Charles C Miller1, Katherine Calder-Becker, Francois Modave. 1. Department of Biomedical Sciences, Texas Tech University Health Sciences Center at El Paso Paul L. Foster School of Medicine, El Paso, TX 79905, USA. charles.miller@ttuhsc.edu
Abstract
BACKGROUND: Pulmonary edema related to water immersion has been reported in military trainees and scuba and breath-hold divers, but rarely in the community. To date, no risk factors for this phenomenon have been identified by epidemiological methods. Recently, sporadic reports of swimming-induced pulmonary edema (SIPE) have emerged in the triathlon community. We surveyed the population of a national North American triathlon organization (USA Triathlon) to determine prevalence of and risk factors for symptoms compatible with SIPE. METHODS: We surveyed the population of USA Triathlon through the organization's monthly newsletter distribution channel. We evaluated prevalence of symptoms compatible with pulmonary edema, and then followed up with a case-control study that included additional cases we had identified previously, to identify risk factors for this condition among triathletes. RESULTS: Symptom history compatible with SIPE was identified in 1.4% of the population. Associated factors identified in multivariable analysis included history of hypertension, course length of half-Ironman distance or greater, female gender and use of fish oil supplements. Of the 31 cases reported, only 4 occurred in the absence of any associated factors. CONCLUSIONS: The identification of hypertension and fish oil in particular as risk factors raise questions about the role of cardiac diastolic function in the setting of water-immersion cardiac preload, as well as the hematologic effects of fish oil. Mechanistic studies of these risk factors in a directly observed prospective cohort are indicated.
BACKGROUND:Pulmonary edema related to water immersion has been reported in military trainees and scuba and breath-hold divers, but rarely in the community. To date, no risk factors for this phenomenon have been identified by epidemiological methods. Recently, sporadic reports of swimming-induced pulmonary edema (SIPE) have emerged in the triathlon community. We surveyed the population of a national North American triathlon organization (USA Triathlon) to determine prevalence of and risk factors for symptoms compatible with SIPE. METHODS: We surveyed the population of USA Triathlon through the organization's monthly newsletter distribution channel. We evaluated prevalence of symptoms compatible with pulmonary edema, and then followed up with a case-control study that included additional cases we had identified previously, to identify risk factors for this condition among triathletes. RESULTS: Symptom history compatible with SIPE was identified in 1.4% of the population. Associated factors identified in multivariable analysis included history of hypertension, course length of half-Ironman distance or greater, female gender and use of fish oil supplements. Of the 31 cases reported, only 4 occurred in the absence of any associated factors. CONCLUSIONS: The identification of hypertension and fish oil in particular as risk factors raise questions about the role of cardiac diastolic function in the setting of water-immersion cardiac preload, as well as the hematologic effects of fish oil. Mechanistic studies of these risk factors in a directly observed prospective cohort are indicated.
Authors: Richard E Moon; Stefanie D Martina; Dionne F Peacher; Jennifer F Potter; Tracy E Wester; Anne D Cherry; Michael J Natoli; Claire E Otteni; Dawn N Kernagis; William D White; John J Freiberger Journal: Circulation Date: 2016-02-16 Impact factor: 29.690