milica

Question

I have a question whether CF patients are not allowed to swim in stagnant water. And how is it with swimming in the sea?

Answer

Thank you for your question. One of the important bacteria in CF is P. aeruginosa as this bacteria is associated with increased decline in lung function and increased symptoms. The guideline referenced below on travelling with CF includes some very important relevant information that answers your question. As described by Hirche et al 2010- most water reservoirs are natural habitats of P. aeruginosa, including sea shores, lakes and rivers. However, there is ongoing controversy about to what extent these sources pose a risk of CF-related lung infection. Whether or not the use of swimming pools should be discouraged is also under debate. Most CF centres allow their patients the use of public pools that are certified by local health authorities. However, the risk of bacterial transmission might be related to the practice used for water disinfection, which differs throughout Europe: The prevalence of P. aeruginosa in public swimming pools was reported to be 4-7% in Switzerland. In contrast, a study from Northern Ireland detected P. aeruginosa in up to 38% of public swimming pool. In the latter study, the prevalence of P. aeruginosa was even higher in private pools and jacuzzis (whirlpools) (72%). There was a similar trend in respect to public and private hydrotherapy pools.
So to summarise, CF patients should weigh the risk before using private pools or spas. Well maintained/chlorinated public pools have a much lower risk than small private pools and jacuzzis (whirlpools). Most CF centres tend to advise CF patients where possible to swim in public pools that are certified by local health authorities. Lakes and rivers do not contain salty water and are not controlled for their bacteria content, especially the stagnat water in lakes represents a risk, therefore bathing for CF patients remain problematic. Even if Pseudomonas aeruginosa can be found at sea shore, the salty cold sea water inhibits the growth/survival of Pseudomonas aeruginosa, therefore bathing in the sea is not regarded as being problematic.
I hope this answers this important and difficult question
Best wishes
Judy Bradley Reader in Physiotherapy Adult CF Centre Belfast
Damien Downey Consultant Physician Adult CF Centre Belfast

08.06.2011

The answer is edited by: PhD Lisa Kent