During the past year the RSTC in conjunction with the Undersea Hyperbaric Medical Society and have revised the PADI's Guidelines for Recreational Scuba Diver's Physical Exam in order to take divers medical conditions under advisement on a more individual level.
I am not a physician or a health professional. However, as an Instructor it is my understanding that this document now is divided up into several "risk" categories; from Temporary to Severe (AKA Counter-indication). And that physicians may make the determination into which "risk" category the patient falls using these revised criteria.
From the Pulmonary section of the Guidelines:
PULMONARY
Any process or lesion that impedes airflow from the lungs places the diver at risk for pulmonary overinflation with alveolar rupture and the possibility of cerebral air embolization. Many interstitial diseases predispose to spontaneous pneumothorax: Asthma (reactive airway disease), Chronic Obstructive Pulmonary Disease (COPD), cystic or cavitating lung diseases may all cause air trapping. The 1996 Undersea and Hyperbaric Medical Society (UHMS) consensus on diving and asthma indicates that for the risk of pulmonary barotrauma and decompression illness to be acceptably low, the asthmatic diver should be asymptomatic and have normal spirometry before and after an exercise test. Inhalation challenge tests (e.g.: using histamine, hypertonic saline or methacholine) are not sufficiently standardized to be interpreted in the context of scuba diving.
A pneumothorax that occurs or reoccurs while diving may be catastrophic. As the diver ascends, air trapped in the cavity expands and could produce a tension pneumothorax. In addition to the risk of pulmonary barotrauma, respiratory disease due to either structural disorders of the lung or chest wall or neuromuscular disease may impair exercise performance. Structural disorders of the chest or abdominal wall (e.g.: prune belly), or neuromuscular disorders, may impair cough, which could be life threatening if water is aspirated. Respiratory limitation due to disease is compounded by the combined effects of immersion (causing a restrictive deficit) and the increase in gas density, which increases in proportion to the ambient pressure (causing increased airway resistance). Formal exercise testing may be helpful.
Relative Risk Conditions
History of Asthma or Reactive Airway Disease ((RAD)*
History of Exercise Induced Bronchospasm ((EIB)*
History of solid,,cystic or cavitating lesion*
Pneumothorax secondary to::
-Thoracic Surgery
-Trauma or Pleural Penetration*
-Previous Overinflation Injury*
Obesity
History of Immersion Pulmonary Edema Restrictive Disease**
Interstitial lung disease::May increase the risk of pneumothorax
* Spirometry should be normal before and after exercise
Active Reactive Airway Disease,Active Asthma,Exercise Induced Bronchospasm,Chronic Obstructive Pulmonary Disease or history of same with abnormal PFTs or a positive exercise challenge are concerns for diving.
Severe Risk Conditions
History of spontaneous pneumothorax.Individuals who have experienced spontaneous pneumothorax should avoid diving, even after a surgical procedure designed to prevent recurrence (such as pleurodesis). Surgical procedures either do not correct the underlying lung abnormality (e.g.: pleurodesis, apical pleurectomy) or may not totally correct it (e.g.: resection of blebs or bullae).
Impaired exercise performance due to respiratory disease.
This Medical Release is MANDATORY for EVERY diver who takes a PADI course, regardless of training level.
~SubMariner~
