Asthma Question

[MJS1946]

I went to my allergy/asthma specialist yesterday to get a release so I could get re-certified. Apparently I have some minor lung scarring and following a breathing test was told I had about 75 percent lung capacity. So, no go on the release. Troubling to me as I am generally asymptomatic, do crossfit regularly, am a frequent runner and do the occasional triathlon.

So, am I dead in the water (no pun intended), or are there some alternatives or ideas? I will snorkel if nothing else. Btw I am pushing 70 years old.

Thanks.

 

[tstormdiver]

Kudos to you & your healthy lifestyle at your age! That is fantastic! I think there are 2 major concerns about Asthma & diving 1. is having an attack underwater, puts you & possibly your buddy at risk, if you can not get the air you need to breathe properly, also the swelling of the tissues can block & hold back air, not allowing it to vent as needed, causing a lung expansion injury. 2. The scar tissue within your lungs can also trap air that may need to be vented as it expands during ascent,... once again risking a lung expansion injury. Just because it has not happened yet, does not mean it can not happen. Unfortunately in today's litigious society, the Dr's must CTA (cover their rear ends).

 

[sheeper]

I have asthma and am cleared to dive. Now i have no symptoms and my measured lung function is 110%. I have no issues diving or with heavy exercise.

several things to do. get retested. your breathing test can be off due to allergies or other factors. a couple of test results will give you a better average baseline.
Run those results past DAN (www.dan.org). That is the single best source for asthma related dive medical knowledge.

 

[MJS1946]

Yep, his concern (and now mine to a lesser extent) is the trapping of air in the alvioli and its expansion as you ascend. Not life threatening if it occurs in one Lund, but terminal if it happens in both. I am wondering (and perhaps this is a question for him) if there are breathing exercises to increase lung capacity which may allow me to get past this........

(Should be "lung" above not Lund-stupid auto correct)

 

[fmerkel]

I am wondering (and perhaps this is a question for him) if there are breathing exercises to increase lung capacity which may allow me to get past this........

There is a common misconception about the lungs, lung capacity, and breathing. People think breathing is about getting O2 in. Well, of course, but it is mostly about getting CO2 out. For that you need to easily push the air in and out through the 'pipes' (trachea > bronchus > respiratory bronchioles > alveolus. The process of moving air (breathing) has not a whole lot to do with lung volume, which is primarily determined by gender, size, age, and genetics. There is almost nothing you can do to change your lung volume.There is almost nothing you can do to change your lung flows, except not have asthma (or control your asthma) and not do stupid stuff to damage them like smoke.

The asthma process (inflammation, constriction, and mucus plugging) is about restrictions in the pipes so air does not move well. This is determined by spirometry (breathing tests).
[Note - an X-ray is almost useless].
Scuba makes the air more dense at depth so it also does not move as freely. In addition you are breathing cold air (from the expansion process, and possibly from the environment itself) during exercise which may set off an asthma attack (exercise induced asthma).

I do know that people can dive with asthma, BUT, you have to have a very very good understanding of you own disease process, and have excellent control of it. In your case would also need an damn good physician willing to sign off on it. Your very first sentence tells me you don't have a good understanding of what asthma is, how it works, and maybe how to deal with it.OTOH if you are being honest with your physical capabilities you may be able to learn what you need to know and deal with it properly.

You may want to read this:
Are Asthmatics Fit to Dive?

[Note on lung volume - One great way to increase your lung volume is smoke for 30+ years and get emphysema (COPD) really bad. If these individuals are measured for lung VOLUME it may be well above normal if they fall into the category of barrel chested. But, their lung FLOWS will be terrible, they can hardly breathe, and their exercise tolerance is awful. These are the people you see using O2 via nasal prongs].

Breathing is very little about lung volume, breathing is all about lung flows.

 

[MJS1946]

Not sure what you mean about my first sentence - merely paraphrasing what I was told by the Dr. I may have tried to simplify somewhat. The test is called spirometry which measures lung function not capacity. Sorry if it caused any misconception.

 

[MJS1946]

BTW, good article by Dr Kay. Perhaps I should schedule an appt as he is close to my secondary residence.......

 

[fmerkel]

[Apparently I have some minor lung scarring and following a breathing test was told I had about 75 percent lung capacity.]
Lung scarring is a pretty vague term and would not be revealed in a spirometry. What is revealed is various kinds of flows and volumes, which is what you want.

Lung capacity is not a big issue. Was that 75% your VOLUME (capacity) or your FEV1 (forced expiratory volume in 1 second)? The FEV1 is critical and should be ~85%.
Did they try to use Albuterol on you and see if the FEV1 improved? They should have if that was your main problem.
Did you get a readout of the test? If not, ask for it. It's yours and it's useful if you know how to interpret it.

Do you use either inhaled bronchodilator (Albuterol most likely), or steroid (there's a bunch), or both? Do you use anything before exercise?

Dr,. Kay is effectively retired recently, but there are some good people up at Virginia Mason where the hyperbalic chamber is. You might call DAN for a referral for someone closer. If there is a chamber around there likely is.

 

[MJS1946]

I currently use singulair and was using Dulera until about a year ago. As I said, I am generally asymptomatic. According to the doc, based on an 18 month old chest X-ray "you have some lung scarring". I did the spirometry test twice once "cold" and once after 4 hits of albuterol without much difference in results. As this is allergy season, that could play into the poor results. Perhaps I should wait until October and give it another go. Should also find a DAN referred Dr too. Thanks for the suggestions.

Generally I don't use anything prior to exercise.

 

[fmerkel]

Dulera is a combo drug of a steroid and long acting bronchodilator. [(mometasone furoate and formoterol fumarate dihydrate)]

Singulair is a single pill prescription medicine that blocks substances in the body called leukotrienes. It's generally used for allergies but has been found helpful for asthma and excercise induced asthma.

Not being responsive to Albuterol could indicate that is doesn't work for you, or what you are taking is doing it's job. Albuterol does not improve lung function in normal individuals.

Seems you did have issues, likely have some residual or still active issues, and will need the help of a pretty savvy diving physician to figure out if you should proceed with this idea.

A good cardiac checkup is a very good idea. Many scuba accidents are heart attacks. The cardiovascular system is intrinsically tied to the respiratory system. With your age and lung issues that's another variable that needs to be looked at.

FWIW, X-rays are poor tools for describing and diagnostics of lung conditions, not horrible, just pretty poor.