Inhaler for dive equipment

[DrBeer]

I've been doing much reading the past few days on asthma and diving. At this point I'm very sure that I should be ok to dive, but I am going to schedule an appointment with a pulmonary specialist with a strong background in dive medicine. Anyway, it seems to me that it would not be difficult to create an inhaler than can be used submerged.

Manufacturers or skilled machinists could simply add another input to the regulator. Attach a small,container of albuterol, or whatever inhalant is prescribed to it with a lock to prevent accidental depression and voila - you have a submersible inhaler. Obviously you would have to have either special housings or special containers (or both) made for this application, as well as watertight seals, but it seems to me that this should be practical. The only concern would be the high concentration of the suspension in a puff. Since most people that I've ever known to use inhalaers regularly take 2-4 puffs, I'm thinking reduced suspension delivery and/or a smaller number of puffs would solve that issue. In fact the higher concentration of the suspension in addition to the higher concentration of air being inhaled would probably prove beneficial and a more efficient delivery system than simply inhaling.

Now this isn't to say those with certain types of asthma have a free license to go diving (especially concerning EIA or cold air-induced forms of RAD), but it could very likely allow a greater number of people with very mild forms of asthma (possibly even very, very mild forms of the aforementioned EIA and cold air-induced RAD) to enjoy diving on a recreational level.

I did research on the use of various inhalant suspensions before dives and most of my research showed that contrary to what some say, the use of a bronchodilator prior to diving would actually benefit someone with RAD, or indeed even those with normal pulmonary functions.

I am no doctor so I could be completely off-base here. Thus I submit this to those doctors here. Maybe I've come up with a nifty invention that could bring more into the hobby and maybe make myself a small penny on the side as well (yeah right! ). Then again, maybe this is a fruitless idea with little practical value.

Any input?

 

[Drew Sailbum]

the engineering problem I see is that I think most inhaler containers would be crushed or made inoperative by the water pressure.

I doubt that drug manufacturers would seriously retool to provide such drugs in a packaging that would hold up well to the pressure.

I could be off base on my assumption, but I don't think it's as simple as cutting a hole in the side of a second stage and snapping in an inhaler mouthpiece.

 

[DrBeer]

No it isn't that simple - you are most certainly correct. You would need a special container as I've already said.

I don't think convincing a company to make a special container to hold the inhalant would be much of an issue. My reasoning is simple - they stand to make a profit. What good capitalist would turn down the chance to make a profit?

This is why I feel this way:

It has been estimated that 5% - 8% of all adults are diagnosed as asthmatics (Mt. Sinai). From a purely statistical point of view, it would stand to reason that 5% - 8% of all recreational divers are asthmatics (this doesn't take into account the 10% or so of child asthmatics who "outgrow" their asthma but are still at risk in a diving situation of a possible recurrence). Obviously this logic is somewhat flawed, but this is just an example. I personally don't think that by the very nature of the sport the percentage is likely this high, but I feel it is close enough for this discussion. So let's say there are 5,000,000 certified divers in the world (an easy number to work with - I'm unsure of the actual figure). If 5% of them are asthmatic, then you have a potential customer base of 250,000 people. If you think about it seriously, someone who has any concerns with shortness of breath would have no reason not to attach a small device to their regulator for emergency use. Statistically, based on what I have read, the actual number of asthma related diving deaths and accidents is insignificant, but also from what I've read this is also something that requires a great deal more study before anything authoritative can truly be said. Either way, every precaution is something that should be given due consideration, and this could possibly be such a precaution.

Ok, now to the profit. We've got a potential customer base of 250,000 people. Let's say since the actual number of sales will be low relative to non-diving asthmatics, the company has to charge more for the special packaging. A friend of mine who uses Albuterol pays about $13 for his inhaler (I could be wrong on this figure). Let's up the price to $50 each. I would imagine divers are somewhat accustomed to paying premiums for their specialty equipment so this should be no exception.

Let us now say that 50% of those 250,000 people throw caution to the wind and decide not to invest. We are now down to 125,000 people who would still be willing to purchase this item. That is $7,500,000 gross income from sales of this product. Obviously this isn't a great deal of money to companies that rake in hundreds of millions if not billions every year, but if the pharmaceutical companies are run like some of the companies I have worked for they will not hesistate to add $7.5 million to their bottom line. Development costs should be low. The only requirements would be a thicker metal used for the container, possibly making it smaller to be less of a hindrance, a stronger valve/gasket system and a threaded end to fit onto or into the nipple attached to the regulator. The sheath and actual device to connect the medication to the regulator could be manufactured by a third party, or possibly a regulator manufacturer could simple drill and tap their own extra hole and supply a sheath. The nipple itself can contain the O-ring thus providing a reliable and secure seal. On top of this a stiff plastic sheath can be put over the medicine to protect it.

