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

	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

	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,

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