21 replies to this topic

[No Pressure]

I thought it would be good to pick a couple of common conditions and talk about the impact these conditions have on a diver.
Many dive instructors will tell you that they were taught that asthma, along with congestive heart failure, seizure disorder, and pregnancy (as well as a couple of other conditions) were absolute contraindications to diving. That means... if you have one of these, you are not diving...

More level headed and reasonable people will say that it is not the diagnosis, but the individual status of that condition that is the determining factor. So asthma, and maybe some of the other conditions above, may be compatible with diving. All that is needed is to find a dive informed doc to "buff you up, and sign you off" on your condition.

So, how bout you highly informed divers give your opinions of what you think about a dive buddy with asthma. We now have another MD in the ranks, with a special interest in asthmatic divers, so I hope she will give us the "latest puffs".

To start off, here are some questions;
1. Would you recommend diving to an asthmatic friend
2. Would you buddy up with an asthmatic diver
3. What special problems might an asthmatic diver develop?

[CuriousMe]

My .02

I have no medical training at all....I've recently researched this a bit though, since I've been recently diagnosed with Asthma.

So here's what I found for your questions:

To start off, here are some questions;
1. Would you recommend diving to an asthmatic friend
I would ask questions first. Is it controlled? How often do they use a rescue inhaler? Do they monitor their Peak Flows or FEV1's at home? Are their triggers stuff that they would encounter while diving?

If the answers were that it was controlled, they don't use their rescue inhaler often (if at all) and they do monitor their breathing numbers.....I'd recommend for them to get checked out by a Pulmo who is diving knowledgeable to get cleared.

2. Would you buddy up with an asthmatic diver
Yes, I'd like to know if they were controlled and what their asthma triggers were.

3. What special problems might an asthmatic diver develop?
Air trapping is the one that scares me the most. I've recently found out that inhaled steroids make you more susceptible to OxTox as well.

Well....I think that ended up being more than .02

Please correct, tear apart or amend the above in any way....as you might guess, this is a topic near and dear to my heart....err lungs, I guess

Peace,
Cathie

[Diverbrian]

Interesting! I was looking at the SSI website a week ago and pulled up the adobe files that they have on diving with asthma and diabetes. Each is about five pages of guidelines to to say basically the same thing that Cathie just said.

Edited by Diverbrian, 20 April 2004 - 10:32 PM.

[Diverlady]

1) I would recommend diving to an asthmatic friend provided their symptoms are controlled. The person would require a doctor's certificate by the certifying agency upon completing the medical questionnaire. Should this friend's GP refuse consent, I would suggest my friend consult a "diving" doctor.
I would suggest they breathe from a tank just to ensure that the dry air wouldn't be a problem.

2) Yes I would buddy up with a diver diagnosed with asthma.

3) Depending on the asthma triggers for a diver, exposure to an underwater emergency may lead to an attack. Also, exercise-induced asthma may be triggered if the diver is in a situation requiring heavy physical exertion. Regular cardiovascular exercise is recommended for asthmatics.

I have read in several diving articles that there is no increased number of reported diving accidents among asthmatic divers than among non-asthmatic divers. This may be due to the fact that asthmatics are more cautious due to their condition but that is just speculation.

Diverlady

[Lubold8431]

Interesting! I was looking at the SSI website a week ago and pulled up the adobe files that they have on diving with asthma and diabetes. Each is about five pages of guidelines to to say basically the same thing that Cathie just said.

Yes, SSI has a protocol for Asthma and Diabetes. Divers with these afflictions MAY be able to be cleared for diving. Obviously, the Asthma has to be controlled and of a certain type.

As an Instructor, I am still very leary of certifying someone with Asthma. Also, some Docs have no clue what could happen to a diver if they suffer an attack underwater. FOr exercise induced asthma, its not a good idea. For people with triggers like cat hair or pollen, that could be another story...

[Walter]

YMCA also has protocols for asthma and diabetes.

[raizyr]

what about "I had asthma as a kid and now it only affects me once a year or two when I've got some other type of issue going on (ie. chest cold)" ?

