Asthma and Diving

[subaquaman]

About the age of seven, I developed a pretty bad chesty cough which my GP diagnosed as asthma. He gave me an inhaler and told me to see a specialist. The first specialist I saw continued to treat me for asthma by giving me new inhalers. But then she moved from the hospital and I saw another specialist. This guy was a bit older and seemed somewhat more experienced. He checked me out and told me that I didn't have asthma; it may just have been a brief thing I had grown out of but I certainly didn't have it anymore.

All was fine until I went to sit my PADI Open Water Course where it says "Have you ever had or do you currently have Asthma, or wheezing with breathing, or wheezing with exercise." Now I have never suffered an asthma attack, never gotten very short of breath, even after exercise and am in fairly good shape. However my doc stuck me on a mechanised peak flow metre which showed I reached 99% of expected range for my age/height. But the doc was afraid of the 1% and wouldn't clear me. I should point out I don't have one doc but go to a practice where a number of them can see me.

So I went back to doc I knew best (who has actually also done her OW course) and she did a peak flow with same results but she didn't feel this would be contradictory to diving so signed the form. She did however, ask me to do a peak flow assessment often and ensure I reached a certain range for my age/height.

Moral of the story: doctors differ and patients... well I'll stay positive for the moment and not finish that!

Now I've read the DAN literature, the scuba-doc literature and as much about the subject in general as I can. One of the things I turned up was that the peak flow range varies considerably and is really only accurately measured against ones personal best. Over the past while I've been consistent in what I'm hitting. Is this what I should be trying to maintain or should I be gauging myself via tables such as this?

Does anyone have any experience of this? Anybody with any medical knowledge they can impart? :06:

 

[PairofMedics]

As a paramedic I see breathing difficulties on daily, sometimes hourly basis. I even suffer from some bronchitis from time to time as a consequence of my profession. There are very few absolutes in medicine and fewer in emergency medicine, and no two patients are exactly alike. This holds true in most every aspect of our world, but medicine especially. Ranges, averages and norm are unfortunately by their very nature innaccurate. For example I am 6' 1" and over 300lbs...and thus medicine's averages say I should be a physical mess with hypertension, tachycardia, high cholesterol and a whole slough of other maladies because I am overweight. And although I am diabetic I do not require insulin, and is due to heredity...not because I am unhealthy. Most healthcare providers are shocked to see a heart rate of 50-60, a pressure of 110/70 and cholesterol in the 70s. We have a saying in EMS...treat the patient, not the number....meaning if the number looks bad but your patient doesn't, set the number aside until you have corroborating evidence elsewhere. If you feel OK...be happy. If you feel crappy...be happy anyway but go see a doctor. And consider the PADI dive tables. They're original intent was for extremely young and athletic men in the NAVY whose greatest health problem was likely to be acne or the occasional broken bone. I dare say that the vast majority of divers today do not fit that mold. But they're the standardized measurement that takes a conservative approach that is generally safe. But each diver is still responsible for his or her own safety. Same concept. At work the most reliable indicator of a patient's condition is when they tell me things are worse. And when someone tells me they truly feel like they're going to die...I start getting ready to work REALLY hard. YOU know when you're not feeling up to par...trust that feeling but be honest with yourself. When the little ******* in the back of your mind perks up and brings the hair of your neck with him, pay attention.

 

[subaquaman]

Thanks for the reply PairofMedics, obviously this thread hasn't sparked much interest with other users yet, but what you say is very similar to what a lot of people have told me, including the second doc I saw! And I cleared my medical the other day fine. Again they said I was in the 90s on the peak flow when compared with average but that wasn't a huge discrepancy she said.

 

[TSandM]

Remember that all "average" measurements are just that . . . almost all biological parameters will follow a bell-shaped curve. Two-thirds of the population will fall within one standard deviation on either side of the mean. But that means quite a few people will be over or under that average. Expecting any individual patient to fall precisely on that value is absurd. A physician who is concerned about a reading of 99% of predicted is being overly cautious -- in my personal opinion. I wouldn't do that.

It is quite possible that you had some reactive airways disease as a child, as a result of exposure to one of the respiratory viruses like RSV which are known to do this. If you are asymptomatic as an adult -- have a normal exercise tolerance, no wheezing, no persistent unexplained cough -- then I would be hard put to it to diagnose you with asthma.

 

[Nova SS]

I can not get anywere close to the number for my age and height, and I have made my self sic trying.
I have had docs prescribed all the latest drugs just to get me into the normal curve but I have ended up in the hospital because of this. These miricle drugs had droped my capacity down to 40% of my normal.

Now I sentled on my personal best for me. Even with my "reduced capacity" my blood gas never drops below 98%, I ride bikes or an excercise bike at least 3 times a week, my BP is 110 /70 and my echocardogram is clean. I just turned 44 and feel like a teenager, as long as the doctors leave me alone.

 

[PairofMedics]

We have a saying in emergency medicine that apparently the ordinary medical establishment is unaware of....if it isn't broken, don't fix it. Too much time is spent focusing on a number instead of the patient. It's been my experience that if someone feels like they can accomplish something, then they can.

