Asthma and diving

[sweatfrog]

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.Most mild asthma attacks require treatment. The may not require a visit to the ER, but they do require treatment. I also don't make them to scare off or discourage anyone from participating. 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.

I don't mean to butt in here and please correct me if I'm wrong, but from my understanding of asthma and to put your explanation in layman's terms; if you have an asthma attack UW, you're unable to exhale and the minimal solution is an inhaler. However, to ascend increases the volume of air in your lungs and you can easily have an overexpansion injury (read: AGE) burst your lungs and die.

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.

It seems to me that recreational diving is for fun. It also seems that if you have an asthma attack UW it is very detrimental to the entire sport of diving. If someone is an asthmatic Scuba Instructor, they are putting their students at risk and that is unacceptable, since their students are depending on them.

 

[offthewall1]

I don't mean to butt in here and please correct me if I'm wrong, but from my understanding of asthma and to put your explanation in layman's terms; if you have an asthma attack UW, you're unable to exhale and the minimal solution is an inhaler. However, to ascend increases the volume of air in your lungs and you can easily have an overexpansion injury (read: AGE) burst your lungs and die.

It seems to me that recreational diving is for fun. It also seems that if you have an asthma attack UW it is very detrimental to the entire sport of diving. If someone is an asthmatic Scuba Instructor, they are putting their students at risk and that is unacceptable, since their students are depending on them.

I agree it would be interesting to know how many diving instructors have some level of asthma. It would be even more interesting to know if the diagnosis of asthma came from an actual test or if like my diagnosis it came simply because I told my doctors I occassionally wheeze.

On a different thread here on SB it was discussed as to whether wheezing alone means you have asthma and what the causes of asthma are. My doctors informed me that any wheezing is in fact asthma... but other people (SB's claiming to be doctors) stated that wheezing alone does not mean you have asthma. It appears even MD's can't agree on things.

I'm beginning to believe that asthma is a term often bantied about by medical doctors whenever someone mentions the word wheezing or difficulty breathing. Perhaps it is used given a lack of other sysmptoms or diagnosis.

Again speaking only from personal experience, I was told I had asthma by three doctors... none of whom had me take the spiro test that apparently is the gold standard for diagnosing it. I was prescribed an inhaler... but I have not had a need to use it since 2005 when it was prescribed. I have tried it a couple of times over the years... not out of need.. but simply to see if it made breathing easier.

My experience with the inhaler is that it does not make it any easier for me to breath. There is no change at all in ease of breathing. I've never had a problem exhaling... but I do wheeze occassionally. I've had chest x-rays - they were clear. I've had heart tests - nuclear walking stress tests - passed them with flying colors. This can lead us back to a stress response or possibly even a compressed or herniated disc which is what my cardiologist actually believes is my problem. The doctor suggests that a compressed disc could be sending signals to my nerve endings triggering a breathing issue. My doctor is a well respected Johns Hopkins Cardiologist. Is this person a quack to?

I think what I'm getting at... is make sure you truly have asthma by requesting the actual spiro test talked about earlier in this thread. I grow more and more convinced that I personally don't have asthma... even though doctors have told me I do.

Based on a long history of diving experiences and scubadocer posts, it would seem implausible that I'd still be here if I had asthma.

Happy Diving!

 

[String]

I agree it would be interesting to know how many diving instructors have some level of asthma. It would be even more interesting to know if the diagnosis of asthma came from an actual test or if like my diagnosis it came simply because I told my doctors I occassionally wheeze.

That's very common here especially amongst GPs who are inherently lazy. Someone goes to them with a wheeze and they write it as "mild asthma" regardless. Consultation over in 2 minutes - that was worth the 2 week wait for an appointment...
The result is a lot of "asthmatics" about who had a slight wheeze 10 years ago.

That's normal people though. No instructor in this country can get through that way as they need a mandatory HSE commercial diving medical which takes about 2hrs a year where peak flow, spirometry, exercise tests and so on are performed. If you're found to be asthmatic there you will not get a medical awarded and therefore you cannot legally instruct at all at any level in the country.

 

[sweatfrog]

On a different thread here on SB it was discussed as to whether wheezing alone means you have asthma and what the causes of asthma are. My doctors informed me that any wheezing is in fact asthma... but other people (SB's claiming to be doctors) stated that wheezing alone does not mean you have asthma. It appears even MD's can't agree on things.

I am of the opinion that many Docters overdiagnose something when they don't have an answer. That's why they practice medicine.

However, the term asthma should put red flags up for any prudent Scuba Instructor. (IMHO) If you're going to continue to teach, you need to have that test done.

My experience with the inhaler is that it does not make it any easier for me to breath. There is no change at all in ease of breathing.

