Asthma & (CCR) Diving

Jim

Hi All,

Request for info please on diving with Asthma.

Reason - Had a dive medical today .... it was the first time I have ever mentioned that I had Asthma .... guess what, it was the first time I had problems getting the medical signed off. My lung volume test is not fantastic (blow as quickly & hard as you can in the tube). I have been signed off to 30m for holiday insurance purposes awaiting fuller tests to sign me off to my qualification depth of 100m.

I realise Asthma has dive consequences for some, however mine is not exercise induced .... I'm physically fit... marathon time 3h50min ... trained and fought Muay Thai for 11 years, with a 10k time sub 40mins .... I currently run or gym 4-5 times a week (mix cardio & weights). I eat and drink healthy (a couple of beers & pizza short of a monk).

I understand the doc's reasons for caution and understand I should have come clean on previous medicals, past is past.

I would like to hear from the diving physicians or other tech CCR divers with asthma .... please no preachers or muppets !!

Cheers.

__________________
Jimbo

rogeringebo

I am no doctor but I do have asthma and it have never disturbed me during diving so I just dont care what people say,.....as long as there are no cats in my scrubber I will be fine...

Best
Rodge

Dave Faye

My dive buddy has asthma which she takes medication for daily. For her open water certification in 08/02, her doctor recommended that she not exceed a depth of 40 feet. Since then, she has routinely done both warm and cold water diving, technical diving to depths of 200 feet and is now starting her CCR training. She's never experienced any problems with her asthma.

She routinely uses an inhaler prior to each dive and has never surfaced from a dive out of breath or in distress.

Each case of asthma is different. Each step has been taken slowly. Each new step she takes, she considers carefully and listens to how her body feels. You know how your body reacts better than anyone.

dteubner

With ann medical condition and diving there are two questions that need to be answered, namely -
1. Will the condition have an impact on diving?
2. Will diving impact the condition?

With asthma the answer to both questions is probably yes.

Asthma's impact on diving
Asthma causes reversible airflow obstruction by causing constriction of the muscle around the smaller airways. This might cause several problems.

Firstly you might get air trapping and predispose to pulmonary barotrauma on ascent. There is surprisingly little data about this but the best guess is that mild asthma doubles the risk. The risk of pulmonary barotrauma (especially in expereinced divers) is low so doubling a small risk is still probably pretty small.

Secondly an asthma attack will dramatically limit someone's exercise tolerance, which might predispose them to an increase risk of drowning if caught in a current or whatever.

Diving's imact on asthma
There are many things encountered diving which might be expected to trigger an attack of asthma. Cold, dry air (I guess worse with open circuit); breathing in salt water (particularly as a mist) and sorb dust might all trigger asthma in susceptible individuals.

If an attack is triggered then there are real risks as outlined above.

There are tests which can be done to measure airways reactiveness including hypertonic saline challenges among others.

So what?

Firstly anyone who imposes a depth limitation on an asthmatic diver probably doesn't understand the issues. Pulmonary barotrauma is just as likely to happen on an ascent form 6m as 100m. Most exertion on a dive happens on the surface.

If I see a person with asthma who wants advice about diving I outline the above issues. There are significant differences between commercial and recreational (there is an Australian Standard for commercial divers); novice versus experienced; and degrees of severity of asthma - each case is different.

If you see me for advice then that's what you get.

If you see me for assessment of 'fitness to dive' which means me to signing a form so that I accept some legal risk to get an instructor organisation off the hook then I won't do it unless you have very mild disease, no dialy medication use and a normal hypertonic saline challenge.

Dave T

Crazyduck

Personally it was very brave of you to openly admit this knowing it could affect your diving ticket. Bravo, for being open.

Instead of just banning everyone is there a general medical standard that the patient can be measured against? I am wondering with this specifically being an insurance/travel question if that brings into play strictly the liability of the insurer in the English market?

Here in the States you check anything on the goddamn little blue folder you just made your changes of learning how to dive- slim to none. In fact, I had a young lady training at the university level and she was ‘joking’ about passing out and a possible seizure- BAM she was gone. Simply the liability that she said it in my earshot- I was now aware and liable. She could not continue with the program until getting a medical forum signed and cleared by her physician.

In fact, recently there has been a trend that divers that are disqualified because of asthma wait ‘x’ months and go to another dive shop- sign up for the class and do not inform the shop that they have a medical condition. While I DO NOT condone this- some people have taken this action.

