Diving with COPD

[Pembina]

Yes, I wear long sleeves, a hat, sunscreen and always stay under the canopy

 

[adfitzer]

as preface i am a medical doctor that dives not a doctor of dive medicine. i do have an interest in dive medicine as a hobbyist more or less. i agree with above and think that your primary risk with diving and COPD is probably arterial gas embolism from pulmonary barotrauma as a result of air trapping that can occur with COPD. tobacco smoking damages lung tissue and distorts lung tissue architecture. air flow through these distorted tissues can become compromised. if airflow becomes compromised or 'trapped' you end up with a gas that wants to expand (or contract) dependent on the ambient pressure in a fixed space-think middle ear squeeze. shallow, shorter dives do little to mitigate the risk given the old adage that the greatest relative pressure differences occur in shallower depths. nitrox would have no effect on the outcome. 'deco stops' are not going to impact air trapping. a 'slow' ascent rate might give more time for 'incompletely trapped' air to ventilate and escape though it would be hard to say how 'slow' is slow enough.
i agree with evaluation by a pulmonologist familiar with dive medicine. it seems that i've read somewhere about evaluating lung structure with a CT scan to determine if there are architectural changes present that increase risk for air trapping.
secondary concerns include cardiorespiratory fitness for strenuous activity.
a question i have, which maybe DDM can answer, is is there any literature on DCS risk in COPD with regards to reduced DLCO?

 

[TONY CHANEY]

Good question Adfitzer. Another one that I have had in the back of my mind for some time is the effects of VQ (ventilation vs. perfusion) mismatch while diving. While on land being upright is essential to maximize lung volumes and blood flow rates. I think that with diving we can decrease the effects of gravity but position seems to still play a major part. With that said, since we are able to achieve a better VQ, within the ICU environment, with the prone position, does it work with horizontal position during deco / safety stops? Any thoughts DDM or others?

to Pembina, you may want to have a second guess to the additional need for O2 during exercise. You stated that you do have an increased in WOB (work of breathing) during exercise. Did you know that decreased oxygen will increase you heart rate and respiratory rate? My suggestion, and it is just that...buy a pulse oximeter and check it out.

 

[DocVikingo]

it seems that i've read somewhere about evaluating lung structure with a CT scan to determine if there are architectural changes present that increase risk for air trapping.

Indeed such exists, e.g.:

http://pubs.rsna.org/doi/pdf/10.1148/radiology.216.3.r00se21768

https://www.researchgate.net/publication/5501869_Quantitative_Assessment_of_Emphysema_Air_Trapping_and_Airway_Thickening_on_Computed_Tomography

http://journal.publications.chestnet.org/article.aspx?articleid=1067626

a question i have, which maybe DDM can answer, is is there any literature on DCS risk in COPD with regards to reduced DLCO?

I do not believe that such yet exists, but could be mistaken.

Regards,

DocVikingo

 

[adfitzer]

In regards to DocVikingo: thanks for the links to articles. I think I've read somewhere that such imaging studies have been used in the evaluation of fitness to dive in those at risk for/history of air trapping. A quick google search on the topic of air trapping, scuba, and ct scan yields the following related article.
http://oem.bmj.com/content/60/8/606.full
While only a case series, the first 2 cases highlight that several years of diving frequently with underlying asymptomatic chronic lung disease without incident does not imply future immunity from serious diving complications. But more importantly to the OP, it suggests that there are resources that may help and hopefully provide for some degree of reassurance that your continued diving is not unacceptably high.

 

[DocVikingo]

Good citation, adfitzer. Thanks.

The OP will also want to be aware that the ordering of imaging such as is being discussed here may require some finessing if he does not wish to pay for the procedure(s) himself. Third party health insurers are certainly going to be loath to cover evaluations solely to assess fitness, pulmonary or otherwise, for recreational diving.

Cheers,

DocVikingo

 

[Duke Dive Medicine]

i agree with evaluation by a pulmonologist familiar with dive medicine. it seems that i've read somewhere about evaluating lung structure with a CT scan to determine if there are architectural changes present that increase risk for air trapping.
secondary concerns include cardiorespiratory fitness for strenuous activity.
a question i have, which maybe DDM can answer, is is there any literature on DCS risk in COPD with regards to reduced DLCO?

Smaller lung defects may not be visible on CT. Re the research question, ditto DocV, not that I'm aware of. In theory, decreased lung diffusing capacity could work both ways, i.e. it could potentially reduce the amount of nitrogen that diffuses in to the blood stream as well as slowing the off-gassing process on ascent. However, if a person's lungs are bad enough that there's a physiologically significant reduction in the amount of inert gas absorbed under pressure, he or she would probably have bigger worries than decompression.

Best regards,
DDM

 

[Pembina]

I thought I would supply an update on my COPD situation. Not much has changed since my diagnosis. Not any better but thankfully, not any worse. I have been unable to find a pulmonologist who dives (it seems as if they shy away from scuba) but I was able to talk a little more with my non-diving pulmonologist and he seemed surprised that I was a diver. He said that he would not tell me that I "Can't" dive but then started in about the effects of atmospheric pressure on the lungs even while flying. But he then said that I don't have the influenza type COPD but that mine is more bronchial. He said I have very few "pockets". I've had chronic bronchitis for years and never had a thought about diving with bronchitis as being dangerous.
That being said, I went home and booked a trip to the Bahamas (in January) and Belize (in March). I've always wanted to dive the blue hole and figured that it may be now or never.
I would like to know your thoughts with this newest information of "bronchial" COPD

 

[pasley]

Note a Dive Medicine Pulmonary Doctor is NOT a Pulmonary Doctor who SCUBA dives, it is a Pulmonary doctor who has additional training in the specialty of DIVE MEDICINE.

DAN Physicians Referral Physician Program

Upon request, DAN will provide contact information for physicians who have recognized training in diving medicine. Please note that diving medicine is generally considered a sub-specialty among the approximately 600 referral physicians within DAN's database.

If you are looking for a physician to conduct a diving physical, or just want to speak with a diving medical specialist in your area, please contact DAN for a referral.

If you are a physician and would like to be included in this referral database, please send your resume or CV for consideration.

It appears you want someone to tell you the answer you want to hear, not what is the safe answer.

DAN is the repository of dive medical knowledge. Their published documents are the informed recommendation of the experts. If you want to hear it from someone, call them and they will refer you to a DIVE MEDICEN Doctor who specializes in lungs. The doctor near you will conduct an exam and then tell you their informed decision.