Asthma and Pulmonary barotrauma

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hamm

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Hi guys,

I have extremely mild asthma (don't use a preventative, rarely use an inhaler and only for slight wheeziness - never experienced an 'attack') but I also fail a spyrometry test "most likely due to thin bronchial tubes"

Now I'm not here to ask for medical advice, just if anyone has heard of or had any experience diving with mild asthma. Most importantly - if i get wheezy whilst down ~20m but do not panic and ascend AS NORMAL but with breathing difficulties, would it be safe to assume that because i am still breathing then i am not at risk of pulmonary barotrauma?
I have left Australia to get my PADI without a medical and had no issues with breathing but am obviously concerned if i make this a big part of my life which i really want to since i LOVE it!

Thanks alot for your time
 
My suggestion would be to contact the Asthma Foundation here in Australia and learn as much about the physiology of the condition as you can. There is a very good Asthma support system here. When you feel that you have a clear understanding of the condition you will be better able to make informed decisions about when, what types of dives and also when you shouldn't dive. It will also mean you are not just taking one person's diagnosis, perception or bias with regards to your life. DAN is also a good source of information. You will no doubt get some conflicting opinions but at least you can sort things out and work out what is best for you!

That said I know of people who have done a lot of diving with no negative impact by carefully managing their condition. I also know of people who have done a lot of diving with no negative impact by sheer blind luck!

There is danger that if you have a bronchiospasm it may block air from escaping that area. The trapped air may expand as you surface and cause over expansion, rupture, barotrauma. You are wise to ask the question before you get into trouble. IMHO the wisest course is to get as much education as you can on the topic
 
Everything of this sort is a risk assessment. As we advise people with significant asthma not to dive, the set of people who fail selection criteria and dive anyway is very small. There are no published data to tell us what the actual occurrence of significant pulmonary barotrauma is, in asthmatics who don't meet criteria for safe diving.

What you really need to know is what could happen if you DO have issues with your asthma. Asthma is an obstructive process, which means air would have trouble getting out of the small air sacs. This could result in pneumomediastinum (air in the center of the chest) which is uncomfortable, but rarely dangerous. Or it could result in a pneumothorax, which, in and of itself, is rarely dangerous in a healthy person with normal lungs. The problem with a pneumothorax while diving, however, is that the gas that escapes from the lungs into the space between them and the chest wall, is under ambient pressure at the depth where the problem occurs. When you ascend, that gas expands . . . and that expansion can push the structures in the center of the chest to one side, intefering with blood return to the heart. This problem is called tension pneumothorax, and it can be lethal. In addition, pulmonary barotrauma can result in arterial gas embolism, and of all diving mishaps, that's the one I'm most afraid of. People with significant AGE end up on the surface in cardiac arrest, and don't get rescuscitated.

You can live through DCS, and be revived sometimes from significant drowning. But some of the things that can happen to you from pumonary barotrauma are not salvageable. You simply have to decide whether a small but real risk of an irreversibly lethal event is worth it to you to dive.
 
@hamm: Is your asthma induced by cold/dry scuba air, stress, or exercise? If so, you could be exposing yourself to a significant amount of risk while diving.

Based on your post, I would recommend that you educate yourself about your condition and the specific dangers of diving with asthma. TSandM's post above is an excellent starting point. Don't stop there. Dr. Lawrence Martin has written a nice essay entitled "Should Asthmatics Not Scuba Dive?"

Read the Divers Alert Network article entitled "Asthma & Diving."

The Scubadoc website has compiled recommendations from various organizations for the medical clearance of asthmatics for diving.

Asthma used to be considered an absolute contraindication to diving. That doesn't appear to be the case nowadays. I have encountered a handful of divers in the past decade who have well managed mild asthma and are active divers. As far as I know, these folks have experienced no scuba-related asthma "incidents," although admittedly I haven't kept in close touch with a number of them. There is precedence for mild asthmatics who dive, but it's important to acknowledge that these people probably accept a higher level of risk while diving than other normal, healthy individuals. How much higher? It's difficult to say.
 
Thanks for your posts everyone, really appreciate it as I have only just begun to research the dangers of what I'm doing.

The only time i get asthma will be (randomly) from fairly strenuous excercise and even then it's a mild wheezing more than anything - had no issues with dry air on my few previous dives. BUT i have been to see a specialist and they did induce a reaction when introduced to the salt mist test. Which is, from what i can gather, straight away a big no.

I think i will go back to the specialist for some more specific answers to my condition now that I am more informed.

Thanks
Hamish
 
Now I'm not here to ask for medical advice, just if anyone has heard of or had any experience diving with mild asthma.

So... you specifically don't want qualified advice from experts in diving medicine?

Maybe you're predicting that they might advise that you take the condition seriously and have it checked out....which you don't want to do.... so you'd rather appeal to the wider diving community for some type of encouragement to do what you strongly suspect is wrong?

Personally, I wouldn't ask for medical advise specifically from unqualified persons.

if i get wheezy whilst down ~20m but do not panic and ascend AS NORMAL but with breathing difficulties, would it be safe to assume that because i am still breathing then i am not at risk of pulmonary barotrauma?

You know what they say about assumptions.

Getting wheezy indicates a constriction. A constriction can lead to trapped air. It might not close your lungs completely, but you only need a small pocket of trapped air within your lungs to cause a potentially fatal lung rupture.

I have left Australia to get my PADI without a medical....

So? There are doctors/clinics outside of Australia. Visit one....

p.s. You'll have to complete a medical disclaimer when enrolling on a scuba course. That disclaimer will ask about asthma. If you answer that form truthfully, then the dive operator will send you for a medical check, because they will need an approval from a qualified doctor before they can teach you. I wouldn't advise lying on the medical form.... that tends to aggravate dive instructors, puts you at risk... and can invalidate any medical insurance cover that you have for scuba diving....
 