Of course if I or anyone else were to seriously investigate the manufacture of such a device there would be a need for much more reliable numbers and testing. Those would not be hard to acquire though. Statistical numbers should be sufficient to determine marketing viability and mathematics (and some empirical work) would dictate construction.

I personally could probably get access to an old regularator and use one of my old standard inhalers just to test the system in 1m or 2m of water. Creating a threaded connector on the medicine container itself should be quite simple. I know of a person who could expertly drill and tap the regulator itself for a nipple. At this point the molding of an acrylic sheath would be necessary so the medicine container itself is unlikely to be damaged. This is also a very simple process.
If necessary I believe that the current inhaler units should be strong enough to withstand the pressure at 150ft provided the sheath itself is completely sealed as to maintain the pressure around the medicine at sea level or close to it.

The only real mechanical issue I see is the amount of force that would be necessary to inject the suspension into the regulator and airstream of the diver.

I think, as long as there are no medical issues that I could very likely be unaware of, that this idea has some small merit.

 

[raviepoo]

C'mon. You've GOT to be trolling. Aren't you?

If you're not, this is just a very bad idea. No pharmeceutical company would re-tool their product to allow it to be compatible with a device that creates a HUGE liability issue.

Think about it. I am parmeceutical company X. I have re-tooled my inhaler so you can use it with a regulator. You go scuba diving and die. Maybe you didn't die of asthma related issues. Maybe you did. One thing's for sure - my company is going to get sued, again and again and again.

Why would any corporation open itself up to that kind of liability?

 

[DrBeer]

This isn't a troll.

Liability is a concern, yes, but generally medicinal companies already take huge risks with all of their medicine in the first place. What is the difference between a person who dies while taking or using any prescription medication before diving (or driving or almost anything else for that matter) as compared to someone who dies with a specially and specifically designed inhaler attached to their regulator for scuba diving? The company would stand to get sued in either instance. As long as the medication (we aren't talking over the counter medication - no one using OTC meds to control asthma should even consider diving at all) was being used as intended and as prescribed the legal issues are no greater than any other medication or delivery system. If they are being abused there is zero liability to the manufacturer as long as abuse potential or what constitues abuse or improper use is very clearly specified by the physician, the pharmicist and the labelling (I have yet to see a doctor who wasn't extremely careful about how to use the medications I was prescribed - same with pharmicists and the paperwork given with all prescription medication is quite complete). We aren't talking off-hand modifications here. You can't modify any medication or delivery system without licensing, approvals from the FDA etc. What I was considering was the sanctioned creation of items specifically made for such a task by the pharmaceutical companies themselves. The only 3rd party appartus would possibly be a nipple on the regulator for attachment and a plastic sheath of some kind for a bit of added protection. Will the liability be worth it to a company? I don't know I am not a lawyer (yet), thus I didn't address the issue. My mention of the modification of an old regulator was to simply see if an inhaler would inject the suspension underwater with the air tank at full pressure - nothing more and certainly not for actual use.

All medical matters aside, it is my opinion that the primary issue would be whether or not the R&D to create something such as this would pay off.

This is only an idea, that is it. There was really no reason to flame me.


*edit*

When I say inhaler I am not referring to the plastic delivery system, but rather the actual metal cylinder itself containing the suspension.

 

[agstreet]

DrBeer once bubbled...
This isn't a troll.

All medical matters aside, it is my opinion that the primary issue would be whether or not the R&D to create something such as this would pay off.

This is only an idea, that is it. There was really no reason to flame me.

He wasn't flaming you, he was expressing his astonishment at an incredibly stupid idea.

I *am* going to flame you however, because, to borrow a phrase from G3, this idea is farm animal stupid and deserves a bit of toasting

Leaving aside the physiological issues for a moment, modifing the drug delivery system of an inhaler to work with a regulator is far more complex than simply adapting the cannister to the LP hose. Even if you could get the pressure issues worked out, metering albuterol into the LP hose drastically alters the dose amount and dose rate from direct inhalation at the mouth. I also have to wonder what effect the propellants and the drug itself would have on the regulator mechanism. No, there is no way a drug manufacturer is going to accept the liability of trying to tie their drug delivery system into a piece of life support equipment, especially not for an amount of gross revenue that wouldn't cover the cost of the FDA trials.

There's also the little issue of holding ones breath. Inhalers require you to take a very deep breath and hold it for 15 seconds or so. Doing this underwater while breathing compressed air is a very bad idea.

