Asthma and diving!

From DAN:

Diving Medicine FAQs
Asthma and Scuba Diving

Q: My daughter has asthma, but it is controlled by medication. Can she learn to dive safely?

A:

In general, asthma is a lung disorder in which there is a tendency for the muscle surrounding the bronchi (breathing tubes) to contract excessively, causing narrowing, or broncho-constriction. As a result, this causes increased breathing resistance, which can manifest as wheezing, chest "tightness", cough, or breathlessness. In asthmatics, broncho-constriction can be precipitated by exposure to allergens, noxious fumes, cold air, exercise or respiratory infections such as a "cold". People with asthma may experience broncho-constriction due to more than one of these factors, but many asthmatics will experience a measurable increase in breathing resistance after exposure to any one or several of them. The increase in breathing resistance caused by bronchial narrowing may be compounded by the accumulation of mucus within the airways.

Serious potential risks may make scuba diving, which is often performed in isolated locations and far from competent medical care, an unwise elective sport for an individual with asthma. There are primarily two issues.

1. During scuba diving the diver experiences a reduction in breathing capacity due to the effects of immersion and an increase in breathing resistance caused by the higher gas density at depth. At 33-feet underwater, the maximum breathing capacity of a normal scuba diver is only 70-percent of the surface value. At 100-feet underwater, this reduction is approximately 50-percent. If, for example, a diver’s breathing capacity is already reduced because of asthma, there may not be sufficient reserve to accommodate the required increase demanded by exertion.
2. Both narrowing of the bronchi and excessive mucus production can inhibit exhalation of air during ascent, and could predispose the diver to pulmonary barotrauma leading to pneumothorax, pneumo-mediastinum and/or arterial gas embolism.

For these reasons, physicians trained in diving medicine have traditionally recommended that people with asthma should never dive. However, a consensus of experts at a 1995 workshop held under the auspices of the Undersea and Hyperbaric Medical Society (UHMS) proposed more liberal guidelines. Essentially, the UHMS workshop panel felt that the risk of diving is probably acceptable if, the diving candidate with some asthmatic ‘history’ demonstrates normal pulmonary function at rest (FVC, mid-expiratory flow, FEV1, FEF 25-75) and then again after strenuous exercise. It was also concluded that the degree of competency in making a medical assessment of diving fitness is enhanced if the examining doctor has relevant knowledge or experience of the diving environment and its associated hazards.

It is important to note that asthma severity can wax and wane. Symptoms may worsen for 4-6 weeks after a "cold" or during certain seasons (for example in response to high levels of pollen in the air.) Therefore, even if a person with asthma fulfills the criteria listed above, diving is not recommended unless the diver is free of respiratory symptoms before each dive.

Reference:

Elliott, D.H. (1996) Are Asthmatics Fit To Dive?, Undersea and Hyperbaric Medical Society (UHMS) – Annual Scientific Meeting, 21-June-1995

Additional Resources:
Read a more detailed article on asthma.

Great article, thanks Papa!

Found another good one!

Here is one that seems reasonable:

Y.M.C.A. Protocols for Diving With Asthma
Based on the latest medical data, the YMCA protocols for asthmatics seem to be the most
reasonable. (http://www.ymcascuba.org/ymcascub/asthmatc.html). It would not be wise to dive if one could not meet these standards.

Links To Asthma

Asthma and Diving
In-depth discussion of the many divergent recommendations regarding scuba diving and asthma.

Asthma: A Clinician's Guide
From the National Asthma Education Program
Office of Prevention, Education, and Control
National Heart, Lung and Blood Institute
National Institute of Health
Bethesda, Maryland 20892

Oregon Institute of Marine Biology
Fitness to dive guidelines for the scientific diver.

Asthma And Diving (Rodale's)
Article by Samuel Shelanski, M.D.

Asthma and Diving
Basic information about asthma and diving from the Australian Lung Foundation

Asthma and Diving
From Fred Bove's excellent web site

From the above Site:


YMCA SCUBA ASTHMATIC DIVER PROTOCOL

Dr. Duke Scott, Medical Adviser

The YMCA of the USA has been and continues to be dedicated to meeting the needs of all people, including those with disabilities, providing them with the opportunity to reach their fullest potential and enhancing the quality of their lives. In accordance with this philosophy, the YMCA scuba Program has been proud to assume the leadership role in dealing with disability issues as they apply to the diving community. YSCUBA has already developed successful programs for physically challenged and diabetic divers. After several years of study, research, and appropriate consultation, YSCUBA is now prepared to initiate a program which will allow qualified asthmatics to participate in YSCUBA training.

