Hot Tub Lung Disease

[Gene]

Has anyone heard of Hot Tub Lung Disease before? I've had a chronic cough for 10 years, and just found out I have the bacteria Mycobacterium avium, which is the culprit in Hot Tub Lung Disease. It apparently happens when hot tubs aren't properly maintained. From the Mao Clinic:

"Hot tub lung" is an uncommon infection or allergic reaction of the lungs due to inhaling the bacterium Mycobacterium avium (M. avium) from a hot tub. M. avium belongs to the same class of bacteria that cause tuberculosis, but it's not contagious.

Hot tubs provide an ideal environment for the growth of bacteria, such as M. avium. Bacterial growth is more likely to occur in tubs that aren't cleaned as often as recommended. Also, added chlorine loses most of its disinfectant properties at temperatures above 84 F (29 C).

The bacteria get into your lungs when the bubbling hot tub water evaporates. The bubbles rise to the surface, burst and disperse the bacteria into the air. Hot tub lung can be easily prevented by properly maintaining your hot tub, or asking about the maintenance of hot tubs at spas or hotels.

from: http://www.mayoclinic.com/health/hot-tub-lung/AN00660

I've never heard of this before, and now it looks like I've got it! This is really scary! Why isn't this better known and advertised?

[Gene]

Has anyone heard of Hot Tub Lung Disease before? I've had a chronic cough for 10 years, and just found out I have the bacteria Mycobacterium avium, which is the culprit in Hot Tub Lung Disease. It apparently happens when hot tubs aren't properly maintained. From the Mao Clinic:

"Hot tub lung" is an uncommon infection or allergic reaction of the lungs due to inhaling the bacterium Mycobacterium avium (M. avium) from a hot tub. M. avium belongs to the same class of bacteria that cause tuberculosis, but it's not contagious.

Hot tubs provide an ideal environment for the growth of bacteria, such as M. avium. Bacterial growth is more likely to occur in tubs that aren't cleaned as often as recommended. Also, added chlorine loses most of its disinfectant properties at temperatures above 84 F (29 C).

The bacteria get into your lungs when the bubbling hot tub water evaporates. The bubbles rise to the surface, burst and disperse the bacteria into the air. Hot tub lung can be easily prevented by properly maintaining your hot tub, or asking about the maintenance of hot tubs at spas or hotels.

from: http://www.mayoclinic.com/health/hot-tub-lung/AN00660

I've never heard of this before, and now it looks like I've got it! This is really scary! Why isn't this better known and advertised?

ANother article from the CDC: http://www.cdc.gov/ncidod/eid/vol7no6/mangione.htm

[chem geek]

LouMart on this forum described his experience getting Hot Tub Lung here.

Could you describe your sanitation regimen for your spa? I've been collecting input on hot tub lung, itch, rash and seeing if there is a correlation based on the type of sanitation. For example, most incidents happened when using Dichlor after each soak (often daily) for more than one month (most more than two) or by not using enough sanitizer at all (i.e. chlorine only once a week).

[Gene]

LouMart on this forum described his experience getting Hot Tub Lung here.

Could you describe your sanitation regimen for your spa? I've been collecting input on hot tub lung, itch, rash and seeing if there is a correlation based on the type of sanitation. For example, most incidents happened when using Dichlor after each soak (often daily) for more than one month (most more than two) or by not using enough sanitizer at all (i.e. chlorine only once a week).

I use "The Natural" - an enzyme based liquid that is supposed to only be added once every three months, plus weekly non-chlorine shock. I've been reading up about The Natural and am no longer confident it is sufficient to keep the water healthy.

From everything I've read, Hot Tub Lung only occurs with people with indoor hot tubs - mine is outdoor, so I'm not sure that the mycobacterium avium in my lungs is actually from the hot tub - but as I've used the hot tub pretty much daily for 10 years, and the disease seems fairly rare, I'm assuming that's where I've gotten it from.

I will probably switch to Baquaspa from all that I've read here - seems like the best choice.

[Gene]

Well, according to my infectious disease specialist, I do NOT have hot tub lung, even though I have the same bacteria that causes it - mycobacterium avium. From what I understand, this bacteria is present everywhere - soil, drinking water, etc. When it gets into hot tub water and multiplies, it can cause a reaction if you breathe enough of it in the bubbles, and that causes hot tub lung. The origin of mine is unknown, but as hot tub lung seems to always occur with indoor hot tubs, and mine is outdoor, its pretty sure my hot tub is not the culprit.

