Diving with an Asthma rescue inhaler

[Cosmographer]

Background info
My DAN-approved doctor has cleared me for diving, and I have had no problems after hundreds of dives. My asthma is well controlled. However, occasionally, when I sneeze, I sometimes start wheezing. And I have sneezed a few times underwater. So, out of an abundance of caution, I was wondering about diving with an inhaler.

Question
Since I use a full face mask, I was wondering if I could either keep an inhaler in it or put it in there if necessary. The mask doesn't really leak much even when I put a few fingers in it. Accessing it isn't as big of a concern as it's ability to function at depth. Do inhalers even work down there? Is it going to explode in my face?

 

[Diver below 83]

Background info
My DAN-approved doctor has cleared me for diving, and I have had no problems after hundreds of dives. My asthma is well controlled. However, occasionally, when I sneeze, I sometimes start wheezing. And I have sneezed a few times underwater. So, out of an abundance of caution, I was wondering about diving with an inhaler.

Question
Since I use a full face mask, I was wondering if I could either keep an inhaler in it or put it in there if necessary. The mask doesn't really leak much even when I put a few fingers in it. Accessing it isn't as big of a concern as it's ability to function at depth. Do inhalers even work down there? Is it going to explode in my face?

First time I’ve heard of someone trying to use an inhaler under water. Interesting idea. Not sure how well it would actually work though.

 

[Zef]

Did you share this history with your "Dan-approved doctor"?

If you are experiencing asthmatic episodes before or during diving then you should rethink if diving is an activity you should be participating in.

It is surprising that your doctor cleared you to dive given recent history of asthmatic episodes. Or perhaps your wheezing after sneezing is not asthma related and you are treating it wrong with the use of an inhaler. I seen many athletes who have "exercise induced asthma" run to their inhaler every time they are out of breath. Soccer players running to the side lines between plays, cross-country runners rooting through their bags after sprinting across a finish line. The reality is that a few of these athletes are experiencing an asthmatic episode brought on by their exertion but the majority have just conditioned themselves mentally that they "need" to use their inhaler because they feel out of breath. Many of these folks use ventolin or a similar brand...this drug is a akin to a synthetic form of adrenalin and using it unnecessary when your heart is already racing due to exertion is is not the best thing one can do....of course if one is having a true episode then one should use it. This is just an example.

If you are having an episode while underwater, you are toying with danger and you are putting those you dive with at risk. If you are experiencing issues other than asthma and you are not addressing it with your doctor then you are still toying with danger.

If I were your dive partner, and you had a full face mask with an inhaler inside it for emergency use, I would decline to enter the water with you. And if you were my dive partner and I found you trying to use an inhaler while we were underwater, I would end the dive responsibly and that would be the last time we ever dived together. You are your dive partner's backup, if you have a contraindicating condition for diving with recent history then you are not fit for diving and are putting your partner at risk by putting yourself at risk.

-Z

 

[Cosmographer]

At least one sanctimonious response is always to be expected here, but I posted this question anyway in the hopes that useful, potentially lifesaving information might come to light. Unfortunately, people like you discourage such discourse which only increases risk.

I know many divers with well controlled asthma who are covered by Dan. And frankly, I trust their actuaries far more than I trust you.

 

[tursiops]

At least one sanctimonious response is always to be expected here, but I posted this question anyway in the hopes that useful, potentially lifesaving information might come to light. Unfortunately, people like you discourage such discourse which only increases risk.

I know many divers with well controlled asthma who are covered by Dan. And frankly, I trust their actuaries far more than I trust you.

Come on, he wasn't saying you can't dive with well controlled asthma, he was saying that diving with an inhaler in a full mask is not good idea, and clearly means your asthma is NOT well controlled.
I'm sorry you were looking for justification for something you want to do, and did not get it.
Your best scenario is to ask the question of your doctor, and see what he thinks of in-water control of an asthma episode. Hopefully, it is NOT an asthma episode, but you need to ask your doctor, not on-line.

 

[Cosmographer]

No, I'm not looking for justification for something I want to do. I've done hundreds of dives over the years and asthma has never been an issue. I don't need justification to dive. Like I said, my dive doctor cleared me for diving after conducting many tests.

What I'm looking for is the mechanics of how an inhaler might work underwater. Simple as that. The previous reply did not contribute any helpful information whatsoever.

