A Pulmonologist's Perspective on Indoor Air Quality, and Blood/Water Chemistry (w/ Mike Fields, MD)

Imagine gasping for air in the middle of a swimming race, feeling like you're suffocating despite being surrounded by water. For countless swimmers, this nightmare scenario isn't just imagination—it's a harsh reality caused by poor indoor air quality at swimming facilities. In a revealing conversation on the Rule Your Pool podcast, Dr. Mike Fields, a pediatric pulmonologist with 18 years of experience, sheds light on a problem that has been quietly affecting athletes for decades.

The Hidden Health Crisis in Indoor Pools

Dr. Fields' journey into understanding indoor pool air quality began with his patients—young, dedicated swimmers who were experiencing breathing problems that couldn't be easily explained. As he observed these cases over nearly two decades of practice, a disturbing pattern emerged.

I've noticed over the years that I've had a lot of patients who are swimmers, high-level swimmers, who spend a lot of time, obviously, not only in the pool, but in the indoor pool environment. And they come to me with breathing problems that have been related to under the umbrella term of asthma... And in talking about it, it became apparent to me that this was much more of a problem indoors than outdoors.

— Dr. Mike Fields, Rule Your Pool Podcast

What makes Dr. Fields' observations particularly compelling is the specificity of the problem. These weren't just general breathing issues—they were directly tied to certain indoor pool environments. Some pools would trigger severe breathing troubles, while others caused no problems at all for the same athletes.

The symptoms these young athletes experience are both immediate and debilitating. They arrive at Dr. Fields' office with complaints of coughing, wheezing, shortness of breath, and an inability to complete their training sessions. For competitive swimmers pushing their bodies to the limit, these symptoms can be career-ending.

Understanding the Mechanics of Swimming-Related Breathing Problems

To grasp why indoor pools can be so problematic for respiratory health, it's essential to understand what happens in the body when airways become irritated. Dr. Fields uses a vivid analogy to explain the process:

The way I describe it is the two-lane, like a highway tunnel, two lanes, flat tile wall, smooth concrete floor, easy to go through. With that inflammation, it's like a spongy, wet wall. And instead of having a clean concrete floor, you then have mud, kind of gunk, mucus all over the floor... when you end up irritating things past that threshold, the muscles in the walls get mad and the muscles get tight.

— Dr. Fields, Rule Your Pool Podcast

This inflammation and constriction create the wheezing sound that many swimmers experience—the sound of air being forced through narrowed airways. For athletes who depend on efficient oxygen exchange to perform at their peak, this narrowing can be devastating.

The problem is particularly acute for swimmers because of their breathing patterns. Unlike other athletes who maintain relatively steady breathing rhythms, swimmers engage in intense cycles of breath-holding, explosive exhalation, and rapid inhalation—all while their faces are inches from the water surface where chloramine concentrations are highest.

The Chloramine Connection: When Pool Chemistry Goes Wrong

The root cause of many indoor pool air quality problems lies in the formation of chloramines—compounds created when chlorine reacts with organic matter like sweat, urine, and other bodily fluids. These chloramines don't just create that distinctive "pool smell"; they become airborne and can cause serious respiratory irritation.

Host Eric Knight brings a unique perspective to this discussion, having experienced the problem firsthand as a competitive swimmer before becoming an expert in both pool chemistry and HVAC systems. His personal story illustrates how quickly and severely these problems can manifest:

I was racing in 2009, and I had an asthma attack in the middle of the race. And I never had an asthma attack. Didn't know what that was. All I knew was I was suffocating in the middle of a race, and I had to get out... I hopped out and went out, and there was like an inch of snow on the ground. And I just remember fresh air... It was freezing cold, but it just felt—I just had to get outside.

— Eric Knight, Rule Your Pool Podcast

The severity of this problem extends beyond individual cases. Knight mentions that at some swim meets, ambulances idle in parking lots, ready for respiratory emergencies. In one particularly notable incident, Olympic swimmer Caleb Dressel had to leave a competition in an ambulance due to poor air quality.

