Diving with COPD

[Pembina]

Tony, thank you for the info and advise. I have been seriously thinking about searching around for a pulmonologist with diving certification for a second opinion. You have hit on many of the questions I have had, especially as to whether it could be cardiac or just the fact that I'm 61 yrs old and a little overweight. I did get a chest x-ray which my regular Dr does every 2 years anyway because of history of lung cancer in my family... father, brother, uncle, grandfather. The only test the pulmonologist did was what I'm guessing was a spirometry test (blow into a tube thing) and the clip on my finger. No CT scan, no treadmill. Yes the inhaler is Spiriva and after a month I do feel an improvement. He did not recommend any physical therapy or oxygen. There really wasn't any discussion about it. He asked if I knew anything about COPD, I said no. He said I'll give you some information about it before you leave which he didn't. I got out to the reception area to schedule my next appointment and realized I didn't get the information. It basically was a single sheet of paper with a link to the Mayo Clinic. Not impressed with this Dr as you can tell.

 

[Pembina]

oh and BTW... Dr said chest x-ray looked good.

 

[Duke Dive Medicine]

Please, I need someone to tell me that it is okay to dive with COPD. I've been diving for more than 30 years. I was a smoker but quit in 1999. I have had chronic bronchitis for many many many years and it has never affected my diving. I recently was diagnosed with COPD (49%). I'm active... even with COPD I continue to exercise, run 5Ks (albeit slowly) and refuse to ride in elevators. Can I still dive? My Dr is not a diver so I have not asked him. If I dive shallow, shorter dives, longer deco stops is it still safe? Would diving on Nitrox have an advantage? What are my risks if I continue to dive? I was really hoping to dive the Blue Hole in Feb.

Nobody can tell you this over the internet. My guess is that the 49% means that your PFT results are at 49% of predicted value. There are several concerns: air trapping would be one; I have seen an arterial gas embolism in a COPD patient (albeit severe, complicated by pneumonia) on the surface, absent any ambient pressure change. Another concern would be gas density. On the surface, you may be able to move air just fine, but gas density increases with increasing depth, which will decrease your exercise tolerance. You need to be worked up by a diving physician. If you provide your location I may be able to make a recommendation. We have a diving pulmonologist here; not sure how close to Durham, North Carolina you are but we'd be happy to evaluate you.

Best regards,
DDM

 

[Pembina]

Nobody can tell you this over the internet. My guess is that the 49% means that your PFT results are at 49% of predicted value. There are several concerns: air trapping would be one; I have seen an arterial gas embolism in a COPD patient (albeit severe, complicated by pneumonia) on the surface, absent any ambient pressure change. Another concern would be gas density. On the surface, you may be able to move air just fine, but gas density increases with increasing depth, which will decrease your exercise tolerance. You need to be worked up by a diving physician. If you provide your location I may be able to make a recommendation. We have a diving pulmonologist here; not sure how close to Durham, North Carolina you are but we'd be happy to evaluate you.

Best regards,
DDM

Not anywhere near NC. I'm near Springfield MO. Any connections here?

 

[TONY CHANEY]

Tony, thank you for the info and advise. I have been seriously thinking about searching around for a pulmonologist with diving certification for a second opinion. You have hit on many of the questions I have had, especially as to whether it could be cardiac or just the fact that I'm 61 yrs old and a little overweight. I did get a chest x-ray which my regular Dr does every 2 years anyway because of history of lung cancer in my family... father, brother, uncle, grandfather. The only test the pulmonologist did was what I'm guessing was a spirometry test (blow into a tube thing) and the clip on my finger. No CT scan, no treadmill. Yes the inhaler is Spiriva and after a month I do feel an improvement. He did not recommend any physical therapy or oxygen. There really wasn't any discussion about it. He asked if I knew anything about COPD, I said no. He said I'll give you some information about it before you leave which he didn't. I got out to the reception area to schedule my next appointment and realized I didn't get the information. It basically was a single sheet of paper with a link to the Mayo Clinic. Not impressed with this Dr as you can tell.