I am not and have not been prescribed an inhaler of any kind nor any other medication to control asthma since I was a teenager. I have no trouble with excercise (other than being a bit out of shape). And even the very rare occasion that my airways become restricted it's usually a short (my breathing returns to normal in 15+/- mins with no treatment) thing and the result of some other current health issue.

I generally consider it a non-issue yet the medical community seems to be undecided on whether asthma can go away.

-C

Edited by raizyr, 21 April 2004 - 02:36 PM.

[Starfish Sandy]

I am a type 1 diabetic - Insulin dependent and have been for 35 years - I don't have asthma - but my diabetes does throw some eventful moments in to my diving. I check my blood sugar 8-10 times on a day dive - and if it's too low - I don't get to go in - better safe than sorry - last summer in Cozumel, my group went in at the drop spot at Deep Columia and 20 minutes into the dive - the back dive guide was to send up a line and I could "drop" in if my sugar was high enough. Which it was!!! I agree, it depends on your control both with asthma and diabetes. I would dive with an asthmatic - just would make sure we had our signals straight before going down!

[No Pressure]

Thanks Cathie for a great summary reply. Im my opinion, asthma per se is NOT a contraindication to scuba diving. It is the baseline state of the condition that is important. Everyone who is intersted should read Cathie's 1) response. Type and amount of mediation needed, "rescue" medication, and what are the asthma triggers are all very important questions that will determine relative safety in diving.
Since some people have "exercise- induced asthma", which for some is based on exposure to cold dry air (as in jogging outdoors in the winter), then breathing off a tank on the surface is a great way to test the system for potential triggers.
Since asthma is basically the small airways closing off due to a trigger, some would take a fast acting bronchodilator inhaler just before diving to open up the airways as much as possible, and "prophylax" against an asthma attack.
raizyr, from what you have presented, I see no reason that you could not dive. I would consider having a bronchodilator medication available, after seeing a diving informed pulmonologist, since you do not want your 15 min of restricted airways to occur at depth. It is difficult to take an inhaler treatment at 80 ft, breathing cold, dry gas as your only option.
Isn't it interesting that agencies have "protocols: for medical conditions. Some are helpful, some are less so. The real bottom line is to find a diving knowledgeable MD who can evaluate your condition, knows the issues. stressors, etc with diving, and can give good, balanced, reasonable information for you to make a decision.

Sandy-ke. Hold that thought. Diving and diabetes will come up shortly.

[No Pressure]

I posted this under diving doctors in response to a question on that thread, but it should be here for those interested in the topic.
NP

The Underwater and Hyperbaric Medicine Society, as well as the United Kingdom, Australia, South Pacific Underwater Medical Society, DAN, and other organizations have a range of recommendations regarding diving with asthma. There is no clear quideline, and most say to consult with your local physician. ( part of the reason for this thread). Australia requires all divers to pass a spirometry (breathing test) before certification. UK states asthmatics can dive if they have not needed a bronchodilator in 48 hours, and depending on the cause of the asthma. DAN has changed their opinion in the last 10 years based on other diving medicine groups imput. A dive organization does not want to put a diver at risk by saying that diving with any condition is guaranteed safe, so the conservative approach has been to say no.
I will try to summarize the info out there.
Mild, internittent, and moderate asthma, if well contolled, may permit those people to continue/ start diving. The only classification of asthma that would prevent someone from diving is severe persistent asthma. This type is described as continuous symptoms, lung function less than 60% of normal, limited physical activity because of asthma. Everything less severe than this can be considered possibly safe to dive.
If you have asthma, get PFT's, or pulmonary function tests, preferably after doing the activity that causes your asthma (cold, exercise, etc). This may mean jogging in the parking lot of your doc's office. Test your lung function during an asthma flare. It should be greater than 60% of expected, and preferrably > 80% of predicted values. With that as a baseline, and with a routine bronchodilator medication regimen (short acting, long acting bronchodilators and/ or inhaled steroids), you may well be OK to dive. If cold dry air is a trigger for you, grab a scuba tank and take it with you to your doc's. Breathe off that thing thru a reg for 10-15 min and then get checked.
Take your asthma meds with you on the dive trip, and take "a hit" from your inhaler before getting into the water. Put it in your dry bag/ carryon, to have after the dive if needed. (Note: that's what I used to do for my asthma. It had gotten better over the years, but I still have an albuterol puffer in my dry box on the boat. I have not died from an asthma attack yet)
DAN and world data basically says that people with asthma who dive get into trouble at the same rate as people without asthma. So asthma has relative risks for decrease in pulmonary reserve underwater, but if stable and controlled, is not an absolute contraindication to diving. I would be happy to go over the potential complications underwater in someone with asthma. They basically are: any diving complications related to the lungs that can happen to anyone, can happen to someone with asthma, and may be more serious cause the lungs ain't normal to begin with.

