Asthma and diving

[SuSexFulDiver]

This link is more specific to Cows Milk and Asthma

ASTHMA

 

[SuSexFulDiver]

By the way I am black also. LOL

 

[ScubaDocER]

As usual I agree with TSandM regarding her statements and suggestions pertaining to Asthma and diving. There is actually an extensive discussion about it in a few other threads that can be found using the search function. The only thing I would add is that IMO, mild, moderate and severe classifications of asthma are only pertinent on the surface. If you have an asthma attack at depth, it is an emergency. The treatment for the attack lies at the surface. As of yet, I have not seen an effective means to provide nebulized medication at depth. I agree that the only means to deal with an asthma attack at depth is a slow ascent to the surface. Keeping the patient calm my help prevent the attack from worsening. Once on the surface, administer a breathing treatment through a nebulizer and call 911 if she is showing any signs of continuing to have difficulty breathing. I would recommend keeping a nebulizer in a dry box at the surface or on the boat at all times. If you're a mile or so off shore and the meds are in your hotel room, then you can turn a bad situation into a very bad situation. The docs are not giving you general guidelines. We are trying to provide a genuine solutions to a potentially fatal problem. There is no current consensus on allowing divers with asthma to dive. It is up to the Instructor, the patients physician, and the patient. Understand the concern that docs have with combining the two. Once the attack occurs, there is narrowing of the airways which inhibits the inflow of air. The air that is trying to be exhaled, is trapped in the alveoli. This air will expand upon ascent. The consequences of such are an AGE or rupturing of the lung tissue causing a pneumothorax. Both can be fatal. Both can be prevented by avoiding diving. This is the dilemma.

Albuterol as an inhaler is not helpful to prevent an attack from occurring. It can halt an attack in progress, but not preempt the attack.

It is imperative that you and your dive buddy are educated about the consequences of diving with asthma. I would suggest that she discuss her situation with a Pulmonologist to determine any risks that may be associated with diving. Ultimately it is a personal decision to dive. Being educated about the decision can minimize the risks.

 

[tc]

Interesting point about the inhalers not preventing an attack, I know I've heard at least a couple of people comment about always taking a hit from the inhaler before a dive.

 

[dpaustex]

I'd say defer to the dock. Asthma has varying levels. I suppose it would depend if you have an "attack" while at depth. Considering a safety stop, it takes 3 mins, plus 1 min per 30 feet, to get to the surface. You certainly wouldn't want to complicate things with an embolism or expansion injury.

They're not trying to "punish" you if you have asthma, just make sure you can dive safely. Remember if you have problems during a dive, someone has to rescue you, which puts them in a bit of danger, to boot.

 

[Kevrumbo]

Interesting point about the inhalers not preventing an attack, I know I've heard at least a couple of people comment about always taking a hit from the inhaler before a dive.

If my airway & breathing feels tight before a dive (sometimes during pre-dive cold weather surface conditions or if I'm fighting a mild Upper Respiratory Infection) I'll take a puff of an Albuterol Inhaler. I'm well controlled on maintenance meds (Advair 100/50 and occassional oral methylprednisolone) and never had any problems with asthma overseas in tropical settings.

I'd say defer to the dock. Asthma has varying levels. I suppose it would depend if you have an "attack" while at depth. Considering a safety stop, it takes 3 mins, plus 1 min per 30 feet, to get to the surface. You certainly wouldn't want to complicate things with an embolism or expansion injury.

They're not trying to "punish" you if you have asthma, just make sure you can dive safely. Remember if you have problems during a dive, someone has to rescue you, which puts them in a bit of danger, to boot.

Which is why I would rather choose to dive solo.

 

[momliz]

interesting discussion - I don't know anything about diving. but have been an asthmatic all my life so let me make two points:

1) I at least can tell when I'm getting even the tiniest bit of airway constriction. So, I could just surface when I feel an attack starting. I think most asthmatics are pretty aware, and asthma attacks aren't usually an all or nothing deal. They come on slowly.

2) Even on the best of days, most asthmatics operate on reduced lung capacity. Mine is usually at 75%, higher when I'm on Prednisone, but thank goodness I have found an excellent preventive regimen (Advair 250, Singulair, and Zyrtec every night) so I haven't taken Pred in years. But, what I wanted to say was I would think coordinating and using one's air would be harder for an asthmatic. When everyone else surfaces with 500 psi left for example, an asthmatic may have less, because or more frequent, shallower breaths. I have always had trouble with the breathing part in Yoga or Pilates classes, since mine is different, as I said more frequent and shallower that mosr people. Of course, I'm also out of shape, so that doesn't help.

So, I'm guessing that asthmatics would really have to watch their air consumption.

