Asthma and diving

[offthewall1]

This has been a fascinating and informative thread and I want to thank all of the contributors for sharing their experiences and advice.

The reason I became interested in this topic is because I dive with someone who does have asthma, well controlled according to her, and she has never encountered any difficulties while I've known her. This includes both while flying and while diving and even during some fairly strenuous and prolonged exertion underwater. But, should she have an episode at 60'....what do I do? What are the proper steps for a dive buddy to take if she does have an attack? I intend to keep diving with her and would, of course, like to be prepared should something occur. Your advice on this would be most welcomed, not just for me but, I think, for all of us who dive.

This is an interesting question. I'm sure the medical experts will chime in at some point... but from a layman Instructors view... I believe it is important at a minimum you verify your buddy has their asthma medication at least on-site... and possibly even with them in the water in a waterproof case.

The thought of bringing an asthmatic in trouble to the surface is scary due to the risk of embolism and over-expansion injury. I don't know if it is realistic to effectively use an albuterol inhaler underwater - but it seems possible since it requires a breath in and then an exhale... So it seems you could take the puff, hold your breath just long enough to get the regulator back in your mouth and do your exhale.

Like I said, I'd like to know what the medical professionals thoughts are on this... but I believe this effort would be safer than bringing them to the surface and then administering the inhaler. Surface administration is of course better than waiting until you get back to the exit point.. which could be too late... so simply having it on site may not be good enough.

During the period for which I thought I had asthma (before just recently finding out I do not,) I always carried my inhaler. From shore based sites I left it at my exit point... and from boats it was always on the boat. In hindsight, I feel this was inadequate preparation. While those I dove with knew I carried an inhaler... it would have done them no good unless they could effectively gotten me back to the boat still alive.

In the end, it is most important that asthmatics dive within their limitations, know their triggers and avoid diving whenever there is a question about their fitness to dive. For you, the dive buddy, I recommend discussing any action to be taken during your dive planning.

In the meantime, are there any diving docs out there that think underwater treatment is a viable option prior to ascent... and if so, what?

Happy Diving...

 

[TSandM]

Unfortunately, inhalers require entraining air from the surroundings, so they are not usable underwater. Somebody, however, has made some kind of a gadget that attaches to a regulator, to allow an asthmatic to dose himself while underwater. The idea frightens me.

The key to the recommendations that asthmatics may dive is that the person has to be CONTROLLED. That means, essentially, rarely to never symptomatic on their current treatment. If someone is given to unpredictable, rapid onset attacks of asthma, that person simply SHOULD NOT DIVE, period. People with significant exercise-induced asthma are advised not to dive, as well, because if one were caught in an unexpected current or any other situation where hard swimming might be required, an attack could be precipitated.

Most asthmatics can be pretty well classified into mild, moderate or severe. Mild asthma is the kind where you don't require medication on a regular basis, and most people like this know what their triggers are (respiratory infections, or exposure to certain allergens). Moderate asthma is asthma where people end up requiring routine medication to prevent symptoms. These are the people who really need to be evaluated on a case-by-case basis for how often they are symptomatic and how predictable their triggers are, in order to know whether they are ok to dive. Severe asthmatics, who are people who are frequently symptomatic, are still advised not to consider scuba diving.

Of all the things that could happen to me in diving, I am most afraid of AGE, because it typically causes severe central nervous system damage or death. As much as I love diving, if I had something wrong with me that would put me at significant risk of AGE, I would not dive.

To answer the question of what a buddy can do if someone has an asthma attack underwater, the only thing is to control ascent rate. A very slow ascent may permit gas to exit from narrowed airways. On the other hand, a slow ascent prolongs the time to treatment. This is why someone who is prone to sudden, severe asthma exacerbations simply doesn't belong underwater.

 

[geokr]

Thanks and if the docs care to chime in on this I would only expect to hear general guideline on procedures, not specific advice in her case. She has told me that she carries an inhaler in her vest "just in case" and that she has tried it underwater to see if it will discharge at depth. Sounds risky to me but it sure couldn't hurt given the alternative of having nothing. Again, she has never had an attack in my presence, only one in the past five years and is not the kind of person to take unreasonable risks. I've thought over some armchair scenarios as to what I would do but, being a layman with regards to these things, have only been able to come up with best guesses. Can albuterol administered before a dive preclude an attack?

