Collected studies on the pathology of war gas poisoning. The Department of Pathology and Bacteriology, Medical Science Section, Chemical Warfare Service. Yale University Press, New Haven, CT.