The only test the pulmonologist did was what I'm guessing was a spirometry test (blow into a tube thing) and the clip on my finger. No CT scan, no treadmill. Yes the inhaler is Spiriva and after a month I do feel an improvement. He did not recommend any physical therapy or oxygen. There really wasn't any discussion about it. He asked if I knew anything about COPD, I said no. He said I'll give you some information about it before you leave which he didn't. I got out to the reception area to schedule my next appointment and realized I didn't get the information. It basically was a single sheet of paper with a link to the Mayo Clinic. Not impressed with this Dr as you can tell.

So I am guessing that the spirometry was performed. There really is no need for the treadmill or CT. since your SpO2 was 97% then there is not need at this time for additional oxygen. You are active so there is not need for physical therapy. While as a RCP student we had to report to a pulmonologist and work within the office. I was really shocked at the lack of information provided to patients or the time to sit down and explain the pathophysiology of lung diseases. A while back I took time to explain to a patient and family members about COPD. He has been Dx for over 30 years and no one has ever explained to him what it is all about. He was lead to believe that he only had a few months to live and he was with us at the LTAC. What he really had was congestive heart failure coupled with COPD which was an acute on chronic condition. He was discharged from the hospital to rehab and came walking in a few weeks later to visit. (I love these outcomes).

Spot on what Duke Dive Med. stated! I would really take his/her advice as they are the experts on this. I would also add a couple of other suggestions: 1) buy a portable pulse oxymeter (around $50.00) and measure your oxygen while exercising. (you might need additional O2 with exercise) 2) Take a good look at the regs that you are using and if you are still wanting to dive then use regs that have a very low critical opening pressure. Most COPD patients have a decreased in NIF (negitive inspiratory force) which is just how much of an inspiratory force you have. If you NIF is rather low then it will require you to work harder to take a breath. 3) Go with the Nitrox. Unless you have sever and advanced COPD where your hyponia is your drive to breath vice increased CO2 then the additional O2 in nitrox might help you out. 4) After you reach the surface, if able, float around for a few minutes prior to climbing up a ladder or walking several yards with all of your gear on. If you are already "winded" at the end of the dive then it will only get worst once you start engaging large muscles and carrying all that weight out of the water. 5) Ask your doctor to prescribe a rescue inhaler if you find that you cannot catch your breath post exercise / dive.

Please keep us posted and I hope that this helps.

 

[Duke Dive Medicine]

Tony makes some good points above. I would emphasize that exercise tolerance on the surface is not the same as exercise tolerance while diving, where inspiratory and expiratory resistance and gas density come into play. You can't exercise to the same level under water as you can on the surface, and this effect increases with depth. If you need supplemental O2 to exercise on the surface; your COPD is severe enough that opening pressure on a properly adjusted regulator is a factor; and/or you physically need the extra O2 that nitrox provides, you probably do not have the necessary exercise tolerance to dive safely independently.

Our database shows that Cox Hospital in Springfield has a hyperbaric clinic with physician staff who can evaluate divers.

Best regards,
DDM

 

[TONY CHANEY]

thanks for additional info DDM. Need some help at Duke?

 

[Duke Dive Medicine]

thanks for additional info DDM. Need some help at Duke?

We can always use a good respiratory terrorist ;-)

 

[Pembina]

Thanks for your time and advice. You have given me a little bit of hope and a lot to think about. I don't feel the need for O2 while exercising. I breath harder but I never feel out of breath. I do feel better though when diving with Nitrox. Is that because of the added O2. I'm a picture taker so I don't feel that I excerpt myself very much when diving. Kick a couple of times then stop to explore and take pictures. I'm never in a hurry to get anywhere unless it is out of a swim through cave (I'm a little claustrophobic) and I spend at least half my dive in shallow water where most of the color is. I don't know whether these attributions make me a safer COPD diver but I'm hoping so.
DDM, do you have any info about any of the Mercy Drs? I'm afraid that is who my insurance is through. If not, I'll just have to cough up the money to see an out of network Dr.
Another question... where do non-divers go on vacation and what do they do? I've always thought laying on a beach was a waste of time (besides I also have history of Basil and Squamous cancer) Is God trying to tell me to stay away from the water and I'm just not listening?

 

[chillyinCanada]

Out of the sun, in any event.