I used to be part of a Mine Rescue Competition team and we would get physicals every year. Part of that was the Spiro test, with and without an inhaler. It does make a difference and if I hadn't seen the results, I would have trouble believing it too.

 

[spud]

For what its worth I'm an asthmatic (under control with inhaled steroids and ventolin)
I'm 53 have been certified for aproximately 5 yrs (advanced , Nitrox ).
I dive the Carribean and the great Lakes ...cold and warm.
To this point I have had no problems what so ever.
Its only a laymans opinion but if you , like myself, have had astma all your life you probably know by now what brings it on and plan your activities accordingly so if you feel good and you have had a recent favorable pulmonary function test carry on with your certification.

 

[sweatfrog]

For what its worth I'm an asthmatic (under control with inhaled steroids and ventolin)
I'm 53 have been certified for aproximately 5 yrs (advanced , Nitrox ).
I dive the Carribean and the great Lakes ...cold and warm.
To this point I have had no problems what so ever.
Its only a laymans opinion but if you , like myself, have had astma all your life you probably know by now what brings it on and plan your activities accordingly so if you feel good and you have had a recent favorable pulmonary function test carry on with your certification.

Sure, until you become overexerted swimming against a current at depth and have an attack.

Just make sure you tell the Divemaster that you have active asthma. It's not fair to anyone on the boat otherwise.

 

[ScubaDocER]

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

It's quite possible that you don't have asthma. Not all wheezing is asthma. Sometimes wheezing occurs from what we call Reactive Airway Disease (RAD). This is not asthma, but mimics some of the symptoms of asthma. It is an exaggerated response of the bronchi to certain triggers. It is treated the similarly and resolves easier. I would seek out a pulmonologist (lung specialist) and have them test you for the difference between the two. Sometimes wheezing comes from bronchitis or a minor lung infection. In this case, the wheezing comes not necessarily from bronchoconstriction, but from inflammation and/or mucous production that causes a narrowing of the bronchi. IThis is treated with anti-inflammatory medication. The wheezing sound that is heard is air movement through a narrowed opening.

Asthma is usually diagnosed when you're little. It can occur as one gets older from environmental conditions, smoking, asbestos, coal mining dust, increased pollen, humidity, etc. The medical community tends to focus on the treatment in most cases rather than the cause. A good pulmonologist can help sort out the causes.

I am EXTREMELY happy that you have never been harmed as a result of diving. As a physician and an Instructor I would never want harm to befall any diver. Without seeing you and evaluating you I cannot state whether or not you have asthma or any medical condition. Since there has been no true research involving diving and asthma it is difficult to truly asses the risk of combining the two. I can comment on the treatment of asthma at the surface and how challenging that can be. From constant nebulized treatments, to pulse oximetry monitoring, cardiac monitoring, to constant reassessment. I cannot imagine doing this underwater. Clearly there are few absolutes in life. People with asthma dive and survive their dives. Same is true for people with seizures, strokes, heart attacks, etc. My desire is not to deny anyone the enjoyment of diving, but to make sure that people understand the changes that occur within their body as it relates to certain medical conditions and combining that with diving. As long as they understand that and can accept that then I have no quarrel or disagreement with them. I might take exception, however, with Instructors with asthma since they may but their students at risk. Again, this is a personal decision for the Instructor but they need to consider the potential danger they place their students in.

 

[ScubaDocER]

I don't mean to butt in here and please correct me if I'm wrong, but from my understanding of asthma and to put your explanation in layman's terms; if you have an asthma attack UW, you're unable to exhale and the minimal solution is an inhaler. However, to ascend increases the volume of air in your lungs and you can easily have an overexpansion injury (read: AGE) burst your lungs and die.

That is correct. Asthma involves expiratory wheezing, meaning to you attempting to exhale through constricted bronchi. The trapped air downstream from the obstruction can expand without being able to escape and you run an increased risk that these air sacs will rupture. Inhalers send medication directly into the bronchi and causes the muscles in the bronchi to relax and restore air flow.

It seems to me that recreational diving is for fun. It also seems that if you have an asthma attack UW it is very detrimental to the entire sport of diving. If someone is an asthmatic Scuba Instructor, they are putting their students at risk and that is unacceptable, since their students are depending on them.

I would say yes here as well. Again, as an Instructor I would not want to see anyone, especially an Instructor, not be able to do something they love and enjoy. Since asthma attacks cannot be predicted, then there is a risk that is associated with diving and asthma. If an attack does not occur, then there is no danger; if an attack does occur, then there is the potential for serious harm to the diver (Instructor) and any student under that Instructors charge. It really is a gamble. I wish I had more optimistic information to give, but until we find a way to intervene on an ongoing attack the risks will remain. The decision to dive with asthma remains with the Instructor and the student.

 

[HBO MD]

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.

 

[spud]

Good post.