Asthma: to dive or not to dive?

[nitroxbabe]

I'm sure this is probably discussed somewhere already but here I go... I have allergies and mild asthma (controlled with medications, use albuterol inhaler maybe once a year if that).

When I first took up diving, my allergist (who is a DM himself) told me that I should never descend past 40 feet so that I could make an emergency ascent if I develop asthma problems while submerged. I was an overcautious diver initially, but as I have had no problems I have continued to expand my horizons and love it!

I have dove deep in everything from 44F to 87F & completed a Resuce Diver course. I have had only one problem but I had overexerted/overbreathed my reg so I am not sure if it was asthma or not. When I had the problem, I was in the Gilboa Quarrie. My dive buddy had on a better cold-water get up than I & went deeper (colder) than I was comfy with. I followed and overexerted when I swam up, half-frozen. I ascended to around 55' and sat down to catch my breath, but aborted the dive after I still didn't feel right after a few minutes. I was definately overexerted/overbreathing my reg, and maybe part of my problem was anger at my buddy (I'd told him I didn't want to go deep prior to the dive)

So anyhow my question is, is my Dr. being overcautious, as is his job, or am I actually tempting fate?

(Not that tempting fate will stop me from diving! Just want to know!)

And are there any other asthmatic divers out there who have any advice?

 

[BillP]

Howdy nitroxbabe:

Sorry to hear about your problem.

You're right, there's a whole bunch of info on asthma and diving on site already. Take a look through:

http://www.scubaboard.com/search.ph...d=152041&sortby=lastpost&sortorder=descending

Also look at Scubadoc's website at:

http://www.scuba-doc.com/asthma.htm

and DAN's website at:

http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=22

Many asthmatics can be cleared to dive after the proper evaluation, but not all. As you know, one of the concerns about diving with asthma is a lung overpressurization injury (barotrauma) from air trapping. Such an injury can occur in much less than 40 feet of water.

HTH,

Bill

The above information is intended for discussion purposes only and is not meant as specific medical advice for any individual.

 

[DocVikingo]

Here'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

 

[AllenG]

BillP wrote to Nitroxbabe: "Sorry to hear about your problem." I would offer that Nitroxbabe's problem isn't asthma, rather it's her allergist, who perhaps is one of those bone-headed medical professionals who parrots ill-conceived, illogical statements. Before the various physicians et al. on this board become unnecessarily enraged, I would reminded you that (a) I too am one of those medical professionals, and (b) my position is based on the fact that her allergist/DM/parrot didn't appear to understand there is also risk above 40 feet.

Decisions regarding diving with a medical condition should be based on your physician provided you with a detailed assessment of dive related risks based on your individual symptoms and history so that you, the patient, can make an informed decision. What sort of testing did the allergist do that led him/her to make these statements regarding your diving? There are any number of spirometry measures (not just a simple "blow" test for peak expiratory flow) and pulmonological procedures that could be considered. Granted we humble board denizens don't know what testing your physician did, but Scubadweeb's words certainly leave me wondering.

Scubadweeb - Please feel free to PM me for more information. I will not engage in the foolhardy practice of providing medical advice over the net, but I would be glad to help direct you in putting together a process to engage a responsible medical professional in such manner as may enable you to make an informed opinion of your own.

 

[nitroxbabe]

... after reading other posts from asthmatic divers I guess I am by far a milder case than many others who dive.

Yes, my doctor did clear me to dive for my certification. He was going to write the note about the 40' restriction but after we discussed it he simply wrote a note saying that I have been apprised of the potential risks. That's fair I think.

Even if my allergist fell down in his advice in this regard, he has otherwise been a great doctor and I do still support him. Believe me, I've seen some truly bad ones & he's not one of them. My "parrot" did in fact perform many tests on me. I do not recall the names of these tests but they were very involved and actually somewhat uncomfortable as I was instructed to try to completely empty my lungs, blowing for as long as possible. Perhaps this is the test to which you refer, AllenG?

