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Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1095-1103 (doi:10.1542/peds.2006-3333)
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ARTICLE

Infant Swimming Practice, Pulmonary Epithelium Integrity, and the Risk of Allergic and Respiratory Diseases Later in Childhood

Alfred Bernard, PhD, Sylviane Carbonnelle, MD, Xavier Dumont, BSc, Marc Nickmilder, PhD

Unit of Toxicology, Department of Public Health, Faculty of Medicine, Catholic University of Louvain, Brussels, Belgium

OBJECTIVE. Irritant gases and aerosols contaminating the air of indoor swimming pools can affect the lung epithelium and increase asthma risk in children. We evaluated the impact of infant swimming practice on allergic status and respiratory health later in childhood.

METHODS. Clara cell protein, surfactant-associated protein D, and total and aeroallergen-specific immunoglobulin E were measured in the serum of 341 schoolchildren aged 10 to 13 years, among whom 43 had followed an infant swimming program. Asthma was defined as doctor-diagnosed asthma and/or positive exercise-induced bronchoconstriction (15% decrease in postexercise forced expiratory volume).

RESULTS. There were no significant differences between the infant swimming group and the other children regarding the levels of exhaled nitric oxide and total or aeroallergen-specific serum immunoglobulin E. Children who swam as infants showed, by contrast, a significant decrease of serum Clara cell protein and of the serum Clara cell protein/surfactant-associated protein D ratio integrating Clara cell damage and permeability changes of the lung epithelial barrier. These effects were associated with higher risks of asthma and of recurrent bronchitis. Passive exposure to tobacco alone had no effect on these outcomes but seemed to interact with infant swimming practice to increase the risk of asthma or of recurrent bronchitis.

CONCLUSIONS. Our data suggest that infant swimming practice in chlorinated indoor swimming pools is associated with airways changes that, along with other factors, seem to predispose children to the development of asthma and recurrent bronchitis.

Key Words: chlorine • trichloramine • nitrogen trichloride • baby swimming • Clara cell protein • CC16 • childhood asthma • recurrent bronchitis

Abbreviations: NO—nitric oxide • eNO—exhaled nitric oxide • EIB—exercise-induced bronchoconstriction • FEV1—forced expiratory volume in 1 second • CC16—Clara cell protein • SP-D—surfactant-associated protein D • IgE—immunoglobulin E • OR—odds ratio • CI—confidence interval

Accepted Jan 25, 2007.


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