Asthma and diving

[ScubaDocER]

ScubaDocER,

I really like your approach. I totally agree that it is not without risks. On balance, after educating myself through my own readings and two medical opinions, I decided to take the risks. I am very well aware of the signs my body sends me and quite willing to cancel a dive if my body is telling me to refrain from doing it.

Thank you all for all the replies to this thread...

You are quite welcome. I wish you many years of happy diving. It is a fantastic sport that people have enjoyed for years. I am still relatively new to Scuba Board and think this is a fantastic place to learn and grow. I have learned more from participating in this environment than I have from any place else. I hope I can contribute to others as they have contributed to me.

 

[offthewall1]

Until the medical community can support them better, agencies and Instructors will probably still not teach asthmatics to dive.

To my knowledge, all agencies and most Instructors allow Asthmatics to dive. I can at least speak for the ones through which I'm certified to teach. All three agencies require a medical form to be completed. On all three there is a box for Asthma. In all cases, a YES to the Asthma question does not deny the person. What it does mean is the person is given a Medical Form to be completed and signed off on by their doctor... stating that the doctor clears them for diving.

This has been going on for at least the past decade. I know many people who dive with varying degrees of asthma and have done so for many years and hundreds of dives with no ill effect.

Diving with asthma is the choice of two people. The student and the students doctor. There are certainly considerations to be aware of... but even in Australia (one of the toughest on medical issues in diving,) checking yes to Asthma is not an automatic NO. It does mean you must have the Spiro test completed prior to diving.

 

[Jumpinghorse]

My husband has asthma and have dove hundreds of dives. His dive doctor, which was trained in dive medicine, gave him the ok to dive. He makes sure he is not congested or short of breath before diving. If he even feels a little bit off, he wont dive. He ascends VERY VERY slowly as well since he knows his lungs contain scar tissue. He has never had any trouble at all. He is well aware of the increased risk as well. For him, the benefit outweighs the risk.

 

[ScubaDocER]

To my knowledge, all agencies and most Instructors allow Asthmatics to dive. I can at least speak for the ones through which I'm certified to teach. All three agencies require a medical form to be completed. On all three there is a box for Asthma. In all cases, a YES to the Asthma question does not deny the person. What it does mean is the person is given a Medical Form to be completed and signed off on by their doctor... stating that the doctor clears them for diving.

This has been going on for at least the past decade. I know many people who dive with varying degrees of asthma and have done so for many years and hundreds of dives with no ill effect.

Diving with asthma is the choice of two people. The student and the students doctor. There are certainly considerations to be aware of... but even in Australia (one of the toughest on medical issues in diving,) checking yes to Asthma is not an automatic NO. It does mean you must have the Spiro test completed prior to diving.

The agencies don't allow students with asthma to be trained to dive as much as they defer to the medical community and the Instructor to approve for the student to be allowed to be trained. As stated in previous posts, a medical clearance is not a protective hand from God saying that you are alright to dive. It is an educated guess made by a physician that the chances of anything happening to you while diving are acceptably small. The "small" window of acceptability is between the agency, the student, and the Instructor. The physician's decision is based on evaluations done on dry land, not in water. They are extrapolating that if you fit to engage in certain activities above water, then this translates laterally into you being able to perform underwater and this simply is not the case. There is no above ground test, not spriometery, pulmonary function tests, not a CT of your chest, that can clear you for diving with asthma. What they WILL do is exclude you from diving if the results are bad enough. If your PFTs are low, your CT is abnormal, or your spriometery test is poor, then you can be excluded. But normal tests do not include you. I suppose my desire is to educate people that a medical clearance is not always what you may want it to be.

With regard to the medical release form. Checking yes to a box is does not automatically exclude you from diving. It is a screening process to decide if there are certain people who should not be allowed to dive from a medical prospective. By the same token, a physician saying you are "fit" to dive does not confer immunity to harm or that is "alright" to dive given that you have asthma. Please see previous posts regarding the dangers associated with diving and having an acute asthma attack underwater. To enhance your chances of successfully completing a dive, one must be educated and willing to accept the risks they undertake to dive. These risks are separate from non-asthmatic divers. If you and your Instructor accept these risks, then the choice remains an individual one.