At any rate I appreciate the input. Yes I am aware of the possibility of air trapping resulting in barotrauma. I guess I will continue as I have, enjoying my diving and cancelling if I don't feel 100%.

 

[DocVikingo]

It is heartening that your allergist, whom you obviously trust, cleared you to dive for certification. That you were able to discuss the issues with him and obtain an approval to dive indicating that you have been apprised of potential risks suggests that he is an agreeable chap with whom you have a comfortable relationship.

Hopefully being a DM provides him with a little extra knowledge on the topic of diving with pulmonary conditions. That you have gone on to complete Rescue Diver, the most physically & psychologically taxing of certs, and to generally tolerate very low water temps, seems to support his decision.

Undergoing many pulmonary tests that appeared very involved & were occasionally somewhat uncomfortable suggests that you received an at the least vigorous work up. BTW, the one where you were instructed to try to completely empty your lungs, blowing for as long as possible, was very likely a spirometry procedure known as forced vital capacity (FVC). As routinely applied, it measures more than just peak expiratory flow, and can provide very useful information about obstructive pulmonary pathology such as asthma.

Your allergist's initial suggestion that you limit your dives to 40' reportedly was based on the assumption that you could make a controlled emergency ascent from this depth in the event that you began to experience respiratory distress. This is not unreasonable. However, as you & he no doubt appreciate the maximal changes in the volume of air in the lungs occur in the first 4 feet of water, so the 40' restriction would not obviate the as yet largely theoretical risk of barotrauma from air trapping.

As regards your single reported instance of breathing difficulty u/w, I don't believe that anyone can say whether this was asthma-related or not. You do indicate that you had overexerted, went deeper than you wanted, became very cold & were angry with your buddy. These could have precipitated an asthmatic event. On the other hand, they could have caused heavy breathing and overbreathing of your reg unrelated to asthma. Of note is that despite all of this you were able to hold at 55' for a few minutes before deciding to abort the dive in a controlled fashion.

Keep a close eye on those factors in the management of asthma over which you have considerable control.

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. Recontact with your physician to discuss this event may be prudent.

Best regards.

DocVikingo

 

[large_diver]

As mentioned in the article listed above, I think one thing to look into is whether your asthma is exercise or cold-temp-induced. These are two of the "warning factors" that usually signal that diving is not a good idea. You mention that both these factors were present when you had your "incident".....

I personally would also not be comfortable diving with asthma without participating in at least some regular exercise above water.....

My $0.02.

 

[nitroxbabe]

Thanks DocVikingo - I appreciate the info. It pretty much answers my questions. It's the doctors' job to be cautious and it's up to the diver to take care of him/herself, making educated decisions.

Yes, LargeDiver while I have had cold and exercise-induced reactions in the past, my asthma is very well controlled and know my personal limitations. And I do aerobic and weights fairly regularly also (I once set a bench-press record at my health club, I'll have you know ).

In other words, I ain't about to stop diving !

Thanks for the input & concern!

 

[DocVikingo]

I won't argue with you.

Be well.

DocVikingo

 

[The Iceni]

nitroxbabe once bubbled...
. . . When I first took up diving, my allergist (who is a DM himself) told me that I should never descend past 40 feet so that I could make an emergency ascent if I develop asthma problems while submerged.

I have no grouse with your allergist, who appears to be approaching your condition sensibly. Hovever I am a little concerned that you could consider making "an emergency ascent" during an asthma attack.

As DocVikingo has rightly pointed out, the problem with asthma is air trapping due to pressure changes and this will occur close to the surface, where the pressure changes are greatest. So, from my perspective - not forgetting decompression obligations - a rapid, "emergency" ascent is something that must be avoided at all costs regardless of the depth of the dive.

Not easy to give advice on the management of brochospasm at depth. Ideally, if it does occur, it should be reversed BEFORE any ascent is contemplated as the risks of barotrauma are very real when bronchospasm is present during any ascent.

Better to do everything possible to prevent it, possibly perhaps by the use of preventive medication in a patient who does not normally need it?:doctor: