Asthma and Scuba Diving....

[IndigoBlue]

The following article, which also can be found by searching the board archives at http://www.scubaboard.com/search.php?s=, may prove informative. It's a piece on asthma & diving that appeared in my Dec '00 "Dive Workshop" column in "Rodale's Scuba Diving" magazine:

"Can I Dive With Asthma?

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.

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, or allergens such as pollen and certain foods and medications. 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.

For example, the YMCA* criteria include 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."

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.

Hope you found this helpful.

DocVikingo

* The YMCA protcol & some background info on diving with asthma can be found here---> http://www.ymcascuba.org/ymcascub/asthmatc.html

Thanks, Doc Vikingo, for the update.

It seems to me still to be a short list:

YMCA
BASC

I do not see NAUI, PADI, nor SSI on this list yet.

Therefore I would conclude that anyone with asthma "might" very well still ""have a problem" finding a qualified instructor willing to go down this road.

 

[rcohn]

Thanks, Doc Vikingo, for the update.

It seems to me still to be a short list:

YMCA
BASC

I do not see NAUI, PADI, nor SSI on this list yet.

Therefore I would conclude that anyone with asthma "might" very well still ""have a problem" finding a qualified instructor willing to go down this road.

I believe SSI has adopted a very similar protocol to the YMCA, however it may not be freely available online. Any SSI shop should be able to download it for an interested diver using their password on the SSI site.

Ralph

 

[MB]

...Therefore I would conclude that anyone with asthma "might" very well still ""have a problem" finding a qualified instructor willing to go down this road.

My take on this is different. I think it would be relatively easy to find an instructor who would teach almost anyone. Few instructors actually understand human physiology enough to make a personal decision, and many are willing to add to their list of certifications regardless of the wisdom of doing so.

Physicians who do not dive might be willing to clear a person with questionable ability simply because they do not understand what happens during a dive. They do not understand just how dry a bottle of air is. They don't realize that even a simple recreational dive can turn into a workhorse of an event if currents or weather conditions change. Some will simply advise against going "deep" even tho that has little impact on the condition.

I've had only one person (that I know of) hide her asthma from me as an instructor. And it did affect her ability to dive and led to a serious health problem. To this day it really hacks me off! Nobody wants to face their their own human frailties (me included), but diving affects the diver AND his or her buddies as well. As an instructor, I wouldn't teach another person with asthma to dive, even if the person had a medical clearance. I'd teach a hell of a lot of watersports to the person, but it wouldn't include breathing hyperdry, compressed air.

 

[IndigoBlue]

My take on this is different. I think it would be relatively easy to find an instructor who would teach almost anyone. Few instructors actually understand human physiology enough to make a personal decision, and many are willing to add to their list of certifications regardless of the wisdom of doing so.

Physicians who do not dive might be willing to clear a person with questionable ability simply because they do not understand what happens during a dive. They do not understand just how dry a bottle of air is. They don't realize that even a simple recreational dive can turn into a workhorse of an event if currents or weather conditions change. Some will simply advise against going "deep" even tho that has little impact on the condition.

I've had only one person (that I know of) hide her asthma from me as an instructor. And it did affect her ability to dive and led to a serious health problem. To this day it really hacks me off! Nobody wants to face their their own human frailties (me included), but diving affects the diver AND his or her buddies as well. As an instructor, I wouldn't teach another person with asthma to dive, even if the person had a medical clearance. I'd teach a hell of a lot of watersports to the person, but it wouldn't include breathing hyperdry, compressed air.

I for one however would not want to certify a student who has any form of asthma. I am glad that I know now that YMCA and SSI do have a program for applicants who do have asthma. I can simply refer them to the nearest YMCA or SSI store.

Scuba is great. But it is just not worth dying for.

And as an instructor, it is not worth having a deceased student on your certification list either.

I can always tell after one or two pool sessions, or possibly after 1 day at the ocean, who is weaker than the other students, just like you also said, MB. I always casually approach the student and confidentially ask what is up? I normally get an honest answer of some kind, and then if the student has not seen a physician about it, training stops until they come back with a signed waiver, if that has not already been taken care of.

Even with the waiver, I have to refer to the agency guidelines and standards in terms of making a final call, based on performance, as to whether this student should be certified. The store normally gives them a refund, if the student should not be certified.

Some people think that only the physicians signed form is needed. However there are still the agency standards and guidelines to follow in addition, as well as the store owner / course director's policies.

Angina, heart problems, insulin dependent diabedes, asthma, cerebral palsy, epilepsy; those are the conditions that warrant follow up and special action by the instructor, if noticed.

Unually a good instructor who is paying attention in a small to moderate sized class (1 to 6 students) can tell. I agree with you on that. Whereas in a huge class of 10 or more, lots of things can go unnoticed.

I do not know what warranted The YMCA and SSI to make allowances for students with asthma. NAUI and PADI have not, as of yet. Like I said, scuba is great, but not worth dying for. Just my opinion. Not gospel.

 

[Snowbear]

Unually a good instructor who is paying attention in a small to moderate sized class (1 to 6 students) can tell.

If the person's medical condition is completely controlled, there would be no way for you to tell - in or out of the water. That is especially true of conditions such as asthma, diabetes and epilepsy. People with those and other conditions who are honest with themselves, have their condition under control and know when to say, "I can't dive today" are as safe as anyone in the water. Even a person who's medically trained relies heavily on what the patient discloses about their history and symptoms. You can't tell by looking or watching a person unless their condition is not under control.