Talk to me about asthma!

[Scott M]

I apologize in advance if some of the wording and terminology are wrong but this new to me.

I have always had a problem with wheezing, am susceptible to bronchitis easily (usually get it three to four times a year) and generally always feel my lungs where never quite right. I have never had an attack such that I could not breath. I went through the testing and found out this morning I have 20% loss when my lungs are effected, which seems like all the time. There seems to be two triggers. First is if I over do it. I tend to be a workaholic and and play even harder. When ever I do this my system gets down and I end up with bronchitis. The other trigger seems to be any type of irritant which means it can come and go almost anytime as there is really no way for me in my life style to avoid such things. I am a hands on type of guy and do a lot if not all of my own work. I had two choices for meds. One was the inhaler to be used prior to strenuous work or if I know I am going to be around an irritant. I opted for the second, which was to go on a maintenance drug. Asthamax.

I have had this for quite some time and only now doing something about it. It has never effected my diving, at least not that I am aware of.

Are there any known side effects, diving related to this drug? Any other thoughts on asthma in general or the medication of choice?

Best Regards

 

[TSandM]

I'm sorry, I had never heard of Asthamax (or asthmamax, if it's possibly misspelled) so I tried to look it up, and could find nothing on any drug by either name.

HERE is the DAN article about asthma. It is typical of what I have read -- Almost everybody limits diving to people who can be rendered asymptomatic without bronchodilators (with inhaled steroids or oral meds) and warns against people whose symptoms are exercise-induced. The risk with asthma is air-trapping. If you get bronchospastic underwater and ascend, air may not be able to exit portions of the lung, significantly raising your risk of barotrauma or AGE. In addition, significant asthma causes shortness of breath and anxiety, which are predisposing factors to panic, which is not a good thing underwater.

I think you should wait a little while and see what your response to your medication is (whatever this medicine is). If your symptoms abate, and you can exercise without wheezing, you probably meet the DAN criteria for continuing to dive.

 

[headsqueeze]

I could not find asthamax either.

Asthma or restriction of airway may be caused by many many factors (including sleep!).

I think a maintenance drug is indicated for your situation - and there are many regimens to choose from. Also, you need a peak flow meter to better understand your asthma.

 

[Scott M]

Whoops, my bad. It is Asmanex Asmanex Twisthaler - Asthma Inhaler Corticosteroid Treatment

I really have no trouble doing exercise or anything that requires heavy breathing, however if I was to do any of those things for an extended period say ran 3 or 4 miles for a week, I would end up with Bronchitis for sure. I went to the doctor for this because I was sick of getting Bronchitis so often and with winter coming I thought it best to do a little preventative medicine. I did the asthma test (can not remember the name for the test) it was the one where they have you breath through a tube for a base then introduce different drugs. I was 20% impairedon the irratant one if that makes sense.

I have never been bothered enough by this to ever give it a second thought, this was preventative on my part.

Thanks for the help.

 

[spectrum]

From our experience asthma induced by cold or exertion are the two that make you want to consider another sport. My wife has allergy induced asthma (pollens, mold, dust mites you name it) and uses a maintenance inhaler just to make sure she goes in clear. For folks with irritant sensitivities (even my summertime eye irritation) diving is a delightful respite from all of the topside allergens.

Since you're working with a doctor I'd seek his advice and if he's not dive savvy find one that is and contact DAN for more info. Your description certainly has undertones of stress and exertion and needs to be unerstood.

Pete (a non medical person)

 

[headsqueeze]

It sounds like you had a spirometry w/ inhalants. The one I do is pre and post albuterol, but not an irritant. Doing so w/ an irritant is something that is not done, so I'm confused on what was given to you. Besides, I would consider it dangerous anyway. A 20% improvement of spirometry values after albuterol MAY indicate asthma, but it might also indicate bronchitis.

I do skin tests for asthma at times if the disease cannot be controlled by medication or avoiding the offending allergen isn't possible and immunotherapy is clinically indicated.

RAST testing is sometimes useful - it's a blood test to identify antigens in the blood you form against those things you are allergic to. Then you can move on to a more focused therapy.

Inhaled monometasone would not be my first therapy for asthma - but something like loratadine (claritin) 10 mg for 6 weeks and repeating spirometry. Montelukast (singulair) would be my second choice.

Get a peak flow meter like I mentioned before and take a reading several times throughout activity. (If you can do it while sleeping, it will be a first!).