There will always be cases of divers who successfully dive with many medical conditions, be they asthma, seizures, sinus disease, or any other malady. The decision to dive is often a personal one more so than a medical one.

 

[offthewall1]

The agencies don't allow students with asthma to be trained to dive as much as they defer to the medical community and the Instructor to approve for the student to be allowed to be trained. As stated in previous posts, a medical clearance is not a protective hand from God saying that you are alright to dive. It is an educated guess made by a physician that the chances of anything happening to you while diving are acceptably small. The "small" window of acceptability is between the agency, the student, and the Instructor. The physician's decision is based on evaluations done on dry land, not in water. They are extrapolating that if you fit to engage in certain activities above water, then this translates laterally into you being able to perform underwater and this simply is not the case. There is no above ground test, not spriometery, pulmonary function tests, not a CT of your chest, that can clear you for diving with asthma. What they WILL do is exclude you from diving if the results are bad enough. If your PFTs are low, your CT is abnormal, or your spriometery test is poor, then you can be excluded. But normal tests do not include you. I suppose my desire is to educate people that a medical clearance is not always what you may want it to be.

With regard to the medical release form. Checking yes to a box is does not automatically exclude you from diving. It is a screening process to decide if there are certain people who should not be allowed to dive from a medical prospective. By the same token, a physician saying you are "fit" to dive does not confer immunity to harm or that is "alright" to dive given that you have asthma. Please see previous posts regarding the dangers associated with diving and having an acute asthma attack underwater. To enhance your chances of successfully completing a dive, one must be educated and willing to accept the risks they undertake to dive. These risks are separate from non-asthmatic divers. If you and your Instructor accept these risks, then the choice remains an individual one.

There will always be cases of divers who successfully dive with many medical conditions, be they asthma, seizures, sinus disease, or any other malady. The decision to dive is often a personal one more so than a medical one.

I agree with everything you said in this post. In The previous post that I quoted you from however, you made it sound as if agencies and instructors were turning away students... which is simply not the case.

There is obviously risk associated with asthmatic diving. I would argue however that the risk is minimal in most cases. Severe asthma would be a contraindication. Mild to moderate not really so.

Life is full of risks. It is up to each of us to select the risks we are willing to take. Without risk there is no reward. The bottom line is people take greater risks everyday by simply getting in their car and driving down the highway. People climb mountains, 40 ft ladders, race cars, play football, etc... all of which in my opinion carry greater risks then an asthmatic who is well controlled - going diving.

From reading and research, the more common practice of using something like sudafed to help with congestion before a dive is a far grreater risk than an asthmatic going diving. Some time ago there was an article from researches (I think in a DAN magazine) which concluded many unexplained drownings while diving - where no other medical reason was found, were believed to have occurred due to a reverse block leading to vertigo - leading to the diver losing their regulator from the mouth and being unable to relocate it during panic (and spinning sensation.)

Routinely still, I hear uninformed DM's, Instructors, Doctors and fellow divers etc... tell others to take sudafed if congested before a dive. This seems a far greater risk in diving than having asthma. Without enough evidence to state it unequivicolly, my understanding from reading medical research from DAN and others indicates more deaths occur from this than from asthmatic diving.

I just want to keep everyone interested in the sport. Lets not scare asthmatics off just for the sake of doing so. You've heard many examples of successful diving here in this thread and there are likely tens of thousands of others, maybe more, diving successfully - and safely with asthma.

 

[ScubaDocER]

There is obviously risk associated with asthmatic diving. I would argue however that the risk is minimal in most cases. Severe asthma would be a contraindication. Mild to moderate not really so.

I am a fan of trying to get as many people as possible to enjoy the sport I love. I agree that there is inherent risk in almost anything one does these days. My desire as an Instructor and as a member of the medical community is to make sure that people are informed as to the magnitude of those risks so that they can make informed decisions. Beyond that, I support a persons right to choose whether or not they wish to dive.