What I have is more serious than hot tub lung, and I have to be on three antibiotics for a year or more. Hot tub lung just requires abstinence to clear it up.

Just wanted to share the information I found - hope it is useful to someone else.

[chem geek]

I am sorry to hear about your experience. I wouldn't be so sure that the bacteria didn't come from your hot tub. Yes, it is a common bacteria, but it only gets into your system if sufficient quantities get breathed in and that can happen in a hot tub, indoor OR outdoor, by the bacteria multiplying and forming biofilms. The aeration jets of the hot tub can dislodge clumps of bacteria biofilm and you can then breathe them in with quantities that are more than your immune system can handle, so they take hold.

I would not consider The Natural to be a sanitary system. The Natural sells bacterial test strips here though I'm not sure it would detect bacteria in biofilms though presumably some should be free floating in the water. The Natural works with seaweed enzymes and I can't find any scientific studies showing that this is effective as a sanitizer. It may be that the enzymes can inhibit bacteria growth, but without a test kit I don't know how you'd know that it really lasted for 3 months protecting the water. I also doubt that the enzymes accelerate normal dissolved oxygen oxidation to be as fast as chlorine so even if they slowed down bacterial growth it might not prevent biofilm formation that could be resistant to the enzymes. The bottom line is that the EPA only approves 3 fast-acting sanitizers: chlorine, bromine and biguanide/PHMB/Baqua. Nature2 with silver ion and MPS is either approved or close (their instructions that refer to using chlorine would certainly be approved; not clear about the MPS alone).

Why do you believe that only indoor hot tubs can have this problem? It may be more likely in indoor tubs due to poor air circulation so more likely to have concentrated spray be breathed in but that wouldn't rule out an outdoor hot tub.

I am going to add this case to my table as "possible" here.

[EDIT] I found this interesting post on this forum by Dr. Spa that may be referring to the same "The Natural" that you were using. [END-EDIT]

[Accent]

Hi,

I posted several months ago about hot tub cough. I was coughing and having tightness of breath when the bubbles were on - even just testing the water. I never saw a doctor about it. After a few posts and questions here, I super-shocked the tub, drained it, refilled, and followed a more careful regime of Nature2 + ozonator + alternating between 1tsp dichlor and 1tb MPS after each use and 1 oz of enzyme weekly in a 260 gallon tub. After a month or so out, I sometimes use an oz of bleach in stead of dichlor. I've gone away a lot during this time, so sometimes have had to shock a bit with extra chlorine. Overall, it seems to have worked pretty well, though now it's about 2.7 months into the fill and I'm starting to cough again and will probably refill soon. Oh yeah, twice when I've had a cough problem, it's been right after I used a clarifier (the kind that's supposed to make particles stick together). Who knows why, but I'm just going to avoid those in the future. In sum, I think this is a workable method for me, though not quite perfected yet.

Cheers

[Hillbilly Hot Tub]

It sounds like your combined chlorines maybe high since it seems to happen later into the tub fill. Also in another post you mention struggling with low PH. Low Ph can also irritate throat and nasel passages causing you to cough. Also at 3 months in, how high is the CYA in your tub?

If you want to try a clarifer I would try Sea Klear. It is a natural, made from crab shells. You can drink this stuff, not that I would! Many clarifiers have oils in them which could be irritating to some people (along with not making sense since you are trying to remove oils!)

[Accent]

It sounds like your combined chlorines maybe high since it seems to happen later into the tub fill. Also in another post you mention struggling with low PH. Low Ph can also irritate throat and nasel passages causing you to cough. Also at 3 months in, how high is the CYA in your tub?

If you want to try a clarifer I would try Sea Klear. It is a natural, made from crab shells. You can drink this stuff, not that I would! Many clarifiers have oils in them which could be irritating to some people (along with not making sense since you are trying to remove oils!)

My CYA levels are in the OK range, according to my test strips. I've tried to minimize the issue by alternating with MPS+Nature2 and using bleach at times. Also, the first time I had the cough problem was 4 weeks into the fill, not at the end. I think that was due to poor sanitizer maintenance from the last fill and into the next, but there was a use of clarifier right before I started coughing.

Sea Klear is the last clarifier I used in this fill. Totally coughed for a couple days after, who knows why.

[Dr. Spa]

One other thing to know, or keep in mind about clairifiers. Yes, they're supposed to cause smaller particles to combing together into something big enough to be filtered out. Sometimes though, those particles will be lighter than water. When tiny individual particles, they may be small enough to stay suspended throughout the water, but when combined together, they become large enough to float (this is one reason some people see a sticky goo floating on the water after using a clairifier).