Asthma: to dive or not to dive?

[large_diver]

Bench press record -- cool.

Sounds like you are on top of things -- the key is to understand your specific triggers and to make sure they are always under control.

 

[nitroxbabe]

about why an emergency ascent would be a bad idea. I'm ashamed to say I'd never thought about it that way. I will keep that in mind.

 

[DivingDoc]

Nitroxbabe:

Please see the following excellent sites on asthma and diving:

http://www.ymcascuba.org/ymcascub/asthmatc.html
http://thoracic.org/chapters/state/...dobe/asthma.pdf
http://www.mtsinai.org/pulmonary/books/scuba/asthma.htm

I agree with DocVinkingo about everything he said -- especially the fact that the largest pressure change occurs in the first 4' of water.

In general, asthmatics who dive should be well-controlled with maintenance/preventive medications, so they are not in need of rescue meds within 48 hrs of diving. These are the guidelines in the YMCA's asthma and diving protocol. There is a chapter on diving and asthma in a textbook which recently came out that suggests that asthmatics take a couple of puffs of their rescue medication (as a preventative measure) prior to each dive. I believe this is controversial, however. (Sorry -- can't remember the name of the textbook -- just saw a xerox of the chapter).

I also would agree with other comments in this thread that an emergency ascent in the case of an asthma attack at depth would be most unwise. Ideally, one should get over the attack before ascending. Paul Thomas suggests that you should reverse the bronchospasm before ascending, but I really don't know how you could do that underwater, as an inhaler would not function underwater. The only thing I could think of is to give oneself an injection of epinephrine, but this has its own problems in terms of cardiac arrythmias and nausea -- both to be avoided underwater.

I believe all asthmatics should plan to make especially slow ascents any time they dive. A 5 minute (as opposed to a 3 minute) safety stop wouldn't be a bad idea either.

Please do not take this as personal medical advise or construe it as a doctor-patient relationship.

ET

 

[The Iceni]

DivingDoc once bubbled...
Ideally, one should get over the attack before ascending. Paul Thomas suggests that you should reverse the bronchospasm before ascending, but I really don't know how you could do that underwater, as an inhaler would not function underwater

Hi Divingdoc,

What I posted was

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.

I deliberately wrote this in the passive grammatical sense because it is obvious that any ascent with bronchospam present is hazardous in the extreme. Therefore it should be reversed before ascent if possible. You posted

Ideally, one should get over the attack before ascending.

which means eactly the same only written differently, but lets not argue the point. I think you may have read more into my post than I actually wrote. Possibly that common language again!

To be honest, I believe most scubaboarders would know that an inhaler would not work underwater, except perhaps, if it were sealed in a rebreather loop! As for epinephrine!!!!.

I believe the general concensus is that if an asthma sufferer is at any genuine risk of developing bronchospasm during a dive he/she is really medically unfit to use scuba. I am sure nitroxbabe knows this.

Slow ascents ans added conservatism? yes. But I am not really sure any purpose would be served by extending decompression stops as you suggest because, as you know, when bronchospasm is not present an asthmatic's lungs function entirely normally. After all asthma is reversible obstructive airways disease.

A number of my bad asthmatic patients, when stable, have peak flows of over 600 l/min, which is better than my own!