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| A post-workout soak in the hot tub is decadent reward for a day of hard work—but what makes you feel great, may also make you sick. ‘Hot tub lung’ behaves like asthma or bronchitis—and it looks as if even your shower has the potential to make you ill.
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Hot tub owners consider yourself warned: bacteria may be thriving in your bubbly midst and gearing up for an unwelcome invasion of your lungs, resulting in breathlessness, coughing and other uncomfortable symptoms.
Hot water can play unwitting host to a strain of bacterium called Mycobacterium avium complex (MAC) that, once inhaled, can cause a troublesome immune reaction in the lungs.
“M. avium sneaks into the lungs via the bubbles produced by the water jets. These bacterium-carrying bubbles rise to the surface and produce a mist, which is then inhaled into the lungs,” says Dr. Viktor Hanak, pulmonary fellow at the Mayo Clinic in Rochester, Minnesota.
Hot tub lung is not contagious, but it can travel in the form of water droplets, infecting those in the general area of the hot tub. Simply cleaning an infected hot tub filter may even result in slight symptoms.
Part of the same class of bacteria that cause tuberculosis, M. avium can produce a range of symptoms including breathlessness, fatigue, cough, chills, fever and tightness in the chest.
The infection appears to be on the rise particularly, if inexplicably, among postmenopausal, white, non-smoking women especially those, it would seem, who prefer a shower to a bath—the warm mist generated by a shower in an enclosed stall can be problematic for some.
Although almost all of us are exposed to the bacteria—it flourishes wherever there is warm moist air or water—only some of us will become ill and even the experts aren’t sure why.
Hot tub enthusiasts are vulnerable on a regular basis, which reinforces the importance of being both informed and vigilant.
Poor hot tub maintenance is the main culprit, according to Dr. Hanak, who led a recent investigation into the uncommon affliction. Relying on disinfectant alone won’t cut it when it comes to keeping your tub safe—water temperature above 84 degrees impairs chlorine’s disinfectant abilities. Lax hygiene—not changing the water frequently—creates an ideal environment for bacteria to thrive. Changing the water monthly or as directed by the manufacturer, using disinfectant and showering before entering the hot tub are two ways to keep you and your tub healthy.
Owners of indoor hot tubs should pay special care as the infectious mist lingers in an enclosed space. (Experts advise you install hot tubs in an open rather than enclosed space to avoid this problem.) There have only been a few cases of HTL associated with outdoor hot tubs.
HTL’s uncommonness makes accurate diagnosis more difficult. Doctors don’t usually make the connection between a patient’s symptoms and hot tub use and as a result the condition can worsen due to misdiagnoses of asthma or bronchitis.
Letting your doctor know that you own or have recently been in a hot tub is important once you present with symptoms. Diagnosis may necessitate undergoing a chest X-ray or CT scan of the lungs, and often a sample of the water will be tested for the presence of M. avium.
Treatment means saying goodbye to the hot tub for a long time—most patients will recover quickly after a tub’s draining and removal. But recovery can take up to a year in some cases—and may even necessitate the use of corticosteroids to control the inflammation. In severe instances, supplemental oxygen is required. Though extreme cases exist, complete recovery is the norm, and HTL generally does not result in lasting damage to the lungs.
How to Avoid Hot Tub Lung:
The Centers for Disease Control and Prevention, which lists HTL as an emerging infectious disease, recommends the following guidelines for the proper treatment and maintenance of water in hot tubs:
- During operation, test the water hourly. Ensure optimal disinfectant ranges—Free chlorine 2-5 ppm; Bromine 2-5 ppm; pH 7.2-7.8 ph level.
- "Shock-treat" the water with disinfectant after use.
- Break up the scum layer by scrubbing before shock treating. This layer can protect germs from the killing power of your disinfectant.
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