[happy2dive]

Hi everyone,
I'm asthmatic and my doctor cleared me to dive. I do take ventolin on board (bronchodilator) for emergencies. However, in 40 dives, apart from a bit coughing underwater I didn't have any problems. Knowing your triggers does help. In my case it's tabacco smoke. This is a problem when I dive in a group with a lot of Europeans, especially Dutch. There's a high percentage of smokers who are not used to taking other non-smokers in to account. And I end up shifting from one place on the boat to another just to avoid inhaling the smoke. I would love to on a diving trip with only non-smokers.
As for taking a preventive puff of ventolin, I wouldn't reccomend it unless it is absolutely necessary. It made me take in way too much air and I ended up being 'drunk' on oxygen.
Greetings from Amsterdam
happy2dive

[No Pressure]

Happy2dive, "drunk on oxygen" Hmmmmm, of all the states I have experienced, that is not one of them. I am glad that you have an understanding doc and that you can dive. Sorry to hear that you have to spend your surface inteval in a toxic environment. Do you think breathing off your regulator on the boat would give them a hint?
Thanks for adding to the thread.

[happy2dive]

Drunk on O2 was just a term that the instructor used. Apparently I was suffering from a form of hyperventilation caused by the combination of ventolin, air from the tank and being under pressure. The effects were not nice...light-headed, woozy and dizzy. Since I almost never drink (allergic...don't have the enzyme to break down the alcohol properly) that was one of the few times I experienced being tipsy. I just crawled into bed that afternoon and had to sleep it off.

When it comes to smoking, I'm loosing the battle in Europe. People smoke blatently under no-smoking signs; people light up in the boat cabin after the briefing in which they been told to smoke outside; in cafe's people tell me to get lost if I ask them to refrain until I've finished eating or drinking my coffee. Well not all smokers are so rude but I've had my fill of these encounters. Yes, next time I should ask for an extra tank for on the boat. Problem is, occasionally I get a skin rash from contact with the smoke so my situation is bit dire.

[No Pressure]

Ventolin can cause your heart rate to speed up, sometimes a lot. That may have happened and caused your dizziness. Sorry to hear about the smokers. I watched 2 guys here complaining about the 87 steps we had to climb with doubles after a tech class, then light up cigs at the top!
You can always fly over and dive with us! The few smokers on the boat are very respectful of other's space, and air.

[Daniel]

:::Raising Hand:::

I am also an asthmatic that has been cleared to dive.

I do peakflow daily, I know my triggers, and as all divers are tought KNOW when to call a dive.

One thing I have noteced as a personal observation during my short diving career, as someone eluded to earlier in this thread I believe, that informed asthmatics are very aware of their trigers, their sorundings, and their breathing, each time I have complete a dive I normally have more pressure in my tank upon surfacing than any others in my group/buddy team.

In fact this March we held our annual "dive a thon" for hemophilac childern, one of the dive instructors that was working surface support forgot about me and my asthma and air consuption rate, so at the 1 hour mark they made me surface to make shure my pressure guage was working right, as soon as he checked it and realized who it was he just signalled for me to return to the group.

Dan
AOW