02/24/2009 US EPA

COMMON HEALTH QUESTIONS RELATED TO MONOCHLORAMINE

25) Do chloramines cause breathing problems?

EPA believes that water disinfected with monochioramine that meets
regulatory standards has no known or anticipated adverse health effects,
including breathing problems.

•	Monochioramine does not enter the air easily and therefore would be
difficult to inhale.

•	CDC's investigation1 of reports of monochloramine-related breathing
problems associated with drinking water use was unable to draw any
conclusions about monochioramine use and health effects.

•	Breathing problems associated with trichloramine and indoor swimming
pools have been reported.2

Trichloramine3, a chemical related to monochioramine and often found in
swimming pools, has been linked to breathing problems.

•	Trichloramine forms in swimming pools when chlorine reacts with
ammonia from bodily fluids.

•	Breathing problems traceable to disinfected water are typically related to
swimming pool use.4

•	EPA continues to review research related to the use of disinfectants used
in swimming pools.

People who believe their breathing problems are related to
monochioramine should consult with their doctors.

•	The causes of breathing problems are often difficult to determine.

•	People who have breathing problems should inform their doctors if they
have spent time in or around a swimming pool recently.

•	CDC's investigation1 of reports of monochloramine-related breathing
problems associated with drinking water use was unable to draw any
conclusions about monochioramine and health effects.

Additional Supporting Information:

1.	CDC and EPA conducted a preliminary investigation of reports of monochloramine-
related respiratory problems associated with drinking water. The investigation consisted
of a questionnaire filled out by complainants. The information collected could be used to
help design future epidemiologic studies.

CDC's trip report can be found at:

http://healthvermont.gov/enviro/water/documents/CDC Chloramines report 011608.pdf.

2.	Reported breathing problems due to chloramines are primarily related to inhalation of
household chemicals (mixing ammonia and bleach cleaning products), indoor swimming
pool air, or industrial exposure. See question 1 for further information about different
types of chloramines.

3.	Trichloramine formation does not usually occur under normal drinking water
treatment conditions. However, if the pH is lowered below 4.4 or the chlorine to
ammonia-nitrogen ratio becomes greater than 7.6:1, then trichloramine can form.
Trichloramine formation can occur at a pH between 7 and 8 if the chloramine to
ammonia-nitrogen ratio is increased to 15:1. Source: Optimizing Chloramine
Treatment, 2nd Edition, AwwaRF, 2004.

4.	Improper pool maintenance can often lead to trichloramine formation: Some
examples include: www.cdc.qov/niosh/hhe/reports/pdfs/2007-0163-3062.pdf and
www.cdc.gov/mmwR/PDF/wk/mm5636.pdf.


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