在室內游泳池游泳與哮喘風險有關


  2003年5月29日-根據一項發表於6月號Occupational and Environmental Medicine的文章表示,在室內游泳池游泳與哮喘的風險增加有關。
  
  布魯塞爾Louvain 天主教大學的Alfred Bernard博士表示,幼兒經常到含氯的游泳池中游泳,這與肺部上皮的通透性增加有關,並且會增加哮喘的風險,特別是與其它風險因素有關。
  
  引起這種反應的物質可能是三氯胺或三氯化氮,加氯消毒的一種高濃度揮發性副產物,很容易被人體吸入,或是當氯與尿、汗水,或其它有機物接觸時產生。
  
  在一項分成三部分的研究中,研究人員從農村和都市學校中,先測量226名健康小學孩童血清中肺部蛋白質(血清中的肺泡表面活化劑相關蛋白質A和B [ SP-A和SP-B ]、16 kDa的Clara 細胞蛋白質[ CC16 ]之含量)及IgE的含量。
  
  從早期的童年開始,這些孩子每週或每隔一個星期在室內的加氯游泳池中游泳。為了評估三氯胺的直接影響,Bernard博士的研究小組也分析了在室內游泳池游泳前後的16名5-14歲兒童以及26-47歲成人的血清。研究小組並使用1996 年到1999年之間,由1,881名7 到14歲兒童所估計的兒童哮喘流行率。
  
  肺上皮滲透性的最佳預測因子是累計的前往游泳池游泳比例,與血清SP-A和SP-B有關。雖然血清IgE與這種比例無關,但是由SP-B的測量可以得知,它與肺部的高滲透性有關。
  
  兒童和成人在室內游泳池游泳一個小時後,血清SP-A和SP-B顯著地增加了。累計的游泳池游泳比例顯著地與運動所導致的支氣管狹窄測試和總哮喘發生率有關。最頻繁游泳的孩子,肺部損傷與一般的吸煙者無異。
  
  因此我們假設,孩子增加暴露於室內游泳池中的氯產物,也許是童年時期哮喘和過敏發生率上升的重要原因,但還需要進一步流行病學的研究。我們提出的問題還包括,是否能研發不以氯為基礎物質的殺菌劑,或至少加強室內游泳池水質和空氣品質的管理,將人們暴露於這些化學物質的量降到最小。

Swimming in Indoor Pools Linke

By Laurie Barclay, MD
Medscape Medical News

May 29, 2003 — Swimming in indoor pools is associated with increasing risk of asthma, according to the results of a study published in the June issue of Occupational and Environmental Medicine.

"Regular attendance at chlorinated pools by young children is associated with an exposure dependent increase in lung epithelium permeability and increase in the risk of developing asthma, especially in association with other risk factors," write Alfred Bernard, from the Catholic University of Louvain in Brussels, Belgium, and colleagues.

The trigger seems to be trichloramine, or nitrogen trichloride, a highly concentrated volatile by-product of chlorination, which is readily inhaled and generated during contact between chlorine and urine, sweat, or other organic matter.

In a three-part study, the investigators first measured levels of lung proteins (serum alveolar surfactant-associated proteins A and B [SP-A and SP-B], 16 kDa Clara cell protein [CC16]) and IgE in sera of 226 healthy primary school children from rural and urban schools. Since early childhood, these children had swum regularly at indoor chlorinated pools weekly or every other week.

To evaluate the immediate effects of trichloramine, Dr. Bernard's group also analyzed sera from 16 children, aged 5 to 14 years, and 13 adults, aged 26 to 47 years, before and after swimming in an indoor pool. The group also assessed the prevalence of childhood asthma, using data from a survey done between 1996 and 1999 of 1,881 children aged 7 to 14 years.

The best predictor of lung epithelium permeability was cumulated pool attendance, which correlated with serum SP-A and SP-B. Although serum IgE was unrelated to pool attendance, it was positively correlated with lung hyperpermeability as measured by serum SP-B.

In children and adults attending an indoor pool, serum SP-A and SP-B increased significantly after one hour at poolside without swimming. Cumulated pool attendance significantly correlated with exercise-induced bronchoconstriction test and total asthma prevalence. For children who swam the most frequently, lung damage was equivalent to that found in regular smokers.

"We therefore postulate that the increasing exposure of children to chlorination products in indoor pools might be an important cause of the rising incidence of childhood asthma and allergic diseases in industrialised countries," the authors write, while recommending further epidemiological studies. "The question needs to be raised as to whether it would not be prudent in the future to move towards non-chlorine based disinfectants, or at least to reinforce water and air quality control in indoor pools in order to minimise exposure to these reactive chemicals."

AstraZeneca has provided a grant to one of the authors.

Occup Environ Med. 2003;60:385-394

Reviewed by Gary D. Vogin, MD

    
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