A Development for Asthmatic Divers: Development of An underwater Inhaler

[Ollie Carter]

Therein is the difference... (this is not about medical insurance, but LIABILITY insurance)

1) The peanut allergy audience is HUGE.

2) such a drug would be a new (novel) solution to a medical malady

This equals money. Easy to pay for the liability insurance.

What the OP has is a modification/change of an existing delivery system. Then, mashing it with what is already classed as a high risk device: regulators.




Ski bindings have been mounted and adjusted by trained monkeys for years.

You bring up an interesting parallel. Many older bindings can not be touched by a ski tech lest their shop lose liability coverage due to manufacturers prohibiting them from touching older gear.

(I have 5 mono skis with ancient Solomon 757 Demo bindings. They still seem to be fine)

Its an interesting point, the peanut allergy audience is big, but as ive stated 12% of the 60 million in the uk are registered with a prescribed version of asthma. The drug is not new, will be using existing canisters of salbutamol, so no need to search for insurances with drug associated insurance/quality testing. The mashing with the regulator was an idea, and right now i couldnt comment on whether it is possible or not. I get the high risk issue though. Its all a high risk situation, so is hard to avoid that hurdle anyway.

I appreciate a can-do attitude. Insurance companies really don’t shiv a git.

 

[Zef]

This falls into the category of:
Some things that can be done, should not be done.

-Z

 

[BoundForElsewhere]

wouldn't the inhaler function differently at different depths / pressures?

 

[BlueTrin]

@Doc what do you for a living ?

seems interesting

wouldn't the inhaler function differently at different depths / pressures?

there are ways he can overcome maybe this issue, if he can make a powder like in the turbo inhalers, then the dose would be constant

 

[Zef]

Will this work like a nebulizer or a standard inhaler?

-Z

 

[Zef]

And what of the situation where an asthma attack occurs and the device fails to deliver or the attack doesn't subside, or it does not subside completely?

This is not an issue for want of an engineering solution...there are physiological issues that exist in diving that do not marry well with the affects of asthma. Administering medication is only one part of the equation...there is still the timeframe for the medication to take effect, there are concerns about the administration of the medication as it applies to diving, the typical inhaler requires the subject to exhale as much as possible, and then inhale fully and hold that inhale for a number of seconds....

....exhaling fully to the point the lungs are empty is not recommended when diving because it can cause collapse of some of the alveoli which don't always immediately rebound. Holding one's breath after inhaling the dose of medication is not recommended either, as this can cause overexpansion injuries if one were to rise in the water column...which is a relevant possibility when taking a very large breath.

Then there is the issue of timing...what happens when an attack occurs at a depth of 40 meters where one has very limited no-deco time? A recreational diver having an asthma attack might find themselves doing a decompression dive that they have no training or planning for, nor the gas reserve to be able to handle such a dive.

How about the asthmatic diver having an attack at similar depths to the example above but they are suffering from narcosis, and although they are having an attack, the narcosis interferes with their decision making process and they fail to administer the medication.

How about the person who takes that deep breath to inhale the dose of medication delivered but spasms and coughs uncontrollably and aspirates water?

What about the person who does not realize they are having an attack, so they don't administer the medication and they become injured because due to blocked airway passages?

There is a reason why symptomatic asthma is a contraindication for diving....it presents a very real danger to the afflicted and that danger is problematic to those diving with them as well.

Diving is a great activity, I love it, and I would love to share my love for it with everyone, but there are some that for nothing more than their physiological condition and the risk(s) it presents, should just not dive.

-Z

 

[kelemvor]

I believe albuterol (the active ingredient in asthma inhalers) can be taken intravenously. If you had to take it underwater, an epi-pencil type injector seems simple enough.

 

[Ollie Carter]

And what of the situation where an asthma attack occurs and the device fails to deliver or the attack doesn't subside, or it does not subside completely?

This is not an issue for want of an engineering solution...there are physiological issues that exist in diving that do not marry well with the affects of asthma. Administering medication is only one part of the equation...there is still the timeframe for the medication to take effect, there are concerns about the administration of the medication as it applies to diving, the typical inhaler requires the subject to exhale as much as possible, and then inhale fully and hold that inhale for a number of seconds....

....exhaling fully to the point the lungs are empty is not recommended when diving because it can cause collapse of some of the alveoli which don't always immediately rebound. Holding one's breath after inhaling the dose of medication is not recommended either, as this can cause overexpansion injuries if one were to rise in the water column...which is a relevant possibility when taking a very large breath.