To that end I want to address the quoted statement. The risk to "mild" asthmatics is not minimal. It is as serious and as genuine as any asthmatic attack that occurs underwater. What we are talking about are the odds of the attack occurring, not whether one is better than the other. Mild, moderate, and severe asthma is only relevant on the surface. A mild asthma attack underwater can quickly turn severe since there is no means to deliver medication to the diver at that time. The initial treatment for all types of asthma attacks is inhaled beta agonists. This, to date, is not available underwater. The ONLY option once the attack has begun is to get the diver to the surface to administer medications designed to reverse the attack. If you do so too quickly, you run the risk causing air trapped alveoli to rupture creating a larger problem, i.e., pneuomothorax, or subcutaneous emphysema (less dangerous but indicative of a potentially serious problem). The use of mild, moderate, and severe forms of asthma are only appropriate on dry land. Because treatment cannot be initiated underwater, and a controlled ascent is mandatory to get the diver to the surface where medications can be given IF AVAILABLE, an asthma attack of any kind can be fatal at depth. Again, this is not to discourage anyone from diving. Merely to educate asthmatics, and Instructors of asthmatics as to the risks inherent in combining diving and asthma. There is a misconception that if you have mild asthma, your chances of being involved in a diving incident related to asthma is less than someone with severe asthma. Since the treatment for both initially is identical and currently unavailable underwater, then the outcome for both may be the same, just one may prove fatal faster than the other. Severe asthmatics may have their attacks more frequently or more intensely when the do occur. But underwater, without intervention, the outcome is still the same.

 

[offthewall1]

I am a fan of trying to get as many people as possible to enjoy the sport I love. I agree that there is inherent risk in almost anything one does these days. My desire as an Instructor and as a member of the medical community is to make sure that people are informed as to the magnitude of those risks so that they can make informed decisions. Beyond that, I support a persons right to choose whether or not they wish to dive.

To that end I want to address the quoted statement. The risk to "mild" asthmatics is not minimal. It is as serious and as genuine as any asthmatic attack that occurs underwater. What we are talking about are the odds of the attack occurring, not whether one is better than the other. Mild, moderate, and severe asthma is only relevant on the surface. A mild asthma attack underwater can quickly turn severe since there is no means to deliver medication to the diver at that time. The initial treatment for all types of asthma attacks is inhaled beta agonists. This, to date, is not available underwater. The ONLY option once the attack has begun is to get the diver to the surface to administer medications designed to reverse the attack. If you do so too quickly, you run the risk causing air trapped alveoli to rupture creating a larger problem, i.e., pneuomothorax, or subcutaneous emphysema (less dangerous but indicative of a potentially serious problem). The use of mild, moderate, and severe forms of asthma are only appropriate on dry land. Because treatment cannot be initiated underwater, and a controlled ascent is mandatory to get the diver to the surface where medications can be given IF AVAILABLE, an asthma attack of any kind can be fatal at depth. Again, this is not to discourage anyone from diving. Merely to educate asthmatics, and Instructors of asthmatics as to the risks inherent in combining diving and asthma. There is a misconception that if you have mild asthma, your chances of being involved in a diving incident related to asthma is less than someone with severe asthma. Since the treatment for both initially is identical and currently unavailable underwater, then the outcome for both may be the same, just one may prove fatal faster than the other. Severe asthmatics may have their attacks more frequently or more intensely when the do occur. But underwater, without intervention, the outcome is still the same.

I'm no doctor, but again I disagree with you. The outcome for mild vs sever asthmatics is not the same. A person subjected to a "mild" asthma attack at depth is much less likely to end up a fatality. Mild asthma attacks may cause a restriction, wheezing or some level of difficulty breathing but not a full closure of the airways. Many mild asthma attacks do not require treatment and subside on their own within minutes with no use of an inhaler. It is unlikely someone with mild asthma would need treatment underwater... but they may desire to use an inhaler upon reaching the surface.