And asking about inhaler use underwater means the asthma is not well controlled? That's a ridiculous stretch when: 1) I stated that my doctor has concluded it was in control, 2) my profile shows that I have numerous dives under my belt, 3) I specifically stated that this interest stemmed from an abundance of caution (as opposed to need), and 4) there are many other reasons why a person might ask this question other than having out-of-control asthma.

IMO, these kinds of responses are more dangerous than they are helpful. No matter how well controlled an asthmatic is, there is a slight chance that he or she might have an episode underwater. Nothing is ever 100%.

What the original responder is saying is similar to saying "diving with spare air is dangerous because of blah blah blah, and therefore you shouldn't ask about it; just don't dive with it. And if you feel safer diving with it, then it means you shouldn't be diving at all because you obviously don't know how to manage your air".

Dismissing a potentially life saving idea because you don't agree with the premise is arrogant at best and dangerous at worst.

 

[tursiops]

You've made your position perfectly clear.
Good luck.

 

[Compressor]

Inhalers will work at different atmospheric pressures however the volume delivered will vary so you will probably overdosing yourself if you could use the inhaler at depth. When the medication is nebulizer and delivered to you, it will be more concentrated than at the surface. This is assuming that the cartridge will be able to withstand the pressure which may is probably not a valid assumption. However they are not rated for use at depth. Overdosing on the medication can be dangerous based on the type of medication. My advice is not to use the inhaler at depth. Perhaps you can be on an oral form of the medication or it's sibling. Also consider that if your medication exploded in your facemask you will suffer injury so again, I suggest you do not do this.

 

[fmerkel]

I'm an asthma educator. I'm one of the people that teach medical people to deal with asthma. I'm a diver. I have cough variant asthma. I think I'm sorta qualified.

To start at the easy stuff:
- I've used a full face mask....a lot. I have no idea how you actually expect to deal with a rescue inhaler while wearing one. The logistics are complicated.
- As pointed out, you would be trying to use a pressurized device....while under pressure. The deeper, the more pressure. My speculation is that the deeper you are. the poorer it would work. At some point it could give up entirely, especially if you are in cold water. I recommend people put them in their pockets for awhile (warm 'em up) if the ambient temperature is low. This improves aerosolization, therefore deposition, assuming you know how to use one (lots of asthmatic think they do, and they don't).
- I'm not much concerned about an overdose. Likely should you somehow figure out HOW to use one underwater, I suspect the particle size would be abnormally large with lots of upper airway deposition. Likely your theoretical dose would be sub-optimal. This is pure speculation. I'm pretty sure no one actually knows unless some hyperbaric physician that has used them in chamber chimes in. I'm curious myself.

OK, the hard stuff. If you are sneezing....then wheezing underwater, I don't care what your physician says or how many dives you have, your asthma is sometimes symptomatic. It's controlled well enough to have let you get away with what you are doing...so far. You are inhaling dry air. Spirometry are never done with bone dry air. If you are diving in cold water, add cold dry air to the mixture. Both/either of those can be a trigger, as can hard/forced exhalation, like a sneeze. Add exercise to the mix and you have a setup for exercise induced asthma.

Face it man, under certain circumstances you get symptomatic while diving. Since you are determined to dive, and have a physician that will back you up, then I suggest you have some up front frank talks with him about what's going on. That is, unless you think he'll pull your OK. Something to ponder.

Good luck with the condition, the inquiry, and the diving.

 

[Jcp2]

There are dry powder non aerosol rescue inhalers available now. Unfortunately, they require some space and dexterity to use, so won’t work underwater unless you are in a relatively large air space (diving bell, submarine?)

If you want to go old school, subcutaneous epinephrine can also be used to treat an acute asthma attack. Auto injectors like an epipen use gas pressure to push the dose, so probably wouldn’t be reliable under pressure. You could preload a small syringe with a measured dose, make sure there is no air in the syringe, vacuum seal it, and then be prepared to stab yourself through you wetsuit in the thigh. The giant syringe in the heart is just for Mission Impossible.

If you are really a DIY guy, you might devise a mechanism in which you preload a set dose of powder medication, connect it with a valve through some sort of manifold or y connector to the lp hose between your first and second stages, and deliver it directly into the second stage. It would be the worlds largest inhaler.