Divers with history of Asthma

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cruisegirl

Contributor
Messages
118
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2
Location
Santa Clarita, California
# of dives
50 - 99
Hi all
I'm inquiring about those divers with Asthma? Any here have any experience with that? Or any info. about it? I have been diving since 2005. I've never had Asthma. But last fall, I got sick and was admitted for 4 days with Bronchitis and an episode of Acute Asthma Exacerbation. Was off work for 12 weeks as well. I'm back to work and walking to get back in shape. Soon to be back in the gym. My lung Dr feels it was a one time episode that won't be an issue. But I'm curious what others have experienced having that condition? Any info would be appreciated.
 
Hi all
I'm inquiring about those divers with Asthma? Any here have any experience with that? Or any info. about it? I have been diving since 2005. I've never had Asthma. But last fall, I got sick and was admitted for 4 days with Bronchitis and an episode of Acute Asthma Exacerbation. Was off work for 12 weeks as well. I'm back to work and walking to get back in shape. Soon to be back in the gym. My lung Dr feels it was a one time episode that won't be an issue. But I'm curious what others have experienced having that condition? Any info would be appreciated.

I would recommend seeing a diving doctor as they can see if you are fit to dive.

I had asthma for a long time, but have not had an attack in over six years. I had to undergo a lung function with a diving doctor before I could be certified as fit to dive.
 
Because an open airway is an extremely important issue in SCUBA diving and we want to avoid having a pneumothorax (lung rupture injury which is never a good thing) diving with asthma is not recommended.

Asthma is a constriction of the airways. This constriction could potentially trap pressurized air in the lungs during a dive resulting in a ruptured lung upon ascent. The bone dry air of SCUBA cylinders could trigger an asthma attack. Imagine what would happen if you were to have a asthma attack at depth. Not a good thing.

You missed 12 weeks of work, so this was not a minor event. I am curious as to why you physician thought it was a one time event.

I would urge you to Not dive until cleared by a physician with a specialty in Dive Medicine. In short someone who is knowledgeable SCUBA Diving and the effects of bone dry air and pressure on the body and you medical conditions.

To sum up in two words - Call DAN 919-684-9111 (their new number for all calls).

Hopefully after seeing a Dive Medicine Specialist you will be able to return to diving.
 
I would recommend seeing a diving doctor as they can see if you are fit to dive.

I had asthma for a long time, but have not had an attack in over six years. I had to undergo a lung function with a diving doctor before I could be certified as fit to dive.

Good advice. I will try to find one. We did a lung function test when I got certified and passed with flying colors. We did one post illness and it's good too.
 
Because an open airway is an extremely important issue in SCUBA diving and we want to avoid having a pneumothorax (lung rupture injury which is never a good thing) diving with asthma is not recommended.

Asthma is a constriction of the airways. This constriction could potentially trap pressurized air in the lungs during a dive resulting in a ruptured lung upon ascent. The bone dry air of SCUBA cylinders could trigger an asthma attack. Imagine what would happen if you were to have a asthma attack at depth. Not a good thing.

You missed 12 weeks of work, so this was not a minor event. I am curious as to why you physician thought it was a one time event.

I would urge you to Not dive until cleared by a physician with a specialty in Dive Medicine. In short someone who is knowledgeable SCUBA Diving and the effects of bone dry air and pressure on the body and you medical conditions.

To sum up in two words - Call DAN 919-684-9111 (their new number for all calls).

Hopefully after seeing a Dive Medicine Specialist you will be able to return to diving.

Hi Pasley,
You have great advice too. As I said above, I will contact DAN to find a dive doctor. Just to be sure. I trust my Dr. immensely but he doesn't dive.

Yeah, asthma attack at depth would be really bad.

Part of the reason I missed 12 weeks was the hospitalization as well as the after affects of the treatment. Plus, at my work, you can only have one MLOA per year without risking your job. Did I milk it, no. But I wanted to be sure I was in condition to go back. I did walking and exercise to see how I tolerated and get prepared. I'm a nurse so I'm in a physical job. As to why he thinks it's a one time event, it's because I've been sick before over the years and never had an asthma event until this bronchitis. And that I recovered so quickly. We'll see.

So I will call DAN. And I'm with you. I hope to return to diving. My biggest fear is not that I will have a problem, but the possibility. It's nerve wracking. lol.
 
I suspect you will be fine.

Chronic asthma induced by exertion, cold or stress is the big problem. Asthma induced by allergies (not a lot of cats underwater) or temporarily by a particular illness should not be problems.

An asthma attack underwater is never a good thing, and may well be fatal. Just to add to Pasley's post, the major problem associated with lung rupture (and it only takes a small tear to cause the problem) is an air embolism, or Arterial Gas Embolism (AGE) wherein air is forced directly across the alveolar wall into the bloodstream, where it then is taken to the heart and pumped pretty much directly to the brain. Bubbles of gas on the brain are never good and can result in permanent disability and death. Sorry if that sounds scary but there's no point wrapping it up in cotton candy and pretending it's okay.

The advice about seeing a hyperbaric physician is sound. Many doctors, I'm sorry to say, have no idea about the effects of asthma underwater; I've seen asthmatics signed off by a general practicioner with completely wrong diagnoses. A direct quote from the medical of the last asthmatic I taught: "Patient has asthma but good lung volume", which is complete crap, since lung volume has nothing to do with the condition. After a thorough spirometry test the diver was cleared by a very experienced hyperbaric physician.

Your local dive centre or, as mentioned above, DAN, will be able to point you in the right direction.

