Scientific studies on the effects of chlorine on the nasal mucosa

Scientific review of nasal problems related to swimming: rhinitis, sinusitis, and irritation caused by chlorinated water and chloramines.

Rhinitis is very common among swimmers

• Swimmers (especially elite athletes) frequently report nasal symptoms and reduced nasal inspiratory flow after training; in a comparative study with runners, swimmers showed worsening nasal function post-exercise and symptoms consistent with “swimming-induced rhinitis.” AJRA 2010
• Reviews indicate a high prevalence of upper airway dysfunction in swimmers training in chlorinated pools. BJSM (review) OAJSM (review)

Role of chlorinated water and by-products (chloramines)

• Airborne trichloramine (NCl₃) in swimming pools is associated with ocular, nasal, and respiratory symptoms among workers and may show vertical gradients above the water surface, increasing exposure for swimmers. Ann Work Exposures Health 2024 OEM 1998 Indoor Air 2021
• Cross-sectional studies in pool staff show concentration-response relationships between NCl₃ and nasal irritation symptoms; biomarkers in nasal lavage and FeNO have also been evaluated. Int Arch Occup Environ Health 2012 J Expo Sci Environ Epidemiol 2012 J Occup Environ Hyg 2019
• Updated public health guidance summarizes the mechanism: chloramines irritate the skin, eyes, and airways (including the nose) when they off-gas, especially in indoor pools. CDC 2025

Data specific to swimmers’ noses

• Prospective cytology studies show that irritation from chlorinated water induces nasal dysfunction; swimmers display cytological alterations compared to athletes from other sports. Rhinology
• Pre-/post-swimming assessments show nasal disturbance and irritation, with measurements of nasal resistance and patency. Acta Otorhinolaryngol Italica
• The prevalence and clinical picture of non-allergic rhinitis in competitive swimmers have been described in the allergy literature. JACI (abstract)

Swimmer’s sinusitis

• Historical reports and clinical investigations show a higher presence of sinusitis and chronic rhinitis symptoms in swimmers compared with controls. Laryngo-Rhino-Otologie (1988)
• Recent pediatric case reports highlight the possible occurrence of complicated sinusitis in the context of pool exposure (sometimes involving unexpected pathogens). Paediatrics & Child Health 2023 preprint/abstract PDF

Breathing and exhalation (valve-based devices)

• Valve-based snorkels exist that were developed for breath-by-breath analysis during swimming (validated for VO₂ and gas exchange), but they are not designed to prevent nasal problems. This represents a gap where a mask that prevents water–nose contact while allowing exhalation could fit. Rodríguez et al. Guidetti et al. Sports Medicine 2023

Key references (direct links)

• Fonseca et al. Exercise-Induced Rhinitis in Competitive Swimmers, AJRA 2010. PDF (SAGE) • alternate PDF
• Pedersen et al. Airway dysfunction in swimmers, BJSM 2012. Website • PDF
• Barbini et al. Airway dysfunction in elite swimmers, OAJSM 2015. Full text
• Gelardi et al. Nasal dysfunction induced by chlorinated water in competitive swimmers, Rhinology. PDF
• Ondolo et al. Nasal and lung function in competitive swimmers, Acta Otorhinolaryngol Italica 2009. Abstract
• Non-Allergic Rhinitis in Competitive Swimmers, JACI (abstract). Link
• Kravitz et al. (Montréal). Association between airborne trichloramine and health symptoms in pool workers, AnnWEH 2024. Abstract
• Thickett et al. Respiratory symptoms and bronchial responsiveness in lifeguards, OEM 1998. Website
• Fantuzzi et al. Airborne trichloramine and symptoms in pool workers, J Expo Sci Environ Epidemiol 2012. PDF
• Nordberg et al. Airway irritation among indoor swimming pool personnel, Int Arch Occup Environ Health 2012. PDF
• CDC. Chloramines and Pool Operation, 2025. Page
• Abeytunge et al. Complicated sinusitis in an adolescent swimmer, Paediatrics & Child Health 2023. Abstract
• Rodríguez et al. Respiratory snorkel and valve system for breath-by-breath gas analysis in swimming. PDF
• Guidetti et al. Is the New AquaTrainer® Snorkel Valid for VO₂ Assessment in Swimming? PDF
• Silva et al. Swimming with the COSMED AquaTrainer and K5… (accuracy and repeatability). Record