Asthma and diving

[frogman159]

Again, even on the surface, asthma can be challenging to treat. The medical community has not reached a consensus as to how diving and asthma can safely coexist. Because of that, dive agencies and Instructors are restricted in their ability to certify divers who have asthma.

They likely never will reach concensus. Asthma as a disease covers an entire continium from very mild cases-where you can probably continue athletic activity for several hours with nothing more than uncomfortable wheezing and 2 puffs of albuterol clears you right up when you get to it, to cases were people end up hypoxic in the ER a couple times per year-

When it comes to diving where do you draw the line?
- A "moderate" asthmatic who is on controller meds and hasn't used albuterol in 4 months? 6 months? 1 year?
-A "mild" asthmatic who does not require controller meds who uses albuterol every 2 months? 3 months? 6 months?

Guess in the end, its up to the individual to know the risks, and for a physician who knows the patient to determine what the likelyhood is that they could have an attack underwater.

The OP says he still requires his rescue meds-

For me, I dive, I've had asthma my whole life- haven't used my albuterol in about 1 year or so, and I'm not on any controllers. Besides, when I have an attack, it has never been debilitating, in high school, I was able to wheeze along and still finish up the game/meet if i didn't have my albuterol with me. A different story from the OP's case.

Oh well that my 2 psi

 

[ScubaDocER]

They likely never will reach concensus. Asthma as a disease covers an entire continium from very mild cases-where you can probably continue athletic activity for several hours with nothing more than uncomfortable wheezing and 2 puffs of albuterol clears you right up when you get to it, to cases were people end up hypoxic in the ER a couple times per year-

When it comes to diving where do you draw the line?
- A "moderate" asthmatic who is on controller meds and hasn't used albuterol in 4 months? 6 months? 1 year?
-A "mild" asthmatic who does not require controller meds who uses albuterol every 2 months? 3 months? 6 months?

Guess in the end, its up to the individual to know the risks, and for a physician who knows the patient to determine what the likelyhood is that they could have an attack underwater.


The OP says he still requires his rescue meds-

For me, I dive, I've had asthma my whole life- haven't used my albuterol in about 1 year or so, and I'm not on any controllers. Besides, when I have an attack, it has never been debilitating, in high school, I was able to wheeze along and still finish up the game/meet if i didn't have my albuterol with me. A different story from the OP's case.

Oh well that my 2 psi

The concept of an asthma attack being mild, moderate or severe is only applicable on dry land. All of the attacks will typically require medication. The mild ones may require a single treatment, whereas the severe ones may require hospitalization. To date, there is not a means to administer any of the medications to a diver having an active attack underwater. If an attack does occur underwater then the consequences can be fatal. It is the lack of predictability as well as the inability to intervene underwater that gives agencies and Instructors pause. The decision to dive with any medical condition is a personal one. Consideration should be made not only for the diver, but for the dive buddy who bears the responsibility for in-water safety. If the question is why wont Instructors certify divers with asthma, I believe that my initial response addresses my belief. If the question is should divers with asthma dive, that is a more personal decision for that diver to make.

 

[JCRC]

OK! Here is the verdict. The Hyper. Doc said he is not gonna stop me from diving, as my asthma seems to be well enough controlled for the activity. The standards have evolved a lot in the past 15 years and it is no longer true that all asthmatic should be forbidden from diving (apart from the Australian views on the issue). His warnings were 1) to listen to my body when it speaks to me, i.e. if I am having a bad day (or a few bad days in the days leading to a dive), do not dive, 2) to make sure that my asthma remains controlled at all time. So I went back to my GP and asked him to assess me to determine just how well my asthma is actually controlled. He changed my steroid to a so called new generation one and says to monitor closely the effect to see if it works well. So given that my instructor has asthma and is in a very similar state as I am, I decided to go ahead.

I did my first pool diving last night and the air was great to breathe. Apart from drying the rook of my mouth, no issue with it. It is actually much harder for me to breathe outside today at - 26 degree C than breathing the air from the tank.... I think I will have fun with this....

 

[gedmondson]

Yup, enjoy your new hobby. I too have life-long asthma that is well controlled with an inhaled corticosteroid. Nevertheless, I always keep my albuterol inhaler in my dive bag and give it a puff before I get in my gear, just as I do before I run 7 miles every other day. Never been a problem for me.

 

[Thalassamania]

Good luck, have fun and be safe. Let us know how it all goes and thanks for the update.