 

[Saturation]

About the age of seven, I developed a pretty bad chesty cough which my GP diagnosed as asthma. He gave me an inhaler and told me to see a specialist. The first specialist I saw continued to treat me for asthma by giving me new inhalers. But then she moved from the hospital and I saw another specialist. This guy was a bit older and seemed somewhat more experienced. He checked me out and told me that I didn't have asthma; it may just have been a brief thing I had grown out of but I certainly didn't have it anymore.

All was fine until I went to sit my PADI Open Water Course where it says "Have you ever had or do you currently have Asthma, or wheezing with breathing, or wheezing with exercise." Now I have never suffered an asthma attack, never gotten very short of breath, even after exercise and am in fairly good shape. However my doc stuck me on a mechanised peak flow metre which showed I reached 99% of expected range for my age/height. But the doc was afraid of the 1% and wouldn't clear me. I should point out I don't have one doc but go to a practice where a number of them can see me.

So I went back to doc I knew best (who has actually also done her OW course) and she did a peak flow with same results but she didn't feel this would be contradictory to diving so signed the form. She did however, ask me to do a peak flow assessment often and ensure I reached a certain range for my age/height.

Moral of the story: doctors differ and patients... well I'll stay positive for the moment and not finish that!

Now I've read the DAN literature, the scuba-doc literature and as much about the subject in general as I can. One of the things I turned up was that the peak flow range varies considerably and is really only accurately measured against ones personal best. Over the past while I've been consistent in what I'm hitting. Is this what I should be trying to maintain or should I be gauging myself via tables such as this?

Does anyone have any experience of this? Anybody with any medical knowledge they can impart? :06:

99% of PF for your age? This is not asthma, and you are correct in the PF are used as personal best when responding to therapy, not as a diagnostic tool. PF can be reduced for many reasons such as chronic smoking.

Asthma has strict criteria for diagnosis, and its primarily done by a pulmonary function test in conjunction with a patient history of a reversible abnormality after treatment with inhaled fast acting medications.

 

[ShoalDiverSA]

...
Asthma has strict criteria for diagnosis, and its primarily done by a pulmonary function test in conjunction with a patient history of a reversible abnormality after treatment with inhaled fast acting medications.

I had this done at my last annual medical and the diagnosis was "borderline obstructive".

I had asthma as a child, which cleared up (I think).

Since moving to Natal, I have developed chest symptoms that may point to my asthma "flaring up" (for want of better words). I sometimes experience shortness of breath/wheezing when performing mild activity. What has been particularly noticeable are the coughing fits that I sometimes get when laughing. This has got me concerned.

I am having my next annual medical next week, so I am going to pay attention during the lung function test.

As an aside, my lung function test during my scuba medical (2 years ago) was "very good". I can't recall the percentages.

The other issue that may be causing the lung problems is allergy/hayfever. There is quite a lot of natural irritants in Natal due to the sugarcane fields and the practice of cane burning.

Cheers,

Andrew

 

[Joanne Hughes]

I wonder how many divers out there actually dont realise they have asthma? I have a friend who has been put off diving because of asthma fears. She never had asthma in her life in the form of an actual attack(or maybe she had but never knew it) until a bad bout of flu causing coughing and allergy symptoms,she went off the the docs, was prescribed asthma drugs for last 2 years but decided to drop them. Peak flows were same with the asthma preventatives and without. A second doctors opinion was that she never had asthma in the first place. Can any of you medics out there give an opinion on what is classed as say mild asthma or permanent asthma. Allergies as well could be misdiagnosed as asthma possibly? Im sure there must be many asthmatic divers (mild) who dont even know they have it. What is the policy of PADI on mild asthma and would it be a serious drawback for those wanting to go on to say Intructor level? Im interested to know. Thanks

 

[mdjh51]

Asthma is defined as a disorder characterized symptomatically by cough, chest tightness, shortness of breath, and wheezing associated with limitations of airflow. The symptoms may be acute and episodic (what most people consider "asthma attacks" or may wax and wane over long periods of time. One or more of the symptoms may be dominant, but all are ususally present. The airflow obstruction is vatiable, and may return to normal between exacerbations. A diagnosis of asthma is made based upon patient presentation with the above symptoms combined with pre- and post-broncho dialator pulmonary function tests.

I always refer a suspected new onset asthma patient to a pulmonologist for further evaluation and diagnosis.

So, if you suspect that you have asthma, a pulmonologist is the way to go. Your PCP may or may not be up to speed on the intracies of asthma diagnosis and management. And remember, there is much more to asthma than the typical attack that most people equate to it.

So why is diving with asthma such a big deal? Asthma is an obstructive airway disease. You can get the air in, but you have a difficult time getting the air out. Trapped air in the lungs is VERY bad during ascent.

I am not sure about PADI, but for NAUI, asthma is an absolute contraindication to diving. Potential risk is too great.

One last thing, if you are consutling with a physician vis-a-vis diving, you should make an effort to see a diving physician, and not just a physician that dives.