Aquatic Health Benefit Bulletin

NSPF is providing monthly Aquatic Health Benefit Bulletins (AHBB) that focus on different topic areas: athletes and non-impaired, cardiopulmonary & systemic, neurological & cognitive musculoskeletal, pediatric, and women's health. The monthly posts will include 300-500 vignettes written in laymen's terms and the corresponding scientific references. The bibliography is organized by a certain topic area with links to publications that are available online. The AHBB is a great resource for the pool and spa industry influencers who want to help build a demand for pools, spas, and aquatic facilities by promotion the benefits of water immersion and activity. It is also a perfect way for aquatic leaders to help promote healthier living and reduce drownings.


April 2018: Asthma & Allergy

Spotlight on Aquatics & Asthma & Allergy 


Asthma and SwimmingContent courtesy of the National Swimming Pool Foundation

Therapists and instructors who work in a therapeutic pool setting are in the “water quality” business. They are offering health and fitness through the judicious application of water. Unfortunately, sometimes it’s the air that needs quality control. Pools which do not properly manage the levels of disinfection byproducts in the air can create respiratory minefields for staff (who are in the pool area the most) and clients (especially the very young and those with pre-existing conditions). One of the culprits in the air quality game is chloramines. Chloramines are a special type of combined chlorine that form in water and then end up hovering as a heavier-than-air gas immediately above the surface of the pool. 

Pools that are not properly ventilated, especially those with inadequate fresh air exchange, are prime environments for chloramine buildup, especially in winter when there is even less air exchange in an attempt to reduce heat loss. A pool which does not adequately eliminate this hovering blanket of gases will make it impossible for the chloramines in the pool to end up in the air, essentially creating a log jam effect. The end result? Respiratory effects.

One of the age-old questions is whether individuals with asthma are more likely to pick swimming as a sport or whether people who choose swimming as a sport just end up with asthma. It may be a combination of the two, but one thing is clear: Pool staff are no longer in just the water quality business. Air quality is the newest game in town.

Recent publications: Systematic Reviews & Meta Analysis

Agopian, A. J., Lupo, P. J., Canfield, M. A., & Mitchell, L. E. (2013). Swimming pool use and birth defect risk. American Journal of Obstetrics and Gynecology, 209(3), 219.e1–9.

Andersson, M., Hedman, L., Nordberg, G., Forsberg, B., Eriksson, K., & Rönmark, E. (2015). Swimming pool attendance is related to asthma among atopic school children: a population-based study. Environmental Health, 14(1), 37.

Armbruster, D., Happel, O., & Scheurer, M. (2015). Emerging Nitrogenous Disinfection Byproducts: Transformation of the Antidiabetic Drug Metformin during Chlorine Disinfection of Water. Water Research, 79, 104–118. Retrieved from

Botlagunta, M. (2015). Water Chlorination and Its Relevance to Human Health. Asian Journal of Pharmaceutical and Clinical Research, 8(1), 20–24. Retrieved from

Drogui, P., & Daghrir, R. (2015). Chlorine for Water Disinfection: Properties, Applications and Health Effects. CO2 Sequestration, Biofuels and Depollution, 1–32. Retrieved from

Espín-Pérez, A., Font-Ribera, L., van Veldhoven, K., Krauskopf, J., Portengen, L., Chadeau-Hyam, M., … de Kok, T. M. (2018). Blood transcriptional and microRNA responses to short-term exposure to disinfection by-products in a swimming pool. Environment International, 110, 42–50.

Fantuzzi, G., Aggazzotti, G., Righi, E., Predieri, G., Castiglioni, S., Riva, F., & Zuccato, E. (2018). Illicit drugs and pharmaceuticals in swimming pool waters. Science of The Total Environment, 635, 956–963.

Gallè, F., Dallolio, L., Marotta, M., Raggi, A., Di Onofrio, V., Liguori, G., … Leoni, E. (2016). Health-Related Behaviors in Swimming Pool Users: Influence of Knowledge of Regulations and Awareness of Health Risks. International Journal of Environmental Research and Public Health, 13(5), 513.

