Brief ReportSwimming-induced pulmonary edema in triathletes☆,☆☆
Section snippets
Background
Pulmonary edema of immersion has been reported in select populations such as submersion divers [1], [2], [3], [4] and combat swimmers [5], [6], but only sporadically in the community setting [7]. Aside from the studies of combat swimmers, who are typically subjected to intense swimming trials, often after massive hydration, no reports of more than a dozen community-based cases have appeared in the literature. Termed swimming induced pulmonary edema (SIPE), the phenomenon has been difficult to
Methods
No validated, community-based pulmonary edema questionnaire has appeared in the literature, so it was necessary for us to develop a survey for this purpose. We reviewed the symptom criteria described previously by Weiler-Ravell et al [5], but since we did not have the benefit of direct examination of our participants as Weiler-Ravell’s group had, we limited our case definition to “cough productive of pink frothy or blood-tinged secretions” for the analysis. This description is both
Results
The age distribution of the overall USA Triathlon population, excluding juniors, is shown in Fig. 1A. USAT statistics on newsletter reading rates indicate that approximately one percent (about 1,400) of the emailed newsletters are opened at each mailing. USAT surveys were returned by 1423 respondents over three cycles of distribution, which indicates that we received responses from 1.3% of the total population, but closer to 1/3 of the people who actually opened the newsletter. Of the 1423
Discussion
This is the first study to report a population-based estimate of SIPE prevalence in community triathletes, and is the first to report statistical risk factor associations in any population. Symptoms compatible with swimming-induced pulmonary edema are estimated to occur in 1.4 percent of triathlon participants in North America, as represented by the membership of the USA Triathlon organization. This is consistent with and well within statistical error of the prevalence of 1.8% reported by Adir
Acknowledgments
We are grateful to the Board of USA Triathlon, Inc., which distributed the prevalence survey, and to the members of the organization who participated in the survey. We are also grateful to Dan Empfield, publisher of slowtwitch.com, who hosted the discussion forum that facilitated the virtual meeting of the first few cases.
The three authors collaboratively designed the survey. Ms. Calder-Becker maintained the case directory. Dr. Miller and Dr. Modave analyzed the data. Dr. Miller wrote the
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This research was supported by departmental funds.
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No conflicts pertinent to the work presented in this article exist for any author.