Personally this should be taken on a case by case situation.
Ps- I am not medically trained nor do I play one on TV. 8)

Andrew

__________________
Howdy Senor- What’s Happening!
Rob Davie April 2005-

Presently in a state of transition from Open Circuit to Closed Circuit.

"You will not be punished for your anger; you will be punished by it." - Buddha.

Genesis

My personal view on asthma is the same as any other diving medical decision - its your butt down there and you should get to make the choice on your own without interference. BUT - you should also be fully informed as to what the risks are so you can make a wise decision when it comes to balancing risk and reward.

As a non-doctor (and someone who doesn't suffer from this but has several friends who do) the "gotcha" that would worry me is the possibility of an attack while underwater. If it happens you're screwed, as you can't use your rescue inhaler! That would be my biggest concern trying to evaluate it.

__________________
"A venturesome minority will always be eager to get off on their own, and no obstacles should be placed in their path; let them take risks for Godsake, let them get lost, sunburnt, stranded, drowned, eaten by bears, buried alive under avalanches - that is the right and privilege of any free American."
http://www.denninger.net
http://www.diversunion.org/liability.htm - Fix the Diving Cert racket

Ben Field

That might be fine for some of the gung-ho/experienced/solo types but the level that Asthma Vs Being able to dive gets picked up is the novice level, then its not just YOUR butt down there but your Buddies too!

While someone is learning they are far more likely to be panicked, flood their mask/reg, get cold water/air in their throat and I supposed more likely to induce some restriction or a full blown attack... even a trained diver who knowingly risks that while diving with others, be they a paid instructor, club instructor or a plain buddy is being wholly unfair IMO.

I know its a pain in the bum for the mild non-exercise induced people who could dive happily without a problem for years but the question must be asked to try and prevent someone with considerable problems getting underwater and into trouble.

Would you want your hidden asthma caused death on someone else’s conscious?

I don't want to sound like I'm saying you're all wrong, just looking at it from the other side...

BEN

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Beware Fridge Suck

JonnyB

Well i dont have astma, but my younger cusin has.
I believe it depends on the astma.
I was very upset last summer when i found out that a divemaster had taken my cusin (12 years old) for an introduction dive. My cusin was aware of that he should not dive with his astma as it is very bad, if he tries to run 100m he will need his inhalor, and he told this tp the DM and he said that it is ok.

Let me tell you this... he is no DM anymore

If you are old enough, you can take the decission yourself. And if you are alergic to cats and nothing else, well i dont belive you are going to see any cats underwater, perhaps a catfish ...
But if you case is severe, just like my cusin, then you have nothing to do underwater...

/Jonny

__________________
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"Outbound flight 777 heavy you are cleared for flight
Due west into that warm red Texas sunset
You have angels on your wings and divers memories on your six."

Rest In Peace

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Crazyduck

I did a work around for inhalers.
This never made it off the drawing board because of certain issues and potential problems.


You need either a full face mask, or a second stage with a larger tube like the Cyklon.


The full face mask you take a port that enters into the oral cup. You need a one way type connection and a solid cap to screw into the port. Take a button from Ikelite and mount it into the top of the hard cap. This keeps the pressure from holding down the inhaler. Then when you need it- press the button and it fires into the oral cavity for the diver to breathe.


The cheaper option is a straight second stage. You need to find a location that you can drill through that is in the inhalation path. I use Cyklons so directly over were the tube molds into the mouthpiece. Cut you yourself a hole the same size as a the inhaler has in the mounting. Then you need a small soft silicone plug attached to the second stage when you are not using the inhaler. Remove the plug and insert the inhaler unit that is made from metal and pressurized. Clear any water and then press down to activate the unit and inject the medicine. Remove the inhaler and put it back into your pocket and reapply the plug.


Anyone of thinking of this process MUST maintain their depth for this process. The albuterol drug relaxes the need to breathe. You don’t want to change your lung pressure at this point.


I provide this as an academic process only.


Andrew

__________________
Howdy Senor- What’s Happening!
Rob Davie April 2005-

Presently in a state of transition from Open Circuit to Closed Circuit.

"You will not be punished for your anger; you will be punished by it." - Buddha.

Toren

I wonder if an anaphylaxis kit might be an answer here, assuming the injector can stand the pressure?

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"Sh*t does happen, it is our job to keep it a minor annoyance by training, proper gear configuration, emergency skills practice and a survival mindset."
--Ron Micjan