Hi cruisegirl,
Here are a couple of articles that you and your lung doctor may find informative:
1. "Can I Dive With Asthma?
Updated version of a piece that appeared in my "Dive Workshop" column in "
Rodale's Scuba Diving" magazine:
Asthma is a chronic but often largely controllable obstructive pulmonary disease that affects about eight to 10 percent of children and five to eight percent of adults in the U.S. Signs and symptoms include shortness of breath, wheezing, tightness in the chest and lasting cough. The potential adverse impact of a severe attack under water is obvious, and could be fatal. Arterial gas embolism (AGE) as a result of air trapping from the constriction and plugging characteristic of this disease has also been a frequent, but as yet inconclusive, concern. The research to date (*--see below) suggests that there is some indication that asthmatics may be at increased risk of pulmonary barotrauma, but much yet needs to be explored.
Asthma Triggers
Asthma is a chronic irritation & hypersensitivity of the respiratory tract, and attacks can be triggered as a reaction to a variety of conditions including stress, cold or exercise, and allergens such certain medications, pollens and foods. The asthmatics body reacts to these triggers, in varying order and severity, by constriction of smooth muscle in the bronchi and bronchioles, inflammation of the airway and increased mucous production. Attacks tend to be recurrent rather than continuous, and there is often much that can be done medically to reverse breathing difficulties when they do occur. In addition, since many of the precipitants of an attack are known, they can be avoided or controlled.
Diving with Asthma
Until the mid-1990s, asthma was largely considered an absolute contraindication to diving. However, thinking in the medical and professional dive community has rather radically altered since then, and those with asthma can now be certified under certain circumstances. Although they differ somewhat, the YMCA, BASC and Undersea and Hyperbaric Medicine Society each offer protocols guiding medical clearance to dive with asthma.
For example, the YScuba (now defunct) criteria included a requirement that all asthmatics have normal resting and exercise pulmonary function tests with no degradation after exercise. The criteria allow those taking routine preventative medications to be evaluated while continuing their treatment. Also required is the ability to exercise and tolerate stress without becoming symptomatic while on maintenance medications, and the absence of a need for rescue inhalers during times of stress or exertion.
If you suffer from asthma, its clearly unwise to deny or minimize this condition to yourself, or hide it from your instructor or the operators with whom you dive. Scuba can involve some of the asthma triggers discussed above, such as cold and exercise, not mention hyperdry scuba cylinder gas. If you have asthma and want to dive, or are already diving without medical clearance, it is critical that you consult a physician to obtain an appropriate pulmonary workup and permission to dive.
Finally, the issue of being a reliable dive partner must be considered. A diver with ashtma should always inform his buddy of his medical status "
(*) "Sports Med. 2003;33(2):109-16.
Asthma and recreational SCUBA diving: a systematic review.
Koehle M, Lloyd-Smith R, McKenzie D, Taunton J.
Allan McGavin Sports Medicine Centre, Department of Family Practice and the School of Human Kinetics, University of British Columbia, Vancouver, British Columbia, Canada.
mskoehle@interchange.ubc.ca
Asthma has traditionally been a contraindication to recreational self-contained underwater breathing apparatus (SCUBA) diving, although large numbers of patients with asthma partake in diving. The purpose of this paper is to review all the research relevant to the issue of the safety of asthma in divers. MEDLINE and MDConsult were searched for papers between 1980-2002. Keywords used for the search were 'asthma', 'SCUBA' and 'diving'. Additional references were reviewed from the bibliographies of received articles.A total of fifteen studies were identified as relevant to the area. These included three surveys of divers with asthma, four case series and eight mechanistic investigations of the effect of diving on pulmonary function. The survey data showed a high prevalence of asthma among recreational SCUBA divers, similar to the prevalence of asthma among the general population. There was some weak evidence for an increase in rates of decompression illness among divers with asthma. In healthy participants, wet hyperbaric chamber and open-water diving led to a decrease in forced vital capacity, forced expired volume over 1.0 second and mid-expiratory flow rates. In participants with asymptomatic respiratory atopy, diving caused a decrease in airway conductivity.There is some indication that asthmatics may be at increased risk of pulmonary barotrauma, but more research is necessary. Decisions regarding diving participation among asthmatics must be made on an individual basis involving the patient through informed, shared decision making."
2. Scuba Diving with Asthma
By Daniel More, MD,
June 01, 2009
People with asthma can lead active lives, but they may have to take special precautions when engaging in particular activities -- including scuba diving.
Asthma and Physical Activity
Asthma is a chronic inflammatory lung disease. The inflammation of the airways can trap air deep within the lungs, resulting in their over-expansion. However, there are numerous asthma medications available to treat this inflammation and air-trapping. Many national and international organizations that publish asthma treatment guidelines stress that people with asthma should be able to lead active, healthy normal lives, including participating in many different sports and activities.
Asthma and Scuba Diving
Scuba diving has long been a popular recreational activity, with over 5 million certified divers in the United States and hundreds of thousands of people becoming newly certified every year. As asthma occurs in 5 to 10% of the population, many of these divers have asthma. In the recent past, however, people with asthma were told not to scuba dive due to the mostly theoretical dangers that are present.
People with asthma would seem to be more prone to accidents from scuba diving. Many asthmatics have air trapped in their lungs, which can expand during ascent to the surface, causing the airways within the lungs to to rupture (barotrauma). If barotrauma occurs within the lungs, air can get into the blood vessels, forming an air bubble that can lodge in the brain or other organs. This is called an air embolism.
Asthma attacks during scuba diving also seem likely, given that many people have worsening asthma symptoms during exercise, such as with scuba diving. In addition, scuba divers breath cold, dry, compressed air, which can cause worsening symptoms in asthmatics. An asthmatic who is scuba diving at significant depths could not possibly use a rescue inhaler for a long period of time until ascent to the surface was accomplished, which could theoretically make an asthma attack worse for the above reasons.
Aspiring scuba divers need a doctors medical clearance before becoming certified to scuba dive. Many doctors, including myself, have been reluctant to allow asthmatics to scuba dive, mostly based on theoretical concerns. However, studies on scuba diving accidents have not shown that asthmatics are at an increased risk for injuries. This may be because people with significant asthma may choose not to scuba dive because the activity causes an increase in asthma symptoms.
Guidelines for Scuba Diving If You Have Asthma
Despite data not showing that asthmatics are at a significant increased risk for diving injuries, many diving medicine authorities still recommend that asthmatics follow special guidelines:
People with past or present asthma should see a doctor familiar with the risks of asthma in scuba diving for a complete physical examination and spirometry.
Scuba divers should have normal spirometry at rest, and in response to an exercise challenge which can be performed in a doctors office. Those with abnormal spirometry at rest, in response to exercise, or those who experience asthma symptoms with cold/dry air exposure should not dive.
Asthma should be controlled with medications before a person participates in scuba diving.
A person should not scuba dive if he is experiencing an increase inasthma symptoms, or if he has needed to use a rescue inhaler in the past few days prior to a planned dive. It would therefore seem reasonable for a well-controlled asthmatic, with normal spirometry and without the need for frequent rescue inhaler use, to participate in scuba diving. It is important for asthmatics to be aware of the possible increased risk for injuries during scuba diving, which could potentially be life-threatening, and to discuss these risks with their doctor.
Asthmatic scuba divers should have frequent, routine doctor visits with spirometry performed to ensure that their asthma is well-controlled prior to diving. It would also seem reasonable for an asthmatic to use a rescue inhaler approximately 30 minutes before diving as a preventative measure against asthma symptoms, just as many asthmatics do before other forms of exercise.
Regards,
DocVikingo
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.