Skip to main content

Table 3 Risk factors associated with SIPE

From: Occurrence, Risk Factors, Prognosis and Prevention of Swimming-Induced Pulmonary Oedema: a Systematic Review

References Study design Subjects Sample size and description Type of exposure Case definition Case ascertainment method Exposures investigated Findings Quality of evidence (see Additional file 4 for more detail)
Personal characteristics Environmental factors
Miller et al. [19] Case- control Triathletes 1400 members of USA Triathlon plus additional 11 cases (31 cases, 1380 controls) Varying Cough productive of pink frothy or blood-tinged secretions Survey of USA Triathlon members plus 11 cases from slowtwitch.com Age, sex, hypertension, diabetes, use of multivitamins, vitamin C, vitamin E, fish oil, flax oil, swimming skill, warm up, pre-swim hydration Wetsuit use, climate trained in, open water/pool, course distance Significant risk factors were hypertension, female sex, fish oil use and long course distance. Self-reported non-validated tool to detect SIPE cases. Limited statistical power due to relatively small sample size. Unclear when health conditions were diagnosed and if medication being taken
Shupak et al. [13] Prospective incidence study Military trainees (Israeli Navy) 35 males aged 18–19 performing 5 swimming trials (2.4–3.6 km) over 2 months (mid-Jan to mid-Mar). Trials were ≥ 1 week apart Moderately cold open sea, (16–18 °C), diving jackets, supine position with fins When, in the absence of prior seawater aspiration, the swimmer reported shortness of breath accompanied by coughing Post-swim questionnaire completed by all trainees Lung function, level of exertion None investigated Lung volume and mid-expiratory flow measured 12 months earlier was significantly lower in SIPE susceptible group compared to asymptomatic group. No correlation between level of exertion and occurrence of SIPE Self-reported non-validated tool to detect SIPE cases. Long period of time between screening and field study measurements. Limited statistical power due to relatively small sample size
Moon et al. [23] Clinical trial Triathletes, divers and one windsurfer 30 participants: 22 males, 8 females (10 cases, 20 controls) Varying No case definition provided Not reported Haemodynamics and gas exchange measurements None investigated SIPE group had significantly higher MPAP and PAWP, and lower tidal volume during immersed exercise Cases had a higher proportion of females and may have been physically fitter. Inconsistency in the way pre-exercise measurements were taken between cases and controls
  1. SIPE swimming-induced pulmonary oedema, MPAP mean pulmonary artery pressure, PAWP pulmonary artery wedge pressure