But more important than the engineering issues is the medical issue. Simply put, if you're so inhaler dependant that you can't make a dive without one, you have no business diving. Have you actually discussed this idea with your doctor? Did your doctor suggest that perhaps you've lost touch with reality? Diving can put tremendous stress on the heart and lungs, which makes asthma a borderline contraindication to diving. A patient with mild asthma is usually OK, but one who is so inhaler dependant that they can't go an hour or so without using it has no business being underwater (except, perhaps, in a submarine).

Alan

 

[DrBeer]

Actually I didn't think your post was a flame at all. Much more informative than the previous poster and you also took the time to explain your reasoning.

This idea was never intended for my personal use. I don't need to use an inhaler. According to the USMC I do not have asthma of any kind. My issue was the fact that it shows up in my medical records and I question the technicians who administered the PFTs. Taking serious chances with ones life in the military is one thing - taking serious chances with ones life for a purely recreational sport is another. So I err on the side of caution in this matter. I'll be seeing a pulmonologist who specializes in dive medicine.

As far as the metering issues - you are probably correct. Mathematically the meter could be worked out, but the reality of it might not be so practical. I mentioned that as well. As I said several times, I'm not a doctor and I was merely bringing this up to get input on. Is it farm animal stupid? I don't think so - there are no stupid questions if asked out of a true desire to learn. Ignorance of advanced medical or engineering issues was precisely why I posted this as an idea that possibly had merit but on the other hand, as I inferred, could be completely without merit as well. I made no assumptions as to the feasibility. I just wanted to know if something like that was in the least bit possible. I suppose it isn't, and now I know and have learned things I was not aware of or had not thought of. It seemed like an interesting idea.

I agree that if someone is so inhaler dependent they have to have one underwater with them then they have no business diving. This was more of an idea to use in emergencies.

Think me dumb if you wish, but I've read things much closer to "farm animal stupid" in professional publications of all sorts, from law and philosophy to mathematics and physics.

I won't annoy the intelligentsia of this forum with any other posts and I apologize for intruding.

 

[redacted]

If the medication can be added to the gas before the dive and remain stable, maybe there is a use for a spare air. Just a thought you might want to examine. No retooling by the drug mfgr and no modification to you primary kit.

 

[agstreet]

DrBeer once bubbled...

Think me dumb if you wish, but I've read things much closer to "farm animal stupid" in professional publications of all sorts, from law and philosophy to mathematics and physics.

I won't annoy the intelligentsia of this forum with any other posts and I apologize for intruding.

First off, I have to apoligize for making an assumption which was the basis of my "farm animal stupid" comment. I assumed you were an inhaler dependant asthmatic, had done just enough misguided research to get yourself into trouble, and were trying to figure out ways treat your disease underwater. Such a person would need to get "slapped upside the head" and discouraged from pursuing something that would likely get themselves killed, possibly taking a buddy along with them. Obviously, this assumption does not apply to you, and I'm very sorry for jumping to such a conclusion.

As for not "intruding" in the future, that's your choice, but one that I think you might want to reconsider. There's a lot of good information to be learned here and people here are much more tolerant than on other forums. Your post was a bit unusual in that it really did appear to be a troll at first. Although people here are pretty nice, they still respond negatively to trolls. As for myself, I thought it was at first a troll, but then appeared to be the scenario I described above.

Sorry again for the misunderstanding.

Alan

 

[DrBeer]

No problem. We all make assumptions from time to time. I took no offense to your reply or even the farm animal comment. It takes a great deal more than that to effect me.

The primary reason for me trying to think of a way to use inhaled medication underwater was for those who have 100% controlled and predictable, mild asthma. Specifically those that have extremely mild and controlled EIA or cold air-induced asthma. I should have stated this more clearly in the original post. Basically I have friends who can run marathons in the Himalayas in their skivvies but cannot get doctors to approve them for diving. I tend to lean towards the doctors recommendation - it is one thing to fall and break a leg running a marathon and a completely different thing to have a mild, possibly even unnoticeable asthma attack underwater and suffer from AEG because of it. Anyway, something like my idea could have been used as a safety device, because you never know. Now that I think about it though, you can just use it before you dive. If you have an attack anyway within the next 6 hours then having an inhaler in the water likely wouldn't have helped you anyway.

I wouldn't have posted if after reading every post from pages 1-6 I didn't feel the community here was somewhat tolerant. My initial post was actually asking how practical it was for me to dive. There is so much conflicting data on the subject that I felt inclined to ask around. Anyone on any established forum will likely respond negatively to trolls. I do on the ones I frequent regularly.

I'll come back. I took things a bit too personally perhaps.