Hot Tub Precautions for Water Quality?

[starion]

Dear LungLine Nurse,
Our neighbors just installed a hot tub outdoors in their shady backyard in Hawaii (though they plan to keep it covered when not in use to minimize leaves and yard debris from falling into it).  
I've read a lot about the dangers of "hot tub lung," but the National Jewish & other articles I've read about it seem to be exclusively regarding INDOOR pools, hot tubs and fountains.  
They plan to closely monitor the water quality of their tub, but are there any particular guidelines/caveats/articles you could recommend to keep their hot tub as safe as possible in terms of water qualilty?  They are using bromide instead of chlorine in their hot tub & it was primarily purchased for their adult son who has muscular dystrophy and is confined to a wheelchair.  We would all like for them to enjoy their new hot tub--SAFELY!
Many thanks for any help you can lend all of us.
Aloha,
Starion

[National Jewish]

Currently the best recommendation is to follow hot tub manufacturer's cleaning and disinfecting guidelines.  The risk for hot tub lung seems to be lessened if it is an outdoor tub as opposed to an indoor tub.

[starion]

Thanks LungLine Nurse & Friends,
They are following the manufacturer's instructions VERY CAREFULLY.  Thanks again!
Aloha,
Starion

[anon074]

hi there

i am not a doctor, but i have heard that most importanlty is to keep the jets nice and clean, and that the jets that spray the water can harm your lungs, the vapor that the jets spray are so tiny that they are easily tranferred into your lungs, therefore if the jets are dirty it can effect your lungs.