weird coughing/gagging while diving

[sufur]

I've been diving for a few years. i have about 170 dives. About a year and a half ago i had just completed a DPV diving course in hawaii and returned to florida for some dpv diving on the Vandenberg and Spiegel grove in the Keys. The first few days of diving went fine with no problems was having a great time. On the last day of diving the Spiegel Grove on getting into the water my mask came lose a little and i did get a bit of water up my nose but didn't think anything of it. As soon as i started descended i noticed my throat feeling dryer than normal which caused me to cough a bit, but i didn't think it was a problem so continued the descent. Well it continued to get worse. And by the time we reached the end of the line at 90ft i was having a hard time. my throat felt extremely dry and now i was starting to cough uncontrollably and it was also making me feel like i was going to gag. well i thumbed the dive and we went back up and by the time i got to 10ft i could barely keep myself together. and when i finally made it to surface i couldn't even keep the reg in my mouth and i pretty much coughed non stop until i got back on the boat.

Initially i thought this was a fluke. but on my very next dive a shore dive in maybe 15 feet of water the same thing happened after about 15 min in the water. It has pretty much continued to happen almost every dive since then. Ive only tried to dive a handful of times since. Ive tried changing regulators. i have not tried changing tanks yet. i went to a regular doctor and he sent me to a lung specialist and did a lung function test and they didn't find anything unusual. I spoke to DAN and they suggested it might have to do with being dehydrated. but I've tried drinking a ton of water leading up to my dive and before the dive and still th e same issue. most of the time it seems to take about 30 min before it happens now. any ideas? one suggestion has been anxiety but i don't know why that would start suddenly for no apparent reason.

diving has been pretty much my biggest hobby for the past few years so it would suck to have to stop diving because of this. if anyone has some insight or suggestions it would be greatly appreciated.

 

[Duke Dive Medicine]

Sufur, does this happen anywhere else but in the water? Are you under a doctor's care for anything, and do you take any medications regularly? How far apart were the dives on the Spiegel Grove and the 15' shore dive you mentioned? How long has it been since you did the Spiegel Grove dive?

Best regards,
DDM

 

[sufur]

DDM, i did notice during a hard workout at the gym once that i was starting to get a coughing sensation.. but without a mask over my face and breathing from a reg i can't really say that it was the same thing. I'm not under a doctors care for anything and I'm not taking any medications. i do take something for sea sickness usually when diving. but like i said this happens on shore dives also. the break between the shore dive and the spiegel was a week or two. but in the past year or so since the first time it happened I've done several dives. shore and boat. i don't know the exact number maybe 10 dives and its happened on all but 1 dive to varying degrees.

I've also noticed what seems to be a constant presence of some thick clear phlegm and no amount of decongestant(sudafed, or mucinex) seems to change it. not sure if its coming out of my sinus or what. even when i drink tons of water. it always seems to be there.

 

[Duke Dive Medicine]

Hi Sufur, I'm not really sure what to make of your symptoms. You've switched regs and the same thing has happened, though it's not impossible that both had a hole or tear in the diaphragm. It could be an environmental irritant that's getting into your tank air and causing upper airway irritation. Just to double check, did I read you correctly in that the cough seems to originate from the upper airway and not from secretions in the lungs? May I ask how old you are?

Best regards,
DDM

 

[fmerkel]

Possibly an occult sinus infection. Post nasal drip could be triggering an asthma-like response. You might also have some very low grade underlying asthma tendencies that only show up with specific provocation.

Example - Did a 4-day dive vacation with the club. On the 2nd day I came up from an uneventful dive and had a persistent annoying dry cough. Suspecting a bad tank I asked around but no one else had issues. The tanks were all being filled with the resort compressor so we were on even footing there. Next dive, same thing, so I talked to the owner. He gladly took me out, showed me all the compressor maintenance records, and looked it over himself. Again, I was the only person with the cough. Except for that I felt fine.

Came home, and came down with a nasty cold, which the cough was the worst part. Obviously the cough was the early warning and triggered by dry scuba air.
Really really bad cough at night, couldn't sleep. Totally non-productive. Turns out I have what I call "cough variant, cold induced asthma". I get this with .....some colds.....not all, and I get a nasty dry cough. Bronchodilators are useless, but inhaled steroids work well. Once I'm well I taper off the steroids and don't have the problem again for a long time. In between I'm symptom free.

Dry air can be a trigger for the cough if the lungs are in an irritated state. The lungs pretty much only have one response to irritation > cough.

I should note that my spirometry is normal when I'm well, and still normal when I have the cough, which is why the bronchodilators don't do any good. I should also point out I'm a Respiratory Therapist with a specialty in asthma.

The thick sputum could be from the nose (the possible sinus infection) or it could be from the lungs. Asthma will create a thick mucus as one of the primary symptoms. Water won't do much of anything for that, nor sudafed or Muxinex. Cough is another VERY common symptom of asthma.

 

[sufur]

yea it just feels like my throat drying out no matter how hard i try to keep it moist. and eventually a stuffy sensation at the back of my throat causes the gagging and coughing. I'm 37 years old. I've been diving since 2009 and never experienced anything like this until last year.

 

[tursiops]

I developed a cough a couple of nyears ago after a number of dives, much the same description as the OP. I now use an Apollo Biofilter on my reg to keep the air moist, and now have very few coughing occurrences, but they are not gone entirely.

 

[Duke Dive Medicine]

I think a visit to an ENT physician would be reasonable. Also, this is pretty remote but since it's associated with immersion and exercise, a cardiac cause can't be entirely ruled out, especially over the internet. That should at least be explored with someone who can examine you in person.

Best regards,
Eric

 

[sufur]

anyone know a ENT that might have a speciality of dealing with divers in south florida?

 

[iamrushman]

been monitoring this thread....you could call DAN for a M.D. referral.....keep us informed of your progress.