Diving with an Asthma rescue inhaler

[Justin Bove]

To answer your question without getting in to a you shouldn’t do this or that because of safety discussion. Science should tell you that your pressurized inhaler will not work correctly as you increase in depth(remember Dalton’s Law from scuba instructional classes) If in theory your inhaler {did} work while you were diving it would give you an over dosage. Though without going over a whole bunch of math here’s what will happen....The inhaler will act like it’s been all used up and out of air/gas/propellant. When I was younger I would feed fish cheese-whiz from the spray bottle. The deeper I dove the less pressure the can had to spray cheese. Also I noticed the more I exposed the can to depth and duration at depth the faster it would go flat. Kinda like if I stuck the can in the freezer. Not enough “gas” to squirt all the cheese out. I don’t know where I’m going with this so I’ll stop. Personally I’d maybe see if there was pill I could take, or used the inhaler before each dive to get the medicine working, or get something that you could spay a metered dosage in to at the surface and then pressurize at your exact depth and inhale. I highly doubt this would work but say you sprayed a dosage in a ballon at the surface then took the ballon with you diving and then say you have an asthma attack at 30m. You’d blowup the ballon at exactly your depth and then inhale all the air from the ballon at that exact depth. Though I know that wouldn’t work because inhalers atomize a liquid or powder that needs to immediately inhaled. Oh and lastly I’d suggest you never dive with an air mix with helium. Helium and asthma don’t mix well.

 

[Rollin Bonz]

The giant syringe in the heart is just for M̶i̶s̶s̶i̶o̶n̶ ̶̶I̶m̶p̶o̶s̶s̶i̶b̶l̶e̶ Pulp Fiction.

FTFY... Come on now...

 

[Jcp2]

My bad. Mission Impossible 3.

 

[Rollin Bonz]

My bad. Mission Impossible 3.

lol

Beg pardon kind Sir. I have thusly googled and your reference is correct! But Vincent Vega did it to Mia Wallace first!

 

[DBPacific]

I can't give any advice to this or existing set-ups for inhalers, but Imma follow and watch this thread. An engineering student at my uni (the brother of my research buddy) is currently trying to design an inhaler that divers can use at depth. As far as I know he's mostly been thinking about a specialized reg and pony bottle-type rig for now, but I don't know if existing ones can be adapted for inhalers. I will say that gas pressure laws will probably mean the inhaler won't work beyond a set depth, and I'd be worried about putting a small cylinder in my mask (have never seen a full face mask in person so maybe it wouldn't squeeze against you or rattle around? I don't know). Do inhalers even have a pressure rating as is?

 

[Scuba Lawyer]

I don't have an answer to the OP's question re: an emergency inhaler inside a full face mask so I'm not much help.

Slightly off-topic, but the whole asthma/diving compatability topic has always interested me. As a child, I had severe asthma up into third-grade. It was so severe I was taken to pulmonary specialists at several of the major medical centers in Southern California and ultimately placed on a regime of nebulizer treatments with all sorts of inhaled medicines. That was how I spent many weekends in first and second grade. During third-grade is when my dad started taking me diving. I had no breathing issues whatsoever. In fact, by the end of third-grade my asthma had disappeared completely. (Coincidence?).

Fast forward a few decades and at age 50 I had some breathing issues and was diagnosed with adult-onset asthma. I carry a rescue inhaler but have rarely had to use it (and even then only when my asthma is activated by a chest cold - when I'm not diving anyway). I have never had an asthma attack while diving (I know, never say never). Docs in the know say I'm fully cleared to dive. Just always wondered how others dealt with the issue.

I've rambled on long enough. Sorry for the detour.

M

 

[Cosmographer]

Thanks for the informative responses. I also know someone trying to design a device for this purpose which is the main reason I asked the question to begin with, although having a bit of asthma myself, it is something that interests me personally as well (I've never had an episode underwater in my 300+ dives, but I'm a "what-if" kind of thinker, so it does come to mind on occasion).

 

[Vitesse2l]

Do we know (I suspect not) what effect asthma drugs have when administered at pressure?

Side note - I attended a talk on DCS and IPO at the UK's Diving Diseases Research Centre last night. Immersion Pulmonary Oedema is actually rather nasty.

 

[Zef]

And asking about inhaler use underwater means the asthma is not well controlled? That's a ridiculous stretch when...

No, asking about inhaler use underwater does not indicate your asthma is not well controlled....but the history of your condition that you publicly shared, that you sneeze and start wheezing underwater while on SCUBA, does indicate your asthma is not well controlled.

...and 4) there are many other reasons why a person might ask this question other than having out-of-control asthma.

SInce you state there are many other reasons how about you list 4 or 5 legitimate reasons a person might be asking?

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

Dismissing the realities of your condition and putting yourself and your dive partners at risk is definitively arrogant and dangerous in a way that far exceeds any information anyone might post in a public internet forum.

You come across as anchored to the belief that you are safe to dive because your doctor signed off on it despite your admission here that you are symptomatic...to think that you could post this information in the "Diving Medicine" subforum without the totality of your post receiving review, scrutiny, and discussion is a bit obtuse....becoming defensive about and stating that the scrutiny and discussion is dangerous is just evidence of how anchored to your perposterous belief that you or anyone else who might have a need to use an inhaler while underwater is safe to dive.

...but I'm a "what-if" kind of thinker...

You would be better served by putting this type of thinking to use from an operational risk management (ORM) perspective. If one's asthma is controlled enough to be medically cleared to dive then the use of an inhaler might be indicated from a pre-dive prophylactic standpoint, but if one considers that in their individual situation there is enough risk that they might have an episode while submerged and breathing compressed air, that they might need to access asthma medication in any form DURING the dive, then ORM and general prudence should lead to the conclusion that the individual is not safe to dive, and should at the very least invoke the question of prudence and safety in their dive partner's conscious thought...that is, if one is being open and honest with their dive partners about one's condition to begin with.

-Z

 

[Duke Dive Medicine]

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?

Hi @Cosmographer ,

As other posters have emphasized, if there's a reasonable possibility that someone will need a rescue inhaler while under water, that individual should not dive.

Since you stated that you've been evaluated and cleared to dive by a physician trained and experienced in examining divers, I'm interpreting your question as more theoretical and that you're thinking about it out of an abundance of caution. A standard-issue asthma inhaler is designed to be used at atmospheric pressure, so it would not function as well under increased pressure (provided you could overcome the engineering problems of storage and delivery under water) and the delivered dose would decrease with increasing depth. @fmerkel could probably tell you the pressure that's in the inhaler and you could do some calculations to determine when delivery would stop completely.

For posterity's sake I'm pasting a few links below.

BSAC guidelines on diving with asthma:
Asthma - UKDMC

A recent paper with recommendations that are parallel to our own. We do provocative dry air testing on asthmatics who want to dive.
SCUBA Diving and Asthma: Clinical Recommendations and Safety. - PubMed - NCBI

From the DAN FAQs:
DAN | Medical Frequently Asked Questions

Hope this helps.

Best regards,
DDM