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How does a hospital ward resemble an indoor swimming pool?

How does a hospital ward resemble an indoor swimming pool?
Many studies show an increased risk of asthma and occupational asthma in cleaners, healthcare workers and elite swimmers. There is reasonable evidence that chloramines, particularly nitrogen trichloride, is responsible in swimmers and indoor swimming pool attendants. Cleaners using bleach and chlorine-releasing agents are more at risk than those not using them. For the first time there may be an explanation and that chloramines can be the link. When chlorine reacts with protein chloramines are formed. Most challenge tests with chlorine-based cleaners have been inconclusive. This study shows that when a protein source (urine in this instance) was added to the chlorine-releasing cleaner, a positive challenge resulted. It was negative following exposure to either of the agents alone.

References

Abstract Available for What causes occupational asthma in cleaners? Moore VC, Burge PS, Robertson AS, Walters GI, What causes occupational asthma in cleaners?, Thorax, 2017;72:581–583.,org/10.1136/ thoraxjnl-2016-208827
Sherwood Burge, Oasys, an author of 'What causes occupational asthma in cleaners?' Vicky Moore, Oasys, an author of 'What causes occupational asthma in cleaners?' Alastair Robertson, Selly Oak Hospital, an author of 'What causes occupational asthma in cleaners?' Gareth Walters, Heartlands, an author of 'What causes occupational asthma in cleaners?'

Full Text Available for Occupational asthma caused by chloramines in swimming-pool air Thickett KM, McCoach JS, Gerber JM, Sadra S, Burge PS, Occupational asthma caused by chloramines in swimming-pool air, Eur Respir J, 2002;19:827-832,
Sherwood Burge, Oasys, an author of 'Occupational asthma caused by chloramines in swimming-pool air' Jennifer McCoach (now Croft), Oasys, an author of 'Occupational asthma caused by chloramines in swimming-pool air' Steve Sadra, Institute of Occupational and Environmental Health, Birmingham, an author of 'Occupational asthma caused by chloramines in swimming-pool air'

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