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This study represents the first systematic review and meta-analysis conducted to assess the association between swimming in recreational water and the occurrence of respiratory illness. Most studies focus their attention on gastrointestinal illnesses occurring after exposure to microbial polluted water. Fourteen independent studies that included 50,117 patients with significant heterogeneity (I(2) = 95.3%) were reviewed. The meta-analysis reports that people exposed to recreational water (swimmers/bathers) present a higher risk of respiratory illness compared to non-swimmers/non-bathers [relative risk (RR) = 1.63 (confidence interval at 95% [95% CI]: 1.34-1.98)]. This percentage increases if adjusted RR by age and gender [RR = 2.24 (95% CI: 1.81-2.78)] are considered. A clear association between swimming in recreational water and the occurrence of respiratory illness was found. The surveillance of water quality monitoring systems is crucial not only for gastrointestinal illness, but also for respiratory ones.