Hang, C., Zhang, B., Gong, T., & Xian, Q. (2016). Occurrence and health risk assessment of halogenated disinfection byproducts in indoor swimming pool water. Science of the Total Environment, 543, 425–431. Retrieved from

Hansen, K. M. S., Spiliotopoulou, A., Cheema, W. A., & Andersen, H. R. (2016). Effect of ozonation of swimming pool water on formation of volatile disinfection by-products - A laboratory study. Chemical Engineering Journal, 289, 277–285. Retrieved from

Hildenbrand, K., Freson, T. S., Barbosa-, C., Nordio, S., Becker, B. E., & Miller, A. J. (2011). The Impact of an Aquatic Exercise Protocol on Physiologic Measures within an Asthmatic Population. International Journal of Aquatic Research and Education, 5(4), 378–388. Retrieved from

Hildenbrand, K., Nordio, S., Freson, T. S., & Becker, B. E. (2010). Development of an Aquatic Exercise Training Protocol for the Asthmatic Population. International Journal of Aquatic Research {&} Education, 4(3), 278–299.

Janyacharoen, T., Kunbootsri, N., Arayawichanon, P., Chainansamit, S., & Sawanyawisuth, K. (2015). Responses of Six-Weeks Aquatic Exercise on the Autonomic Nervous System, Peak Nasal Inspiratory Flow and Lung Functions in Young Adults with Allergic Rhinitis. Iranian Journal of Allergy, Asthma and Immunology, 14(3), 280–6. Retrieved from

Li, J., Wang, W., Moe, B., Wang, H., & Li, X. (2015). Chemical and Toxicological Characterization of Halobenzoquinones, an Emerging Class of Disinfection Byproducts. Chemical Research in Toxicology, 28(3), 306–318. Retrieved from

Marco, E., Lourencetti, C., Grimalt, J. O., Gari, M., Fernández, P., Font-Ribera, L., … Kogevinas, M. (2015). Influence of physical activity in the intake of trihalomethanes in indoor swimming pools. Environmental Research, 140, 292–299.

Mountjoy, M., Fitch, K., Boulet, L.-P. P., Bougault, V., van Mechelen, W., & Verhagen, E. (2015). Prevalence and characteristics of asthma in the aquatic disciplines. The Journal of Allergy and Clinical Immunology, 136(3), 588–594.

Peng, D., Saravia, F., Abbt-Braun, G., & Horn, H. (2016). Occurrence and simulation of trihalomethanes in swimming pool water: A simple prediction method based on DOC and mass balance. Water Research, 88, 634–642. Retrieved from

Seys, S., Hox, V., Gerven, L. Van, & Dilissen, E. (2015). Damage‐associated molecular pattern and innate cytokine release in the airways of competitive swimmers. Allergy, 70(2), 187–194. Retrieved from

Soltermann, F. (2015). Trichloramine in swimming pool water: analysis methods, factors influencing its fate and effects of UV treatment. ETH-Zurich. Retrieved from

Spiliotopoulou, A., Hansen, K. M. S., & Andersen, H. R. (2015). Secondary formation of disinfection by-products by UV treatment of swimming pool water. Science of the Total Environment, 520, 96–105. Retrieved from

Spiliotopoulou, A., Hansen, K. M. S., & Andersen, H. R. D. (2015). Disinfection by-product formation of UV treated swimming pool water. In Proceedings of the 6th International Conference Swimming Pool & Spa. Retrieved from

van Veldhoven, K., Keski-Rahkonen, P., Barupal, D. K., Villanueva, C. M., Font-Ribera, L., Scalbert, A., … Kogevinas, M. (2018). Effects of exposure to water disinfection by-products in a swimming pool: A metabolome-wide association study. Environment International, 111, 60–70.

Villanueva, C., & Cordier, S. (2015). Overview of Disinfection By-products and Associated Health Effects. Current Environmental Health Reports, 2(1), 107–115. Retrieved from

Wang, D., Bolton, J., Andrews, S., & Hofmann, R. (2015). Formation of disinfection by-products in the ultraviolet/chlorine advanced oxidation process. Science of the Total Environment, 518, 49–57. Retrieved from

Włodyka-Bergier, A., & Bergier, T. (2015). Impact of UV disinfection on the potential of model organic-nitrogen precursors to form chlorination by-products in swimming pool water. Desalination and Water Treatment, 57(3), 1499–1507. Retrieved from