Of course restricted airways could cause some level of concern with regard to over-expansion injury and other maladies, but as long as airways are not completely blocked, the risk is minimalized with a slow and proper ascent. At question is whether or not someone who feels restricted breathing at depth will control any associated anxiety and proceed properly to the surface. That is the real question - and is why diving asthmatics need to be accutely aware of their condition, their skill level and dive within prescribed limitations.

This will always be a hot button topic... but again, risks in our daily lives are far greater than this, yet we choose to do them everyday. Live your life, not in fear... but in joy... but take the time to understand the risks associated with what you do... be it diving with asthma... or driving on the highway amongst the idiots.

 

[Thalassamania]

I'm no doctor, but again I disagree with you. The outcome for mild vs sever asthmatics is not the same. A person subjected to a "mild" asthma attack at depth is much less likely to end up a fatality. Mild asthma attacks may cause a restriction, wheezing or some level of difficulty breathing but not a full closure of the airways. Many mild asthma attacks do not require treatment and subside on their own within minutes with no use of an inhaler. It is unlikely someone with mild asthma would need treatment underwater... but they may desire to use an inhaler upon reaching the surface.

Disagree all you want, I sincerely hope that your need to express your opinion does not cause someone to die. What you are missing is the fact that even slightest occlusion of the wrong passageway after it has been filled with ambient pressure air can result in and AGE, we're not talking DCS, but AGE!

Of course restricted airways could cause some level of concern with regard to over-expansion injury and other maladies, but as long as airways are not completely blocked, the risk is minimalized with a slow and proper ascent.

If you can not quote a reference in peer reviewed medical journal I suggest that you, right here and now, so state. In fact I will go so far as to warn people that I have never seen such an article (which is not guarantee that it does not exist), but barring your production of such a reference IMHO they should consider you just another internet quack.

At question is whether or not someone who feels restricted breathing at depth will control any associated anxiety and proceed properly to the surface. That is the real question - and is why diving asthmatics need to be accutely aware of their condition, their skill level and dive within prescribed limitations.

It's offical, you are a certified internet quack and a danger to your fellow divers.

Feeling restricted breathing at depth and exhibiting associated anxiety is not the issue at all, that is, perhaps, a tertiary concern. The issue is that an asthmatic, who is exposed to cold dry air, and has has even a single mucus plug blockage, can die. This potential exists long before they may present with any symptoms such as shortness of breath or wheezing.

This will always be a hot button topic... but again, risks in our daily lives are far greater than this, yet we choose to do them everyday. Live your life, not in fear... but in joy... but take the time to understand the risks associated with what you do... be it diving with asthma... or driving on the highway amongst the idiots.

Live your life knowing the real risks, don't die needlessly because some self-important fool needs to try and show off by running his ratchet.

Offthewall1: come up with the reference and you will have my abject apology. Fail to do so and you will live with the sobriquet of "dangerous fool" as long as you continue to post dangerous and demonstrably incorrect advice.

ScubaDocER: You are wayyyyyyy too nice a guy.

 

[ScubaDocER]

I agree with everything you said in this post. In The previous post that I quoted you from however, you made it sound as if agencies and instructors were turning away students... which is simply not the case.

There is obviously risk associated with asthmatic diving. I would argue however that the risk is minimal in most cases. Severe asthma would be a contraindication. Mild to moderate not really so.

Life is full of risks. It is up to each of us to select the risks we are willing to take. Without risk there is no reward. The bottom line is people take greater risks everyday by simply getting in their car and driving down the highway. People climb mountains, 40 ft ladders, race cars, play football, etc... all of which in my opinion carry greater risks then an asthmatic who is well controlled - going diving.

From reading and research, the more common practice of using something like sudafed to help with congestion before a dive is a far grreater risk than an asthmatic going diving. Some time ago there was an article from researches (I think in a DAN magazine) which concluded many unexplained drownings while diving - where no other medical reason was found, were believed to have occurred due to a reverse block leading to vertigo - leading to the diver losing their regulator from the mouth and being unable to relocate it during panic (and spinning sensation.)

