INTRODUCTION
The quality of the water and the air of swimming-pools is currently a
topic of interest in occupational and environmental health. Even though
the beneficial effects of swimming on increasing physical activity,
cardiopulmonary fitness and improving lung function are
undeniable1, concerns have been raised regarding the
potential negative effects on human health of water disinfectants used
in swimming-pools.
The World Health Organization (WHO) highlights the need of adequate
water disinfection of swimming-pools to prevent microbial proliferation.
Disinfectants are the principal management-derived chemicals added to
minimize the risk of microbial contaminants, and although several
options are available (bromine, ozone, copper-silver, UV irradiation,
electrochemically generated mixed oxidants, UV/hydrogen peroxide, etc)
chlorine-based products have been typically preferred due to their
effectiveness and lower overall relative cost, in spite of possibly
leading to unwanted effects.
Indoor swimming-pools are of particular concern since they are used
regularly all year round, and volatile
chlorination by-products (CBPs)
can become trapped within the swimming-pool complexes indoor air. The
higher the concentration of these volatile CBPs in the water, the higher
their concentration in the air above the pool2.
Besides inhalation of volatile or aerosolized solutes, there are two
other main routes of exposure to chemicals in swimming-pools: water
ingestion, and skin absorption (which may represent a source of
muco-cutaneous symptoms). These several routes add to the individual
“exposome”, which comprises all environmental exposures that a person
experiences from conception throughout the lifespan3.
CBPs may affect the respiratory and skin health of those who stay indoor
for long periods, such as swimming instructors, pool staff, and
competitive swimmers. Whether those who use chlorinated-pools as
customers, particularly children, may also be affected has been a matter
of debate. We aimed to review this topic, by describing the chemical and
toxicity of these compounds given the types of exposure and reviewing
health effects of such exposures in different populations considering
also personal and environmental risk factors, in order to propose
recommendations and to identify unmet needs in this area.