Histamine Challenge Test - Fail = No Diving??

[simonc]

I have asthma. Came on when I was 21...now I'm 35. Change in seasons (summer - autumn - winter - spring) gets me going.

I have been diving for many years now - but only a couple of times a year, both pre asthma and post asthma. My physician had me on pulmicort 400 (bronchiole anti-inflammatory) twice a day as a preventative and ventolin as needed. Worked a treat and I rarely, if ever need ventolin.

Recently I was given a histamine challenge test (on my insistence) that required me to stop my meds and be tested following successively higher doses of histamine. Needles to say without meds…I failed the test and was barred from diving.

Upon reading this board and the advice of the YMCA and SSI on asthma diving protocols, I decided to follow up on this some more. I went to a different doc and explained my history, he said he could not certify me fit to dive because he belonged to the Australian Hyperbaric Medicine Society who believe asthma = no diving. However he was prepared to help me “off the record”.

He swapped by meds to Sybicort - saying it provides both the anti-inflammatory corticosteroid budesonide (in Pulmicort) and the rapid and long-lasting bronchodilator formoterol (in Oxis) in a single inhaler. I am to take this twice a day for 1 month, and then get tested again on the histamine challenge, but to keep on the meds for the test. He wants to see if the meds help me to pass the test. Pass the test on meds = safe to dive (although he still can’t certify me fit). If I fail the test he can up the meds and re-test me, as I’m starting on the lowest dose. If I fail again he believes I should take up snorkeling.

This histamine challenge test seems to be the defining thing…..??? I hope Symbicort does the trick.

SimonC

 

[GoBlue!]

I don't understand why you would've wanted to subject yourself to a histamine challenge test. The diagnosis of asthma was previously made...of COURSE you're likely to have airway hyperreactivity to histamine. Sounds like you had very good control with Pulmicort alone, as you rarely needed to use your albuterol rescue. If I were caring for your asthma, I would've left you the heck alone. If you were needing frequent albuterol (Ventolin), THEN I would've added a long-acting bronchodilator.

The debate of asthma & diving is the subject of many other threads & publications, so I won't reiterate the diversity of opinions here, but I would NOT consider a histamine challenge a test of whether or not your asthma is controlled. Instead, I would go based on your symptoms & FEV1.

If, for some reason that I'm not following, your physicians want you to "pass" a histamine challenge, you could also consider one of the meds such as zafirlukast or montelukast (US Trade names Accolate & Singulair, respectively...leukotriene receptor antagonists) to be added to the regimen. Once again, not necessary in my opinion if you were rarely using albuterol when taking Pulmicort regularly.

Standard disclaimer applies....this does not constitute medical advice, and certainly does not imply a doctor-patient relationship. Continue seeking the advice of your healthcare providers.

Jim