Routinely still, I hear uninformed DM's, Instructors, Doctors and fellow divers etc... tell others to take sudafed if congested before a dive. This seems a far greater risk in diving than having asthma. Without enough evidence to state it unequivicolly, my understanding from reading medical research from DAN and others indicates more deaths occur from this than from asthmatic diving.

I just want to keep everyone interested in the sport. Lets not scare asthmatics off just for the sake of doing so. You've heard many examples of successful diving here in this thread and there are likely tens of thousands of others, maybe more, diving successfully - and safely with asthma.

I'm no doctor, but again I disagree with you. The outcome for mild vs sever asthmatics is not the same. A person subjected to a "mild" asthma attack at depth is much less likely to end up a fatality. Mild asthma attacks may cause a restriction, wheezing or some level of difficulty breathing but not a full closure of the airways. Many mild asthma attacks do not require treatment and subside on their own within minutes with no use of an inhaler. It is unlikely someone with mild asthma would need treatment underwater... but they may desire to use an inhaler upon reaching the surface.

Of course restricted airways could cause some level of concern with regard to over-expansion injury and other maladies, but as long as airways are not completely blocked, the risk is minimalized with a slow and proper ascent. At question is whether or not someone who feels restricted breathing at depth will control any associated anxiety and proceed properly to the surface. That is the real question - and is why diving asthmatics need to be accutely aware of their condition, their skill level and dive within prescribed limitations.

This will always be a hot button topic... but again, risks in our daily lives are far greater than this, yet we choose to do them everyday. Live your life, not in fear... but in joy... but take the time to understand the risks associated with what you do... be it diving with asthma... or driving on the highway amongst the idiots.

I can certainly respect that we may disagree on this issue. My desire is to educate, not necessarily debate. I am concerned however about a comment you made regarding the categorization of asthma and how it relates to diving. Again, mild, moderate and severe are subjective descriptions of a medical condition that has NO treatment underwater. An asthma attack at depth is an emergency. The bronchoconstriction that occurs as well as the mucosal inflammation that coexists cannot be treated at depth. Once bronchoconstriction occurs and the airways narrow, airflow is impaired. Stress hormones are released that exacerbate this process and increases the constriction. Air-trapping occurs with makes gas exchange across non-ventilated alveoli sacs impossible. The body uses the chest wall muscles to increases it's ability to move air across constricted bronchi which exacerbates the attack. This is a dangerous and potentially fatal cycle that cannot be broken at depth. Please do not confuse the categorization and treatment of asthma at the surface with trying to categorize an asthma attack at depth. There is no direct correlation. Once at attack has BEGUN, it rarely stops without intervention. There are things that people can do to try to decrease the likelihood that an attack will occur, but once it HAS begun, then medical intervention is mandatory. I speak as a board certified Emergency Medicine physician with 13 years of clinical experience and 8 years of clinical and academic experience teaching and training residents, interns, and medical students to become competent medical professionals. Most mild asthma attacks require treatment. The may not require a visit to the ER, but they do require treatment. I don't make my statements lightly, but with some experience behind them. I also don't make them to scare off or discourage anyone from participating. I make them so that anyone who reads these posts can make educated decisions about their desire to dive. They are my opinions based on my experience. I reiterate though that an asthma attack involving bronchocontsriction is never acceptable during diving. There is really no such thing as a little narrowing. Impairment of airflow can and will be fatal if not treated quickly. While I welcome and respect a discussion on any topic, your comments are dangerously erroneous and may lead some asthmatics to believe that they should not be concerned about a mild asthma attack at depth. That line of thinking will lead to dead divers, which is an unacceptable philosophical approach.

The discussion of asthma and diving is not whether you will have a mild, moderate, or severe asthma attack underwater (ANY attack underwater is unacceptable), but if you as a diver are aware that such an attack can occur and if you are willing to accept the consequences of such an occurrence.