 

[String]

I think that depends on the diving community also. Without a really strong statement from a hyper-doc I would not permit an asthmatic to participate in a dive under the auspices of any institution that I worked for.

Its a yes on a form if they have ANY asthma so requires a signed doctors certificate to allow them to dive. If someone has them i'll allow them to dive. If they don't i wont.

 

[Thalassamania]

It is my responsibility is assure the institution, through its risk management office, that divers are operating with as little risk as possible, so I take a somewhat different view, I can't just pass it off on to the Docs.

It's rather unlike your sig: "Remember, underwater only YOU are responsible for YOUR own safety. Nobody else is." Someone else is ... me!

 

[frogman159]

OK! Here is the verdict. The Hyper. Doc said he is not gonna stop me from diving, as my asthma seems to be well enough controlled for the activity. The standards have evolved a lot in the past 15 years and it is no longer true that all asthmatic should be forbidden from diving (apart from the Australian views on the issue). His warnings were 1) to listen to my body when it speaks to me, i.e. if I am having a bad day (or a few bad days in the days leading to a dive), do not dive, 2) to make sure that my asthma remains controlled at all time. So I went back to my GP and asked him to assess me to determine just how well my asthma is actually controlled. He changed my steroid to a so called new generation one and says to monitor closely the effect to see if it works well. So given that my instructor has asthma and is in a very similar state as I am, I decided to go ahead.

I did my first pool diving last night and the air was great to breathe. Apart from drying the rook of my mouth, no issue with it. It is actually much harder for me to breathe outside today at - 26 degree C than breathing the air from the tank.... I think I will have fun with this....

Glad to hear you checked everything out. Congrats on the medical clearence. Enjoy

 

[ScubaDocER]

OK! Here is the verdict. The Hyper. Doc said he is not gonna stop me from diving, as my asthma seems to be well enough controlled for the activity. The standards have evolved a lot in the past 15 years and it is no longer true that all asthmatic should be forbidden from diving (apart from the Australian views on the issue). His warnings were 1) to listen to my body when it speaks to me, i.e. if I am having a bad day (or a few bad days in the days leading to a dive), do not dive, 2) to make sure that my asthma remains controlled at all time. So I went back to my GP and asked him to assess me to determine just how well my asthma is actually controlled. He changed my steroid to a so called new generation one and says to monitor closely the effect to see if it works well. So given that my instructor has asthma and is in a very similar state as I am, I decided to go ahead.

I did my first pool diving last night and the air was great to breathe. Apart from drying the rook of my mouth, no issue with it. It is actually much harder for me to breathe outside today at - 26 degree C than breathing the air from the tank.... I think I will have fun with this....

I am happy that your Instructor feels comfortable enough to allow you to dive. It is a personal choice for both the diver and the teacher. It assumes a good bit of risk and responsibility, but if that is something that both are willing to do, then I hope it works out well for both of you.

Glad to hear you checked everything out. Congrats on the medical clearence. Enjoy

I did want to address the concept of medical clearance. Medical clearance is not a holy pass that somehow confers immunity on the diver. It is an educated guess made by a physician that the odds of something bad occurring are reasonably low. Take it with a grain of salt. Become educated about the combination of asthma and diving. The treatment and management of scuba and diving is a theoretical one, not a tested one. The physician is basing their decision on the management of asthma on land, not underwater. Having asthma "under control" is only valid on the surface, not underwater. Controlled asthma is manageable on dry land. Medication is administered, and the danger is usually abated without difficulty. No physician can clear an asthmatic to dive underwater because there is no empiric or evidence based medicine to support such a decision. It's similar to pregnancy and diving. Since the medical community has no evidence to support the effects of diving on a fetus, it is not allowed. No studies were done, no evidence collected or evaluated. It was determined that the risk to the fetus was too great to allow a pregnant woman to dive. The decision to clear a person to dive medically is a subjective one at best. Be knowledgeable of that fact and use your best judgment to determine if you are fit to dive. Ask yourself if you had an attack underwater, what would you do. Your instructor should ask themselves the same question, what would THEY do. Do they know how to intervene? Do they know the dangers of bringing you up too quickly? Do they know how to provide appropriate assistance to you once you are on the surface? This is more than "I have not had an attack in awhile so I should be fine". Be educated and make sure your Instructor is as well.

 

[JCRC]

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...