Good luck, and when the doctor clears you, enjoy your return to the underwater realm!

Cheers

C.
 
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 asthmatic’s 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, it’s 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 doctor’s 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 doctor’s 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.
 
Hi Cruisegirl,

I've been diving with mild-persistent asthma for 20 years and have never had a problem, but some things that I do to reduce my risk are:

1. Use nitrox whenever it's available - I always use a bronchodilator before diving and there are fears that this reduces the lungs' capacity for eliminating nitrogen on ascent, so by using nitrox I cut the amount of nitrogen that goes into my body in the first place. Nitrox is not expensive and is readily available at many locations.

2. Stick to a maximum ascent rate of 10 m/min and put in a deep stop at 15 m for a couple of minutes - A study by DAN that was summarized in "Alert Diver" magazine around 4-5 years ago suggested that this reduces microbubble formation compared to 18m/min with one stop at 5m, but even slower ascent rates didn't seem to make more of a difference.

3. Always maintain positive buoyancy at the surface and take things slowly at depth. This is good practice anyway, but as asthma can sometimes be triggered by exertion it makes sense to do everything possible to avoid overexertion.

4. The people I dive with know that I have asthma and so does my diving doctor. I started diving at 14 and developed asthma at 17. This was back in the day when the merest mention of asthma would get you an immediate and total ban from diving, so, being a reckless teen, I hid it. When attitudes became more liberal I decided to stop being a closet asthmatic and went to a diving doctor for assessment. By this time I had over 1,500 incident free dives, including a number of deco dives on hypoxic trimix well beyond the recreational dive limit. I was told that I was borderline for fitness to dive, but under the circumstances the doc was willing to pass me as fit if I was willing to carefully monitor my condition, go for regular check ups and let him know the moment anything got worse. I agreed and, since my asthma doctor and diving doctor were now the same person, I was able to tailor my treatment to my needs and my asthma improved.

Please bear in mind that I'm not a physician, these are just my own experiences not recommendations for all asthmatics.

Vittorio
 
Hi Vittorio,
I so appreciate you posting your info. It's given me some reassurance. I am not Nitrox trained so will try to see about doing that this year. I see my Dr. in 2 weeks and will hopefully be released to dive. He was actually going to release me a month ago but I wasn't ready. I've been increasing exercise to test myself. So we'll see how it goes. But all good tips and I appreciate it. Thanks.


Hi Cruisegirl,

I've been diving with mild-persistent asthma for 20 years and have never had a problem, but some things that I do to reduce my risk are:

1. Use nitrox whenever it's available - I always use a bronchodilator before diving and there are fears that this reduces the lungs' capacity for eliminating nitrogen on ascent, so by using nitrox I cut the amount of nitrogen that goes into my body in the first place. Nitrox is not expensive and is readily available at many locations.

2. Stick to a maximum ascent rate of 10 m/min and put in a deep stop at 15 m for a couple of minutes - A study by DAN that was summarized in "Alert Diver" magazine around 4-5 years ago suggested that this reduces microbubble formation compared to 18m/min with one stop at 5m, but even slower ascent rates didn't seem to make more of a difference.

3. Always maintain positive buoyancy at the surface and take things slowly at depth. This is good practice anyway, but as asthma can sometimes be triggered by exertion it makes sense to do everything possible to avoid overexertion.

4. The people I dive with know that I have asthma and so does my diving doctor. I started diving at 14 and developed asthma at 17. This was back in the day when the merest mention of asthma would get you an immediate and total ban from diving, so, being a reckless teen, I hid it. When attitudes became more liberal I decided to stop being a closet asthmatic and went to a diving doctor for assessment. By this time I had over 1,500 incident free dives, including a number of deco dives on hypoxic trimix well beyond the recreational dive limit. I was told that I was borderline for fitness to dive, but under the circumstances the doc was willing to pass me as fit if I was willing to carefully monitor my condition, go for regular check ups and let him know the moment anything got worse. I agreed and, since my asthma doctor and diving doctor were now the same person, I was able to tailor my treatment to my needs and my asthma improved.

Please bear in mind that I'm not a physician, these are just my own experiences not recommendations for all asthmatics.

Vittorio
 
... some things that I do to reduce my risk are:

1. Use nitrox whenever it's available...
This may help reduce your risk of DCI but does nothing for the asthma related increased risk of a barotrauma or AEG

...- I always use a bronchodilator before diving and there are fears that this reduces the lungs' capacity for eliminating nitrogen on ascent, so by using nitrox I cut the amount of nitrogen that goes into my body in the first place. Nitrox is not expensive and is readily available at many locations...
Hence the use of Nitrox, it may work, I am not qualified to say. Naturally I must repeat the mantra of the use of drugs before a dive is not recommended as the effects of pressure on the drug are not well understood or studied and the risk of the drug wearing off during the dive.


...2. Stick to a maximum ascent rate of 10 m/min and put in a deep stop at 15 m for a couple of minutes...
3. Always maintain positive buoyancy at the surface and take things slowly at depth. This is good practice anyway, but as asthma can sometimes be triggered by exertion it makes sense to do everything possible to avoid overexertion.
Always good advice for all divers.

...4. The people I dive with know that I have asthma and so does my diving doctor. .... willing to carefully monitor my condition, go for regular check ups and let him know the moment anything got worse. I agreed and, since my asthma doctor and diving doctor were now the same person, I was able to tailor my treatment to my needs and my asthma improved.
Always sound advice. You know the risk, your doctor knows the risk and you let your dive buddies know so they can make their own decision. Sounds like you have your asthma under control.
 

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