Then there is the issue of timing...what happens when an attack occurs at a depth of 40 meters where one has very limited no-deco time? A recreational diver having an asthma attack might find themselves doing a decompression dive that they have no training or planning for, nor the gas reserve to be able to handle such a dive.

How about the asthmatic diver having an attack at similar depths to the example above but they are suffering from narcosis, and although they are having an attack, the narcosis interferes with their decision making process and they fail to administer the medication.

How about the person who takes that deep breath to inhale the dose of medication delivered but spasms and coughs uncontrollably and aspirates water?

What about the person who does not realize they are having an attack, so they don't administer the medication and they become injured because due to blocked airway passages?

There is a reason why symptomatic asthma is a contraindication for diving....it presents a very real danger to the afflicted and that danger is problematic to those diving with them as well.

Diving is a great activity, I love it, and I would love to share my love for it with everyone, but there are some that for nothing more than their physiological condition and the risk(s) it presents, should just not dive.

-Z

you raise some interesting points, but i feel like you have misunderstood the point of the product a little.

you are purely considering an attack, which is the most severe reaction possible, while asthma operates and has effect on people on a less extreme manor. im talking about people getting a little shortness of breath, wheezing a little etc. in the event of an attack, even above ground sometimes inhalers dont work, and an attack decends into something more serious. for these people, i would recommend completely that they dont dive, but they have a far more severe case. Im aiming more for casual asthmatics.

With the point about decompression sickness and no making coherent decisions, i dont believe you can blame the functionality of an aid on misjudgement or consequential illness. When somebody drives a car, the car is not blamed when somebody with chronic fatigue falls asleep at the wheel.

 

[Ollie Carter]

wouldn't the inhaler function differently at different depths / pressures?

Im not sure yet, would involve flow testing which is potentially on the cards. My assumption as a young engineer:

Pressure increases when diving occurs due to the compression from weight of water. The human body has equilibrium pressure with air, or near so, (shown as you are steady state in atmospheric pressure, but the body would explode in space because of the imbalance) but as the water pressure increases it is compressed. comes from the equation pressure = force / area. This is not the same, or more accurately said, negligible when you have something encased in metal or something which will resist the pressure. You do not see a drop or gain in your air pressure if you look at your gauges when you descend if you get what i mean. therefore in an asthma canister, the pressure as long as the canister shows enough resistive force should remain constant, therefore each does will remain constant (as dosage is subject to factors of open valve time and internal pressure).

 

[Zef]

you raise some interesting points, but i feel like you have misunderstood the point of the product a little.

you are purely considering an attack, which is the most severe reaction possible, while asthma operates and has effect on people on a less extreme manor. im talking about people getting a little shortness of breath, wheezing a little etc. in the event of an attack, even above ground sometimes inhalers dont work, and an attack decends into something more serious. for these people, i would recommend completely that they dont dive, but they have a far more severe case. Im aiming more for casual asthmatics.

With the point about decompression sickness and no making coherent decisions, i dont believe you can blame the functionality of an aid on misjudgement or consequential illness. When somebody drives a car, the car is not blamed when somebody with chronic fatigue falls asleep at the wheel.

To your first point....your sentiment that there are "casual asthmatics" is indicative that you might be married to the idea of your invention above and beyond reason. If one is not so afflicted that they do not need medication then your device is not necessary, and if one is symptomatic and using medication to intercede and control asthmatic episodes where your solution would be handy, they should not be diving.

To your second point...the example that I gave were not arguments against the device you are engineering, they were examples of why asthmatics, who are symptomatic, should not be diving.

Again, this is not about what can be done...if we, as a human race, were able to put and maintain a space station in orbit around the planet, devising a way to administer inhaled medication while underwater should not be all that difficult....it is a question of should it be done. To me, based on what I know of asthma, having grown up with it, having a background in athletic training/exercise science, there answer is "no". If one is going to use inhaled medication prophylactically, there are medications like cromolyn sodium (Intal) that if used on a regular/continuous basis has been seen to be effective at preventing asthmatic episodes....the issue is that one needs to take this medication regularly, not just the morning of a dive, to be effective. One could also argue that if one is taking this type of medication that they should not be diving, as it is evidence that they are symptomatic as the medication is prescribed to control the symptoms/prevent episodes. I can't think of a valid reason why someone with asthma, "casual" or not, that needs to take medication for it, should be diving...they are increasing the risk for themselves and those they are diving with.

-Z