Tips from divers with mild asthma?

[Joneill]

I have been cleared to dive by a respiratory doctor (what do you call those?)

We call them Pulmonologists in the US!

 

[Puppeteer]

My ENT and Asthma specialist originally diagnosed me with mild asthma after my lung capacity had reduced by about 15% after I had an infection that induced a wheeze. I worked with him to ensure I was safe to dive, and I had to pass a manitol challenge before he would sign off, and he recommended a preventative inhaler (Alvesco).

In my case though I had never had an asthma attack, it was diagnosed only due to the reduced lung capacity associated with the infection. Interestingly after I started diving regularly my lung capacity improved and I'm no longer diagnosed as asthmatic, but still maintain Alvesco and have regular checks with my specialist, where he measures my lung capacity.

 

[Vitesse2l]

I'm a UK diver with mild asthma have been signed off by the DDRC in Plymouth as fit to dive. I've never had a problem but obviously everyone is different.

The onus is on me to decide if I'm OK to get in the water. There are considerations regarding who you inform - your buddy, the dive organiser etc.

OP, I hope you enjoy the diving here.

 

[Youssef]

In my case though I had never had an asthma attack, it was diagnosed only due to the reduced lung capacity associated with the infection.

Same here actually! Never had an asthma attack but was told that is the most likely cause after describing my symptoms. Part of the reason I want to see a doctor again is to confirm it is asthma in the first place.

Glad to hear it got better over time though, that’s reassuring.

 

[MB NZ]

The asthmatics I have dived with use the don't ask don't tell rule, so I can't give you numbers
as they're implementing the SGO rule, So Go Diving
combined with the SAC rule don't think about it and their comfort increases like the SAC rate

LOL! My wife and I are both doctors. When we first met, we went on a diving holiday to Malta. She just had to tick the yes to asthma box on the health questionnaire triggering a dive medical and losing a day's diving. When we saw the diving doctor, he did a very brief history and examination and said good to go. Wife said never again!

In a fit, young person with well controlled asthma who is currently well, I don't see the point of a cursory "diving medical", but don't trust what you read on the internet!

 

[Ukmc]

DAN’s position is that mild AND well controlled asthma is no longer an absolute contradiction to diving, that is WITH a clearance from a medical professional.

 

[Wallowa]

That was meant as an actual question not a dismissal. I am curious what other organisations have to say about it (regardless of whether or not it affects my own decision)

No, I didn't take your question as dismissive. No problem. In the world of internet 'experts' I do not wish to appear to be self aggrandizing by stating my 'credentials'. I would point you towards a plethora of diving medicine texts to garner the views of the physicians. It can be overwhelming but the devil is in the details and you must in the end make your decisions based on those details. Note that in my opinion over time standards have changed to placate certifying organizations quest for more of the pie. The more 'flexible' the standards, the more students they can attract for that bigger piece of the pie.

When you are ready just use your common sense and basic physics to adjudge the degree of risk you are willing to assume if you dive with asthma. It always will be a matter of probability, but only you can determine how much you are willing risk. It is not simply a matter of chancing an embolism, but also of exercise tolerance.

Here are few diving medicine authors to look up if you are so inclined: Lippmann, Edmonds, Bennett, Bove, Schilling, MeBane; there are many others. Consider a methacholine or histamine challenge test if you doubt that you are asthmatic; that of course is up to you and your physician. In my world "if there is any doubt, there is no doubt" concerning diving safety. Today in my opinion a true "Diving Doc" who understands all the parameters in play is a rare breed. Yes, medical 'practice' evolves but the physics of barotrauma is immutable notwithstanding our social rush for "better living through chemistry".

No more from me, it is your decision, again good luck and stay safe.

DSO

 

[Nic2750]

I have mild, well-controlled asthma, a medical clearance to dive, and I dive regularly. The only thing I do differently is that I'm diligent in tracking my peak flow 2-3 times a day, regardless of whether I'm diving. My "personal best" is 450, and I don't dive if it's less than 80% of maximum, even if I feel fine. For me, low peak flow invariably means I'm coming down with something (usually cold/flu) that aggravates my asthma and often makes it difficult to equalise.

So far, I've never had to cancel a dive, but I have avoided planning dives when I can see my peak flow is trending down. I carry a ventolin with my dive kit just in case, but I've not yet had to use it.

Note: I'm just sharing my experience, not giving medical advice!

 

[Youssef]

Thank you for sharing your experience Nic! I’ve been reading up on it and your method aligns with the recommendations from the UKDMC here:


To minimise the risks of diving with asthma we recommend the following:

* The diver should do their peak flow (PF) twice a day for at least three days before diving & during the diving period. Should it drop 15% below that individuals normal best they must not dive, until it has been normal for 48 hours

* If the diver has had to use a reliever inhaler they must not dive until their PF has been normal for 48 hours

*Should the diver become short of breath or wheezy on the surface or underwater the dive should be abandoned

* Due to the theoretical risk of barotrauma all ascents should be slow but within the recommended computer ascent rate. In particular the last 5 meters should be very slow

*It may be a good idea to take a reliever inhaler half an hour before diving to decrease the risk of bronchospasm .

*If there is any change in the diver’s overall asthma control they should seek further advice from their GP & then their diving physician before further diving.

 

[Nic2750]

Thank you for sharing your experience Nic! I’ve been reading up on it and your method aligns with the recommendations from the UKDMC here:


To minimise the risks of diving with asthma we recommend the following:

* The diver should do their peak flow (PF) twice a day for at least three days before diving & during the diving period. Should it drop 15% below that individuals normal best they must not dive, until it has been normal for 48 hours

* If the diver has had to use a reliever inhaler they must not dive until their PF has been normal for 48 hours

*Should the diver become short of breath or wheezy on the surface or underwater the dive should be abandoned

* Due to the theoretical risk of barotrauma all ascents should be slow but within the recommended computer ascent rate. In particular the last 5 meters should be very slow

*It may be a good idea to take a reliever inhaler half an hour before diving to decrease the risk of bronchospasm .

*If there is any change in the diver’s overall asthma control they should seek further advice from their GP & then their diving physician before further diving.

Thanks - there are some good tips in there as well that I can add to my repertoire. It's interesting that they suggest taking an extra reliever before diving rather than an extra dose of a preventer.