 

[offthewall1]

I can certainly respect that we may disagree on this issue. My desire is to educate, not necessarily debate. I am concerned however about a comment you made regarding the categorization of asthma and how it relates to diving. Again, mild, moderate and severe are subjective descriptions of a medical condition that has NO treatment underwater. An asthma attack at depth is an emergency. The bronchoconstriction that occurs as well as the mucosal inflammation that coexists cannot be treated at depth. Once bronchoconstriction occurs and the airways narrow, airflow is impaired. Stress hormones are released that exacerbate this process and increases the constriction. Air-trapping occurs with makes gas exchange across non-ventilated alveoli sacs impossible. The body uses the chest wall muscles to increases it's ability to move air across constricted bronchi which exacerbates the attack. This is a dangerous and potentially fatal cycle that cannot be broken at depth. Please do not confuse the categorization and treatment of asthma at the surface with trying to categorize an asthma attack at depth. There is no direct correlation. Once at attack has BEGUN, it rarely stops without intervention. There are things that people can do to try to decrease the likelihood that an attack will occur, but once it HAS begun, then medical intervention is mandatory. I speak as a board certified Emergency Medicine physician with 13 years of clinical experience and 8 years of clinical and academic experience teaching and training residents, interns, and medical students to become competent medical professionals. Most mild asthma attacks require treatment. The may not require a visit to the ER, but they do require treatment. I don't make my statements lightly, but with some experience behind them. I also don't make them to scare off or discourage anyone from participating. I make them so that anyone who reads these posts can make educated decisions about their desire to dive. They are my opinions based on my experience. I reiterate though that an asthma attack involving bronchocontsriction is never acceptable during diving. There is really no such thing as a little narrowing. Impairment of airflow can and will be fatal if not treated quickly. While I welcome and respect a discussion on any topic, your comments are dangerously erroneous and may lead some asthmatics to believe that they should not be concerned about a mild asthma attack at depth. That line of thinking will lead to dead divers, which is an unacceptable philosophical approach.

The discussion of asthma and diving is not whether you will have a mild, moderate, or severe asthma attack underwater (ANY attack underwater is unacceptable), but if you as a diver are aware that such an attack can occur and if you are willing to accept the consequences of such an occurrence.

I'm not interested in debating either. I completely respect the medical advice you're giving in the thread... and I acknowledge you're level of education on the subject is far greater than my own. I am also appreciative of the fact you're not like so many others on the board who would be jumping down my throat right now.

My expertise on the subject comes from personal experience. You will find my posts relating to this subject on other SB threads.

Either I have been mis-diagnosed by three seperate doctors (all of whom have told me I have "mild" asthma, or you are wrong. By that I mean I have been told by three qualified Medical Doctors (one being a DAN doctor) that I have mild asthma. I have been diving for twelve years and thousands of dives around the world. Many of my dives have been working dives... under extreme physical exertion. Many times I have felt a difficulty breathing, begun wheezing (I'm assuming an asthma attack) underwater and I'm still here.

Based on the information you're providing to me in this thread, either I'm the luckiest man on earth... or I do not have asthma. Perhaps I simply overworked myself and do not have asthma. I do find it interesting that three medical doctors have diagnosed me with mild asthma without ever having me do the spiro test that is so talked about.

I also find it interesting that none of the three have told me not to dive or that diving was dangerous for me. Being an Instructor myself, I was already aware of the risks associated with asthmatic diving... and I am fully aware of what all of them are, including AGE.

What my whole point in this thread has been is to agree with you that there are associated risks... but that these risks are no different than all the others we take in our daily lives. We all have to make educated decisions... and quite honestly, I'd me happier dying doing something I loved, then growing old being hooked to a respirator because I could no longer breath on my own.

I think in the end, I must go to a doctor and insist on the Spiro test... to once and for all... after all these years determine if I truly have asthma... or if three doctors are wrong... and you're right. I'm hoping you're the one that's right... because if you are... I don't have asthma... I'm just a little out of shape.

Happy Diving... and thanks for the great posts