The Engineering Challenge: When Two Worlds Don't Communicate

One of the most fascinating aspects of the indoor pool air quality problem is how it stems from a fundamental communication breakdown between two industries. Knight explains that pool professionals and HVAC professionals often "talk right past each other" because they use similar terminology in completely different ways.

For example, the word "return" means opposite things in each industry. In pool systems, returns send treated water back to the pool. In HVAC systems, returns bring air back to the system for treatment. This linguistic confusion can lead to serious design flaws in indoor pool facilities.

The solution requires expertise in both areas—understanding how pool chemistry affects air quality and how HVAC systems can be designed to properly remove chloramines from the air. Without this dual expertise, facilities end up with systems that look good on paper but fail to protect the health of swimmers and staff.

Treatment and Prevention: A Medical Perspective

From a medical standpoint, Dr. Fields emphasizes that swimmers experiencing these symptoms shouldn't have to choose between their sport and their health. Modern asthma treatments can be highly effective when properly applied:

One of the things that I say to my patients all the time is that if you have asthma, we should still have you being able to do everything you want to do, just like anybody else, maybe you need medicine, fine... I can't make somebody into an Olympic-level athlete, but I can certainly at least help them to not be held back by something that is a medical problem that can be treated.

— Dr. Fields, Rule Your Pool Podcast

However, medication should be viewed as a temporary solution while addressing the root cause—poor indoor air quality. The most effective approach combines proper medical treatment for affected individuals with systematic improvements to pool ventilation and water chemistry management.

Dr. Fields also notes that asthma is an umbrella term covering various subtypes of airway inflammation. What swimmers experience may be specifically exercise-induced asthma triggered by poor air quality, which requires targeted treatment approaches.

The Path Forward: Better Design, Better Health

The conversation between Dr. Fields and Eric Knight reveals that solutions to indoor pool air quality problems do exist, but they require proper implementation from the design phase. Key elements include:

• Proper ventilation systems designed specifically for indoor pool environments
• Careful management of pool chemistry to minimize chloramine formation
• Regular air quality monitoring and testing
• Clear communication between pool operators and HVAC professionals
• Education for swimmers, coaches, and facility managers about the health risks

The episode also touches on an intriguing parallel between pool chemistry and blood chemistry, highlighting how the same principles that keep pool water balanced also apply to maintaining proper pH and chemical balance in the human body. This connection underscores the importance of understanding chemistry in both contexts.

Conclusion: Taking Action for Healthier Swimming

The conversation with Dr. Fields illuminates a serious but largely preventable health crisis affecting swimmers at all levels. Poor indoor air quality isn't just an inconvenience—it's a significant health hazard that can end athletic careers and cause lasting respiratory problems.

The solution requires a multi-faceted approach combining proper facility design, diligent pool chemistry management, effective ventilation systems, and appropriate medical care for affected individuals. Most importantly, it requires recognition that this problem exists and commitment from facility owners, operators, and the broader swimming community to address it.

For swimmers experiencing breathing problems in indoor pools, Dr. Fields' message is clear: these symptoms are treatable, and you shouldn't have to choose between your sport and your health. Seek proper medical evaluation while advocating for better air quality at your training facilities.

As the swimming community becomes more aware of these issues, there's hope that future generations of swimmers won't have to suffer through the respiratory problems that have plagued so many athletes. With proper knowledge, design, and commitment, indoor pools can be both high-performance training environments and healthy spaces for everyone who uses them.

Episode Chapters

• 00:00 Introduction and Guest Background
• 05:00 Dr. Fields' Observations on Swimming-Related Breathing Problems
• 12:00 Eric Knight's Personal Experience with Indoor Pool Air Quality
• 18:00 Understanding Asthma and Wheezing in Swimmers
• 25:00 The Engineering Challenge of Indoor Pool Design
• 32:00 Treatment Approaches and Medical Perspective