I have left Australia to get my PADI without a medical...
So? There are doctors/clinics outside of Australia. Visit one....

p.s. You'll have to complete a medical disclaimer when enrolling on a scuba course. That disclaimer will ask about asthma. If you answer that form truthfully, then the dive operator will send you for a medical check, because they will need an approval from a qualified doctor before they can teach you. I wouldn't advise lying on the medical form.... that tends to aggravate dive instructors, puts you at risk... and can invalidate any medical insurance cover that you have for scuba diving....
@DevonDiver: I believe that the OP mentioned leaving Australia to get scuba certified due to the country's highly conservative stance on dive clearance for asthmatics. In recent history in Australia (not sure what the current status is), the policy for establishing dive fitness in asthmatics was clear cut: a person with a history of symptoms and medication for asthma in the past 5 years should not be cleared to dive. Even if that policy has loosened up a bit, I'm fairly certain that the OP's "failed" spirometry test would result in disqualification for diving.

Contrastingly, the asthmatic dive clearance standards in the UK appear to be much more permissive. Different countries, different rules.
 
Medicals are required for OW, Deep and higher level courses here in OZ interestingly I have been told by a dive op not required for AOW. As far as I know there is no legally binding requirement to deny asthmatics clearance. It depends on the Dive doctor.

Some are much more conservative than others. IMHO a second opinion is often a good thing. A friend of mine went for a dive physical with a "Dive Doctor" who basically told her he was not comfortable clearing people over 50 to scuba dive! This was the only so called Dive Doctor in their town so she insisted he do whatever tests where necessary to prove or disprove her fitness to dive. She passed all the tests but one was marginal so she was declined! Surprise surprise!

Dr Simon Mitchell see Tec Talk 15: Simon Mitchell on CO2 retention and the "off effect" - Rebreather World Acknowledged the tendency of some Dive Doctors to deny clearance on medicals for fear of being held liable in our litigious society. He also stated that he and some others don't like to deny people access to the sport he is so passionate about without good cause They would rather do full investigations and assist patients to make well informed choices. There is too high a risk that people will ignore the advice and do it anyway.

That is why I suggest that the OP learn as much as he can about his condition and get at least two Medical professionals to evaluate his case. If they agree it is easier to accept the decision if they don't then a third may be necessary. I do not suggest seeing doctors until you find on who agrees with you but having the appropriate information to make a good decision.
 
Medicals are required for OW, Deep and higher level courses here in OZ interestingly I have been told by a dive op not required for AOW. As far as I know there is no legally binding requirement to deny asthmatics clearance. It depends on the Dive doctor.
@bowlofpetunias: My comments regarding Australia's stance on dive clearance for asthmatics were based on an article published in GP Review by Dr. David Batt which has been posted on the National Asthma Council Australia website. The document is entitled "Asthma in Deep Water." See the following quote for the relevant information:
To hire or buy scuba equipment in Australia, a diver needs accreditation, which includes medical certification. Most Australian doctors providing diving accreditation use the SPUMS (South Pacific Underwater Medicine Society) guidelines.3

International recommendations for diving and asthma vary widely. Through the SPUMS guidelines and the Thoracic Society of Australia and New Zealand position statements,4,5 Australia has traditionally taken a conservative approach to asthma and diving, with asthma treatment in the past 5 years precluding medical certification. In contrast, the British Sub Aqua Club and the UK Sports and Diving Medical Committee suggest that people with mild, well controlled asthma may dive, with exclusions being cold, exercise and stress triggers or symptoms or reliever treatment in the 48 hours prior to diving.5
Based on what you wrote, it sounds like the guidelines that physicians are using for asthmatic dive clearance in Australia have loosened up in recent years. :idk:
 
@bowlofpetunias: My comments regarding Australia's stance on dive clearance for asthmatics were based on an article published in GP Review by Dr. David Batt which has been posted on the National Asthma Council Australia website. The document is entitled "Asthma in Deep Water." See the following quote for the relevant information:

Based on what you wrote, it sounds like the guidelines that physicians are using for asthmatic dive clearance in Australia have loosened up in recent years. :idk:

To hire or buy scuba equipment in Australia, a diver needs accreditation, which includes medical certification. Most Australian doctors providing diving accreditation use the SPUMS (South Pacific Underwater Medicine Society) guidelines.3

Yes it seems like more Dive Doctors are using discretion that seems to be acknowledged here by the statement that MOST as I highlighted in red in your post may be using the more conservative guidelines. Asthma is a horrific problem in Australia. Some statisticians claim we are the worst country in the world for number of asthmatics. :idk: I saw a lot of asthmatics when I was in Canada. Perhaps the sheer number of people diagnosed/effected has resulted in a rethinking of the position:idk: perhaps people are managing their conditions better.

I can't quote a link for you because part of what I am saying is based on private conversations with Dive Doctors and attending talks presented at Ozteck etc. There has been some recognition that declining medicals too often results in people diving uninformed and untrained.

We took our nitrox course last year and were not required to take a medical. When I asked about it I was told that Medicals were required for OW and DEEP but not AOW. Once we have been certified we are not required to have further medicals to maintain certification.

There are laws falling under the Occupational Health and Safety Regulations in Queensland. There are laws regarding testing of Scuba tanks because they are high pressure tanks. We have been unable to find any actual LAW that requires certification to rent or buy gear. This seems to be a requirement imposed by the scuba industry here. I think there is a general feeling that it is better to self regulate in this way so that the government doesn't find a need to come in and impose regulations that will be less umm acceptable and responsive to the industry!
 
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