whats the latest Medical Advice for people with Asthma who want to dive?

[AnneWright]

Please, what’s the latest Medical Advice for people with Athsma who want to dive?


My son is incredibly keen to do an Open Water Diver Course as he has recently been accepted into a Marine Science Program at University, here in Australia.


He was asked to get a Diving Medical prior to the commence of the course, however we were informed that Athsma is huge problem if you want to do the course and it was unlikely that he would ever be able to dive as it would be incredibly dangerous for several reasons which do seem understandable.


Unenthusiastically, my son still went to get the Medical with a trusted local doctor. After a few quick tests, my son walked out with a big grin on his face ready to start his diving course.


I am a little concerned about the situation and would like to know what the instructor will say when he arrives on the weekend for the course with the medical? More importantly, what is the latest medical advice for people with Athsma who want to dive and how big of a threat is diving with Athsma?
Anne.

 

[TONY CHANEY]

For what's it's worth I am a Respiratory Therapist. So with that you can take the rest as you would like. 1) what causes the attacks? There are attacks caused by pets, coldness, exercise, weather changes etc. If exercise induced then you might not want to continue to dive. 2) How often are the attacks. Means is it under control? 3) How severe are the attacks? I have seen anywhere from coughting to having to be intubated. I would suggest that never skip your medication, do your peak flow 2-3 times a day and let those that dive with you know you have asthme.

 

[TSandM]

Asthma is a diagnosis that covers a very wide spectrum of disease manifestations. Some people are only mildly wheezy or plagued with a dry cough after viral infections; other people are dependent on daily medication to allow anything like normal mobility and function. For this reason, it is difficult to say how dangerous "asthma" is for divers. I think it's pretty obvious that having any major problem with one's breathing when underwater is a bad thing. People who are symptomatic on a daily basis and dependent on medication are pretty high risk for increased symptoms in any circumstance. I think most physicians would advise such people not to place themselves in situations where support for their breathing is a long way off.

On the other hand, a person who rarely requires any medication and has normal exercise tolerance between bouts may be quite safe to dive, especially if his asthma triggers are known (certain allergens, or viral illnesses) and can either be avoided, or diving can be avoided when they are present.

The theoretical concern with asthma and diving is that asthma is a process of obstruction of small airways. When you descend on Scuba, the air you breathe becomes more and more dense with depth (that's how a regulator works -- it delivers air at the pressure where you are, so as you get deeper and the pressure increases around you, the pressure at which the air is delivered goes up, too). As you ascend, that air expands and has to leave the lungs. In asthma, exhalation is difficult and parts of the lung may not empty normally; if air gets trapped and continues to expand, it can damage the lung or cause air bubbles in the circulation. To my knowledge, there are no studies or even case reports suggesting that any diving injuries are due to this, but that may well be because for a long time, a diagnosis of asthma meant that no doctor would clear the person to dive.

 

[Duke Dive Medicine]

On the other hand, a person who rarely requires any medication and has normal exercise tolerance between bouts may be quite safe to dive, especially if his asthma triggers are known (certain allergens, or viral illnesses) and can either be avoided, or diving can be avoided when they are present.

Ditto TSandM. We look at pulmonary function both before and after provocative testing (exercise) and if it's normal, we'll consider clearing an asthmatic to dive. We look closely at triggers, because the dry air from a SCUBA tank can itself trigger an asthma attack.

 

[AnneWright]

1) what causes the attacks?

The attacks are usually exercise induced.

2) How often are the attacks?

He hasn't had an attack for several months, however they are quite unpredictable.

3) How severe are the attacks?

The severity of the attacks vary, but used to be worse when he was younger.


Thanks for the information so far, however I'm still unconvinced that it is the safest thing for him to be doing considering his history.

 

[Duke Dive Medicine]

Anne,
Unpredictable exercise-induced asthma is cause for concern in diving. Did the physician perform pulmonary function testing? If so, was he tested both before and after exercising?
Best,
DDM

 

[indydivegal]

Duke Dive Med - What do you think if it is allergy induced, only use inhaler when necessary and not on daily basis? Just curious.

 

[Duke Dive Medicine]

Duke Dive Med - What do you think if it is allergy induced, only use inhaler when necessary and not on daily basis? Just curious.

Hi indy,

That depends on the allergy trigger, frequency of inhaler use, and results of pulmonary function testing. We assess each asthma patient individually. We don't automatically disqualify people who use medications but we look carefully at how well-controlled the asthma is.

Best regards,
DDM

 

[indydivegal]

No problem! I know of someone with environmental allergies (dust, leaves, feathers, dogs, cats, etc.) and it triggered an asthma issue, not badly, but enough that an inhaler was used for a short time. Now it is only used when necessary, events are not frequent. Thanks for the info, really appreciate it!

Oh btw - it was a first time event for the inhaler.