I have to admit that my bias is that medicals be performed as part of the assessment for suitability for pursuing diving.
While this is not the norm in the US, I think it would assist in pre empting potential medical issues that could lead to difficult situations ; whether this be asthma, diabetes, epilepsy, cardiac issues etc, which have all been questioned on this board.
It seems ironic to me that the diving community and the licensing agencies are all very aware of certain risk factors but do not pursue them pro-actively, and hence intervene early rather than after the fact. This has been the practice in Australia, where a cadre of hyperbaric docs were trained to perform the appropriate tests. This also serves to educate the dive community and diffuse responsibility. When in doubt, the local teaching facility can easily refer to an HBO Doc or HBO facility.
In terms of this specific issue of asthma, it was our previous practice to evaluate what would incite bronchoconstriction in each patient, and it's reversibility with therapy. I think this remains valid in helping the patient make an informed decision in the setting of a thorough and professional evaluation, and a clear plan of therapy.
The recreational communities lack of clear and strong medical standards is just one more example of where "profit, and the best interests of the participant be damned," has been the driving force of the dominant recreational agencies. Withing the science community we have always had very rigorous medical qualifications and testing and we continue to do so.
From
AAUS Standards
Scuba and other modes of compressed-gas diving can be strenuous and hazardous. A special risk is present if the middle ear, sinuses, or lung segments do not readily equalize air pressure changes. The most common cause of distress is eustachian insufficiency. Most fatalities involve deficiencies in prudence, judgment, emotional stability, or physical fitness. Please consult the following list of conditions that usually restrict candidates from diving.
(Adapted from Bove, 1998: bracketed numbers are pages in Bove)
CONDITIONS WHICH MAY DISQUALIFY CANDIDATES FROM DIVING
1. Abnormalities of the tympanic membrane, such as perforation, presence of a monomeric membrane, or inability to autoinflate the middle ears. [5 ,7, 8, 9]
2. Vertigo including MeniereÃÔ Disease. [13]
3. Stapedectomy or middle ear reconstructive surgery. [11]
4. Recent ocular surgery. [15, 18, 19]
5. Psychiatric disorders including claustrophobia, suicidal ideation, psychosis, anxiety states, untreated depression. [20 - 23]
6. Substance abuse, including alcohol. [24 - 25]
7. Episodic loss of consciousness. [1, 26, 27]
8. History of seizure. [27, 28]
9. History of stroke or a fixed neurological deficit. [29, 30]
10. Recurring neurologic disorders, including transient ischemic attacks. [29, 30]
11. History of intracranial aneurysm, other vascular malformation or intracranial hemorrhage. [31]
12. History of neurological decompression illness with residual deficit. [29, 30]
13. Head injury with sequelae. [26, 27]
14. Hematologic disorders including coagulopathies. [41, 42]
15. Evidence of coronary artery disease or high risk for coronary artery disease
1. [33 - 35]
16. Atrial septal defects. [39]
17. Significant valvular heart disease - isolated mitral valve prolapse is not disqualifying. [38]
18. Significant cardiac rhythm or conduction abnormalities. [36 - 37]
19. Implanted cardiac pacemakers and cardiac defibrillators (ICD). [39, 40]
20. Inadequate exercise tolerance. [34]
21. Severe hypertension. [35]
22. History of spontaneous or traumatic pneumothorax. [45]
23.
Asthma2. [42 - 44] (emphasis mine)
24. Chronic pulmonary disease, including radiographic evidence of pulmonary blebs, bullae, or cysts. [45,46]
25. Diabetes mellitus. [46 - 47]
26. Pregnancy. [56]
SELECTED REFERENCES IN DIVING MEDICINE
Most of these are available from Best Publishing Company, P.O. Box 30100, Flagstaff, AZ 86003-0100, the Divers Alert Network (DAN) or the Undersea and Hyperbaric Medical Association (UHMS), Bethesda, MD.
ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Gibbons RJ, et al. 1997. Journal of the American College of Cardiology. 30:260-311.
ACC/AHA Guidelines for Exercise Testing: Executive Summary : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing) -- Gibbons et al. 96 (1): 345 -- Circulation
Å¢ssessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations. Grundy et. al. 1999. AHA/ACC Scientific Statement.
Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations : A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology -- Grundy et al. 100 (13): 1481 -- Circulation
- DIVING MEDICINE, Third Edition, 1997. A. Bove and J. Davis. W.B. Saunders Company, Philadelphia
- DIVING AND SUBAQUATIC MEDICINE, Third Edition, 1994. C. Edmonds, C. Lowery and J. Pennefather. Butterworth-Heinemann Ltd. Oxford
- MEDICAL EXAMINATION OF SPORT SCUBA DIVERS, 1998. Alfred Bove, M.D., Ph.D. (ed.). Medical Seminars, Inc. San Antonio, TX
- NOAA DIVING MANUAL, NOAA. Superintendent of Documents, U.S. Government Printing Office, Washington, D.C.
- U.S. NAVY DIVING MANUAL. Superintendent of Documents, U.S. Government Printing Office, Washington, D.C.
1 Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations. Grundy et. al. 1999. AHA/ACC Scientific Statement. http://www.acc.org/clinical/consensus/risk/risk1999.pdf
2 Are Asthmatics Fit to Dive? Elliott DH, ed. 1996 Undersea and Hyperbaric Medical Society, Kensington, MD.