 

[frogman159]

Since this thread is still going, I found this article, probably the most comprehensive article I'm read to date on the subject.

For you enjoyment:
Should Asthmatics Not Scuba Dive?

 

[Bubbletrubble]

Since this thread is still going, I found this article, probably the most comprehensive article I'm read to date on the subject.

For you enjoyment:
Should Asthmatics Not Scuba Dive?

@frogman159:
Although your linked document does contain a lot of useful information, I'd like to caution readers that the article and its cited source publications are quite old.

The standard of care for asthmatics has changed in recent years. New medications have come to market -- some of which are efficacious but also may present increased risk of life-threatening asthma attacks in certain patient populations (e.g., SMART study on Serevent).

Discuss any concerns you might have about asthma and diving with a physician (preferably a pulmonologist) who has an understanding of diving medicine.

Have fun and dive safe.

 

[frogman159]

Yes, a bit dated, but it does highlight many of the discussions in this thread..From details on informed concent, to a review of the sparse documented evidence of AGE in asthmatic divers, to a review of issues on why scubadiving and asthma is such a challenging issue

What I found of paticular intrest is the realative small number documented cases of asthma related AGE, which is what I was searching for when i ran into this article.

There is no discussion of asthma treatment either so I'm not sure why that was even brought up.

Much of medicine is based on outdated studies...Even IM epi....."Oh Snap!"

 

[SuSexFulDiver]

I have Asthma, but I learned as long as I do not eat any dairy products, I have no Asthma symptoms. Also I learned dairy products would make my allergies very bad. Since I have cut out eating anything with dairy or as much as possible, both my allergies and Asthma symptoms are almost completely controlled. Now when I have allergy attacks, its limited to a little bit of sneezing. I have not had a Asthma attack or any symptoms since I stopped eating dairy.

Im not sure if dairy is the cause of Asthma, but for me cutting out dairy in my diet has helped me tremendously. They say some people are lactose intolerant and some have Dairy allergy. I have dairy and malt allergy. Dairy cause serious respiratory and sinus problems with me. I no longer get stuffed nasal and nasal drip, and serious allergy attacks, which feel like the flu. If I eat something like Pizza, and then go on a long hilly bike ride in the hills, I will have an asthma attack, as long as I don't eat any dairy, I can climb hills all day in the worst air quality.

I wonder if dairy could also be some of the cause of Asthma in others also, or make the symptoms worse?

 

[SuSexFulDiver]

Oops, Both Eating and drinking dairy.

 

[SuSexFulDiver]

Now if I could only get the torn labrum fixed in my right hip, so I can continue diving.

 

[SuSexFulDiver]

By the way, after years of going to doctors to help me figure out why I suddenly had Allergy syptoms, and Asthma. I began to pay close attention, to what I was doing, that would cause Allergy type of reactions or sinus infections (rhinitis/sinuitus) and such. It kept getting worse, eventually, since I love eating cereals like Cherrios, Corn Flakes and Cap N Crunch.

I would notice I would get awful headaches on the left side of my head, followed with very stuffy sinuses after eating cereals with cows milk, then I noticed my whole respiratory system / breathing would feel different. I guess I am hypersensitive , and can notice the slightest changes in my body. It kept getting worse and worse, till I said screw it, im going to stop drinking milk and see what happens. So I did and a month or so into being strict with my diet of No Dairy.

I replaced the milk with Silk Soy Milk. I felt MUCH MUCH better. I would ride my Mountain bike in the hills on long steep rides, without any symptoms at all of Asthma or Allergy attacks. So I then at some cheese, and BAM, lots of sinus congestion, and Asthma attack during a bike ride. I then repeated it over a few more times of no dairy and then with consumption of dairy, and the same results like clock work when eating or drinking dairy.

I spent years at the hospitals with doctors, and none ever suggested the problem could be dairy. They just kept getting my money LOL with all the allergy shots and medications and visits and such.

I then googled "Milk is bad for you" types of topics, and my suspicions regarding milk is confirmed with other research, Like this.

Dr. Kradjian addresses cow's milk

I have never had any problems with Asthma while diving, Since around the time I got certified, was around the same time, I learned to stay away from Dairy. Now I know, when ever I cheat with some Pizza, what to expect.