 

[Scott M]

From our experience asthma induced by cold or exertion are the two that make you want to consider another sport. My wife has allergy induced asthma (pollens, mold, dust mites you name it) and uses a maintenance inhaler just to make sure she goes in clear. For folks with irritant sensitivities (even my summertime eye irritation) diving is a delightful respite from all of the topside allergens.

Since you're working with a doctor I'd seek his advice and if he's not dive savvy find one that is and contact DAN for more info. Your description certainly has undertones of stress and exertion and needs to be unerstood.

Pete (a non medical person)

I can eliminate cold as a trigger as I ski and have never had an issue skiing before, during or after. Exersion could be trigger but hard to tell because that almost always involves working on something that is going to create an irratant. Sanding, working outdoors, saw dust etc. so not sure if it is the exersion or other.

Thanks

 

[Scott M]

It sounds like you had a spirometry w/ inhalants. The one I do is pre and post albuterol, but not an irritant. Doing so w/ an irritant is something that is not done, so I'm confused on what was given to you. Besides, I would consider it dangerous anyway. A 20% improvement of spirometry values after albuterol MAY indicate asthma, but it might also indicate bronchitis.

That test name does not sound familiar. I will call tomorrow and get the name and the results from the doctor. The lady said they adminster a series of tersts until something shows. We did the pre and post albuteral, I inhaled one medicine and then another which was the last one. I do not know the names of them. I wish I was more help here but I am not a doctor.

I do skin tests for asthma at times if the disease cannot be controlled by medication or avoiding the offending allergen isn't possible and immunotherapy is clinically indicated.

RAST testing is sometimes useful - it's a blood test to identify antigens in the blood you form against those things you are allergic to. Then you can move on to a more focused therapy.

Inhaled monometasone would not be my first therapy for asthma - but something like loratadine (claritin) 10 mg for 6 weeks and repeating spirometry. Montelukast (singulair) would be my second choice.

Get a peak flow meter like I mentioned before and take a reading several times throughout activity. (If you can do it while sleeping, it will be a first!).

Is this an over the counter item? I checked with my parents. There is a history of asthma in the family mostly mild. The doctor said mine was mild. We really do not have any specialists in the area with regards to diving.

I am kind of torn here. I went in because I wanted to avoid getting bronchitis again (It is usually always acute bronchitis if that helps). I am just starting to do a lot of diving in the local lake and have a trip to Roatan coming up in a month and now I hear this. I do not want to quit diving.

Thanks for the help.

 

[headsqueeze]

The peak flow meter is available over the counter w/o prescription. Here is a picture...


Take a bunch of readings - get the highest reading possible. Go for a run, take a reading. Before and after diving, take a reading. In the morning, take a reading... It's great data for decision making as to either the cause or treatment of your recurrent bronchitis.

Do you need chronic treatment? If an occasional bronchitis is easy to treat and you make quick recoveries, then sometimes it is best to leave it at that. Will it limit your diving? Probably not.

I don't want to make matters worse, but there are so many causes of your condition. Changes in weather can cause fluctuations in the peak flow, or even nighttime acid reflux, or chronic sinus infections. Yes, it is confusing and can be difficult to pinpoint the cause. I would say it's almost as tough to find the cause to recurrent bronchitis as it is to diagnose a rash over the phone.

 

[Scott M]

The peak flow meter is available over the counter w/o prescription. Here is a picture...
View attachment 49541

Take a bunch of readings - get the highest reading possible. Go for a run, take a reading. Before and after diving, take a reading. In the morning, take a reading... It's great data for decision making as to either the cause or treatment of your recurrent bronchitis.

Do you need chronic treatment? If an occasional bronchitis is easy to treat and you make quick recoveries, then sometimes it is best to leave it at that. Will it limit your diving? Probably not.

I don't want to make matters worse, but there are so many causes of your condition. Changes in weather can cause fluctuations in the peak flow, or even nighttime acid reflux, or chronic sinus infections. Yes, it is confusing and can be difficult to pinpoint the cause. I would say it's almost as tough to find the cause to recurrent bronchitis as it is to diagnose a rash over the phone.

Thank you greatly for the insight and assistance. I have been reading everything I can find about the subject and it seems the more I read the less I know. You are so right when you say there are just way to many possible causes to pinpoint it over the web. I wanted a quick fix answer and there just is not one to this issue. I am going to have to find a local (as possible)Medical Professional that is more versed in this. In the mean time I am going to have to be cautious and smart before I jump in until I can figure this out. Luckily on my up coming Roatan trip I will have a few Medical Professional friends with me. Local diving is going to have to be shallow and easy for a little while. Decisions I can live with, literally.

Again I can not tell how much I appreciate the help.

Absolutely Best Regards
Scott