Respiratory Function and Changes in Lung Epithelium Biomarkers after a Short-Training Intervention in Chlorinated vs. Ozone Indoor Pools

BACKGROUND Swimming in indoor pools treated with combined chemical treatments (e.g. ozone) may reduce direct exposure to disinfection byproducts and thus have less negative effects on respiratory function compared to chlorinated pools. The aim of this study is to analyze the effects of a short-term training intervention on respiratory function and lung epithelial damage in adults exercising in indoor swimming pool waters treated with different disinfection methods (chlorine vs. ozone with bromine). METHODS Lung permeability biomakers [surfactant protein D (SP-D) and Clara cell secretory protein (CC16) in plasma] and forced expiratory volumes and flow (FEV1, FVC and FEF25-75) were measured in 39 healthy adults. Thirteen participants swam during 20 sessions in a chlorinated pool (CP), 13 performed and equivolumic intervention in an ozone pool (OP) and 13 were included in a control group (CG) without exposition. RESULTS Median plasma CC16 levels increased in CP swimmers (4.27 ± 3.29 and 6.62 ± 5.51 µg/L, p=0.01, pre and post intervention respectively) while no significant changes in OP and CG participants were found. No significant changes in median plasma SP-D levels were found in any of the groups after the training period. FVC increased in OP (4.26 ± 0.86 and 4.43 ± 0.92 L, p<0.01) and CP swimmers (4.25 ± 0.86 and 4.35 ± 0.85 L, p<0.01). FEV1 only increased in OP swimmers (3.50 ± 0.65 and 3.59 ± 0.67, p=0.02) and FEF25-75 decreased in CP swimmers (3.70 ± 0.87 and 3.37 ± 0.67, p=0.02). CONCLUSION Despite lung function being similar in both groups, a higher lung permeability in CP compared to OP swimmers was found after a short-term swimming program. Combined chemical treatments for swimming pools such as ozone seem to have less impact on lung epithelial of swimmers compared to chlorinated treated pools.