Bernard Alfred, Carbonnelle Sylviane, de Burbure Claire, Michel Olivier, Nickmilder Marc
Department of Public Health, Catholic University of Louvain, Brussels, Belgium.
Environ Health Perspect. 2006 Oct;114(10):1567-73. doi: 10.1289/ehp.8461.
The pool chlorine hypothesis postulates that the rise in childhood asthma in the developed world could result at least partly from the increasing exposure of children to toxic gases and aerosols contaminating the air of indoor chlorinated pools. To further assess this hypothesis, we explored the relationships between childhood asthma, atopy, and cumulated pool attendance (CPA). We studied 341 schoolchildren 10-13 years of age who attended at a variable rate the same public pool in Brussels (trichloramine in air, 0.3-0.5 mg/m3). Examination of the children included a questionnaire, an exercise-induced bronchoconstriction (EIB) test, and the measurement of exhaled nitric oxide (eNO) and total and aeroallergen-specific serum IgE. CPA by children (range, 0-1,818 hr) emerged among the most consistent predictors of asthma (doctor diagnosed or screened with the EIB test) and of elevated eNO, ranking immediately after atopy and family history of asthma or hay fever. Although the risk of elevated eNO increased with CPA [odds ratio (OR) = 1.30; 95% confidence interval (CI), 1.10-1.43] independently of total or specific serum IgE, the probability of developing asthma increased with CPA only in children with serum IgE > 100 kIU/L (OR for each 100-hr increase in CPA = 1.79; 95% CI, 1.07-2.72). All these effects were dose related and most strongly linked to pool attendance before 6-7 years of age. Use of indoor chlorinated pools especially by young children interacts with atopic status to promote the development of childhood asthma. These findings further support the hypothesis implicating pool chlorine in the rise of childhood asthma in industrialized countries.
泳池氯假说假定，发达国家儿童哮喘发病率上升至少部分是由于儿童越来越多地接触到污染室内氯化泳池空气的有毒气体和气溶胶。为了进一步评估这一假说，我们探讨了儿童哮喘、特应性与累计泳池出勤时间（CPA）之间的关系。我们研究了341名10至13岁的学童，他们以不同的频率前往布鲁塞尔的同一个公共泳池（空气中三氯胺含量为0.3 - 0.5毫克/立方米）。对这些儿童的检查包括一份问卷、一项运动诱发支气管收缩（EIB）测试，以及呼出一氧化氮（eNO）、总血清免疫球蛋白E和过敏原特异性血清免疫球蛋白E的测量。儿童的CPA（范围为0至1818小时）是哮喘（医生诊断或通过EIB测试筛查）和eNO升高最一致的预测因素之一，仅次于特应性以及哮喘或花粉热家族史。尽管eNO升高的风险随CPA增加而增加[优势比（OR）= 1.30；95%置信区间（CI）为1.10 - 1.43]，且独立于总血清免疫球蛋白E或特异性血清免疫球蛋白E，但仅在血清免疫球蛋白E > 100 kIU/L的儿童中，患哮喘的概率随CPA增加而增加（CPA每增加100小时的OR = 1.79；95% CI为1.07 - 2.72）。所有这些影响都与剂量相关，并且与6至7岁之前的泳池出勤最为密切相关。特别是幼儿使用室内氯化泳池会与特应性状态相互作用，促进儿童哮喘的发展。这些发现进一步支持了在工业化国家中，泳池氯与儿童哮喘发病率上升有关的假说。
