Diving with pulmonary obstruction

[Ranidolphin]

Hi all,
I'm new to this board so please bear with me. I'm just looking for a little bit of kind but expert advice as I'm at my wits end right now.

I am a certified rescue diver and have been scuba diving for around 15 years trouble free. About 3 years ago I started to dive as part of my job (I work in an aquarium) and as a requirement we must have a commercial dive medical yearly. The first 2 years I passed with no problems but this year I can't seem t make the spirometry requirement. The requirement is a ratio >75%, but I'm lying somewhere between 65 and 72. I've had no previous history of asthma or cpod. I don't smoke although I have been around friends and family that smoke.
So the dive doctor sends me to a respiratory specialist who also upon inspection can't find anything wrong with me but repeats the test and its the same. I take ventolin with no improved results on the spirometry, so she says its unlikely to be asthma. Instead she puts me on an inhaler which supposedly clears up any asthma or mucous in my system, and tells me to come back in 1 month. I come back, the test is the same and now they want to send me for a methocholine test to see if it will induce asthma. But initially she said I don't have asthma. She doesn't believe in sending me for any further investigative tests as she believes they will not show up anything. However she did state that if I have pulmonary obstruction I may have to reconsider diving as a profession. However I haven't been given any clear diagnosis. I'm so worried that I may not be able to continue diving, even though I have been doing it for so long without any issues. Plus I don't know what I have or what could be causing my bad spirometry reading. The dive doctor said that asthma wouldn't rule out diving completely, as all my other test results are clear and asthma can be managed, he's just waiting for the respiratory doctor to clear me. Is it possible to develop asthma later in life, and will it mean the end of diving for me?? Is there any way I can improve my lung function??

thank you so much

p.s. I'm a 29yr old female none smoker, moderately fit

 

[Duke Dive Medicine]

Rani,

What kind of respiratory specialist did you see, and what did his/her inspection consist of? Have you had any radiological studies of the chest?

Best regards,
DDM

 

[Ranidolphin]

Rani,

What kind of respiratory specialist did you see, and what did his/her inspection consist of? Have you had any radiological studies of the chest?

Best regards,
DDM

hi ddm,

i have been seeing an accredited dive physician (who initially conducted the spiro test), but because he is not a pulmonary specialist, I have been referred to a respiratory physician for further investigation. The respiratory doctor is a specialist in internal medicine and lung disorders (asthma, copd, bronchitis etc) but not in diving medicine. I had a chest x Ray which was clear and a spiro test inhaling a bronchodilator, which came back negative for asthma. The dive physician suggested Mri and ct but the respiratory doctor thinks they will show no pathology. She suggested a methocholine test and if that show asthma, then to do a hyper saline test. She basically said I have some kind of pulmonary obstruction and i may have to permanently refrain from divibg, but if this is the case I need a diagnoses of some sort!!

thank you for your help

 

[iamrushman]

very interesting...keep us informed of your progress....may all be well with you.

 

[Duke Dive Medicine]

hi ddm,

i have been seeing an accredited dive physician (who initially conducted the spiro test), but because he is not a pulmonary specialist, I have been referred to a respiratory physician for further investigation. The respiratory doctor is a specialist in internal medicine and lung disorders (asthma, copd, bronchitis etc) but not in diving medicine. I had a chest x Ray which was clear and a spiro test inhaling a bronchodilator, which came back negative for asthma. The dive physician suggested Mri and ct but the respiratory doctor thinks they will show no pathology. She suggested a methocholine test and if that show asthma, then to do a hyper saline test. She basically said I have some kind of pulmonary obstruction and i may have to permanently refrain from divibg, but if this is the case I need a diagnoses of some sort!!

thank you for your help

I don't blame you for wanting a diagnosis, I would too. What were your earlier numbers for the PFT when you "passed" it the first two times? Have you ruled out some sort of environmental irritant, e.g. mold under the house?

Best regards,
DDM

 

[Ranidolphin]

My last passing number was 81%. Now I'm around 71%. We have been having a haze over the country (from tree burning in Indonesia) but they said a reaction to that is unlikely if I don't already have asthma. So I guess it's looking like it might be asthma, but is it possible to develop it within a year??

 

[uncfnp]

Ranidolphin. Sorry to hear about your issue and I know it is tough to not have a diagnosis. I can't tell you what is wrong but I can tell you that it is possible to have adult onset asthma. It is also possible to have mild asthma that goes undiagnosed for years. Even the passing number you gave me would concern me in a health nonsmoker. But it is also odd that you give no history of any respiratory or allergy issues in your past.

And frequently people just don't know the correct way to do a spirometry test or give it less then a 100 percent effort but that doesn't sound likely here.

 

[Duke Dive Medicine]

Asthma seems unlikely given the complete lack of response to bronchodilators. Rani, what was the name of the other medication they gave you, the one you took for a month? Does the timing of the decline in your PFT scores correlate at all with exposure to the smoke from the tree burning you mentioned? It will be interesting to see the results of the saline test.

Best regards,
DDM

 

[timz]

Sorry to hear that. Are you from Singapore, Malaysia, Thailand or Indonesia??

 

[Ranidolphin]

Asthma seems unlikely given the complete lack of response to bronchodilators. Rani, what was the name of the other medication they gave you, the one you took for a month? Does the timing of the decline in your PFT scores correlate at all with exposure to the smoke from the tree burning you mentioned? It will be interesting to see the results of the saline test.

Best regards,
DDM

the medication was seretide 25/125. I'm living in Singapore at this moment and the haze has been on and off for around 2 months. I did have some reaction to the smoke. I developed a sore throat which turned into a cough. My pft has remained the same throughout this time period. The respiratory doctor says I may have to be on the medication for the rest of my life, but I don't see why since its provided no improvement to my lung function.