And, to the diver above who cut out dairy - it sounds like you're allergic to a protein in milk, very different than lactose intolerance. And, allergies are a common asthma trigger. here's some info, if you don't already know about it (which I'm sure you do...)

Milk allergy - MayoClinic.com

 

[Standingbear56]

I think this is one of the most interesting discussions I've seen on SB as well as one of most informative. Being a long time EMT, I have assisted in the treatment of patients having asthma attacks ranging from simple wheezing to ones where prehospital advanced life support (Paramedics) could not stop it, some of these ending up with the death of the patient. These all occured on land with medically trained help is available. Underwater however is a whole different ball game. As an instructor my questions are these: seeing what can happen on land including patients who have had their asthma under control for years and all of a sudden an attack seems to come on unexpectantly, where does that leave me, the instructor, if one of my students has an attack? Rescue aside which of course would be done to the best of my ability as well as continuing care to my level of training - what are the odds of my student getting an AGE, which can prove fatal? Where do I stand if this happens? I understand that no physician can absolutely guarantee that an asthma patient will never have an attack underwater. The wide variety of opinions from both lay and professional people show that this is a subject that needs further study on all levels. Given the fact that all asthma attacks require medical intervention and can cause AGE, let alone drowning via panic, where should an instructor draw the line? One agency I teach for does not allow teaching students with Asthma, while for the other, it's a gray area depending on what the doctor says. Since the ultimate responsibility for accepting a student for training rests with me, the instructor, is it better to err on the side of caution (medically and legally) and say no, or take the chance, as many here with asthma have had no problems at all.
Thanks,
George

 

[ScubaDocER]

I think most asthmatics are pretty aware, and asthma attacks aren't usually an all or nothing deal. They come on slowly.

I would agree with most of what you said with an addition. I think most asthmatics that I have treated are aware of the triggers that may initiate an attack. Some do however occur without warning. The problem is when you mix asthma and diving you get a different outcome. When an asthma attack occurs underwater, it is an emergency. It can become an all or nothing deal especially if the treatment is not readily available. The clinical consequences of asthma can be treated rather easily on the surface by a trained patient or trained medical personnel. Nebulized inhalers can be given if necessary. Steroids can be given if necessary. Patients can be mechanically ventilated if necessary. These are not available at depth. Bronchial constriction and mucus production, the two main causes of asthma attacks, cannot be treated at depth. On the surface, they may be minor occurrences, but at depth, they can be life threatening.

You also made a comment about just surfacing if you feel an attack coming. Depending on your depth, breathing gas, nitrogen absorption, or decompression obligation, this may not be an option. It is a risky gamble.

 

[ScubaDocER]

I think this is one of the most interesting discussions I've seen on SB as well as one of most informative. Being a long time EMT, I have assisted in the treatment of patients having asthma attacks ranging from simple wheezing to ones where prehospital advanced life support (Paramedics) could not stop it, some of these ending up with the death of the patient. These all occured on land with medically trained help is available. Underwater however is a whole different ball game. As an instructor my questions are these: seeing what can happen on land including patients who have had their asthma under control for years and all of a sudden an attack seems to come on unexpectantly, where does that leave me, the instructor, if one of my students has an attack? Rescue aside which of course would be done to the best of my ability as well as continuing care to my level of training - what are the odds of my student getting an AGE, which can prove fatal? Where do I stand if this happens? I understand that no physician can absolutely guarantee that an asthma patient will never have an attack underwater. The wide variety of opinions from both lay and professional people show that this is a subject that needs further study on all levels. Given the fact that all asthma attacks require medical intervention and can cause AGE, let alone drowning via panic, where should an instructor draw the line? One agency I teach for does not allow teaching students with Asthma, while for the other, it's a gray area depending on what the doctor says. Since the ultimate responsibility for accepting a student for training rests with me, the instructor, is it better to err on the side of caution (medically and legally) and say no, or take the chance, as many here with asthma have had no problems at all.
Thanks,
George

You make a valid point for all Instructors to consider. There are no easy answers and I can appreciate both perspectives. There are asthmatics who have successfully dove with few if any problems. In an attack occurs at depth, the only real option is a slow ascent to the surface, hoping the the diver does not develop an AGE or pneumothroax. I would suggest a long talk with the student, the physician (if available), and your LDS (if you are going through a LDS) to make sure that everyone involved is aware of the risks. If you as the Instructor don't feel that it is safe for the student to dive, then tall them so. It is a students desire to dive, but your responsibility to ensure that their diving experience is as safe as possible, for yourself and the other students in the class. If you can document BEFORE you put them in the water that they are aware of the risks of diving with asthma, and they accept, then you should be ok. I would check with the lawyers for confirmation of this.