Asthma affects more than 14 million Americans. At least 75 percent of asthmatics demonstrate hypersensitivity to airborne allergens. Atopy, the genetic predisposition for the development of IgE antibodies to common allergens, is an accepted risk factor for asthma among children and adults. In addition to allergens, numerous activities, or exposures that precipitate or exacerbate episodes of asthma, have been identified. These "triggers" include viral infections, environmental pollutants, medications, foods, sustained exercise, cold, and emotional distress. Identification and avoidance of these allergens and triggers are important components of asthma management. They obviously are important in determining which asthmatics can safely participate in scuba training and scuba diving.

During the 1990's impressive strides were made in the management of asthmatic individuals. The reason for this is two-fold. First, there was the realization that asthma is a chronic inflammatory disease involving the lungs' bronchial tree. This changed the focus of treatment from symptomatic therapy to preventive therapy by utilizing medications that inhibit or reduce bronchial inflammation. Second, a multitude of anti-inflammatory drugs have been developed. These new drugs offer a prolonged period of action and therefore increased protection during periods of increased exertion, such as during scuba. These two factors have revolutionized the treatment of mild to moderate asthmatics. This allows us to approach asthmatics based on their level of function as opposed to their classification. That is, their ability to exercise is independent of whether or not their asthmatic condition requires medication for control.

In the third edition of Diving Medicine (1997), Dr. Tom S. Neuman discusses the case for and against asthmatic scuba divers. I found his case for allowing selective asthmatics to participate in scuba programs very compelling. I recommend that any of our YMCA instructors who contemplate teaching asthmatics to dive become familiar with his recommendations.

Dr. Neumann first discusses the studies and concepts that are most frequently used to argue against diving for asthmatics. He then explores these studies, showing how some of the results may have been misinterpreted. In fact, new studies are described that contradict some of the previous findings. Lastly, he reports on two recent symposia, attended by diving-medicine experts, which concluded that "asthma did not predispose to diving-related pulmonary barotrauma" and that "the limiting factor for asthmatics is adequate ventilatory capacity underwater."

In light of their conclusions, Dr. Neumann suggests that the research data to this point does not support the absolute banning of all asthmatics as diving candidates. Also, the diving community cannot ignore the excellent safety record of the many "closet" asthmatic divers in the United States and certified asthmatic divers of the British Sub-Aqua Club. The B.S.A.C. does not certify exercise-induced asthmatics. On the other hand, we cannot ignore the data that suggests the potential risk of barotrauma is greater in asthmatics. Still, it is obvious that asthmatics are a very heterogeneous group with varying degrees of respiratory difficulties. Therefore, as with diabetics, each asthmatic's eligibility for scuba training should be evaluated on his or her own merits.

Based on these findings, the YSCUBA Program recommends the following guidelines for determining which asthmatics are fit to participate in our scuba training programs. This protocol should be used by a potential asthmatic scuba student in consultation with his or her physician to determine eligibility for scuba training. Once accepted, the student must be closely monitored by the instructor. If the student's asthma becomes symptomatic during pool training or open-water dives, he or she must be dropped from the class and disqualified from further scuba training.

The YSCUBA Program began accepting qualified asthmatics as scuba students as of January 1, 2000. Initially, all potential asthmatic scuba students are required to receive clearance by the YSCUBA Medical Advisor prior to being accepted into an instructor's class. The reason for this is twofold. The first is to be sure that the student and YSCUBA are covered by our professional liability insurance. Our insurance will only cover us if the asthmatic meets the requirements set forth in the Protocol. Second, the YSCUBA training of asthmatics will be closely scrutinized by the other diving agencies as a whole. Therefore, we must monitor the progress of these individuals closely, not only during their training, but also during their entire diving experience. The data we accumulate will be utilized to confirm our position that select asthmatics are fit to dive. It will also be used to modify the Protocol as needed and to aid us in developing more effective teaching methods. Every instructor who chooses to teach asthmatics will be required to submit data concerning the students' response to scuba training. Every asthmatic student will be requested to periodically submit information concerning his or her diving activities. The necessary forms and method for reporting this information will be provided by the YSCUBA Medical Advisor. The YSCUBA instructor and/or the asthmatic student's physician should contact the YSCUBA Medical Advisor, Dr. Duke Scott to obtain a copy of the Asthmatic Protocol.

Duke Scott, M.D.
YSCUBA Medical Advisor
1606 Arrowhead Trail
Neptune Beach, FL 32266
Phone: (904) 246-0750
Fax: (904) 246-4947
Email: dr1313@aol.com

SCUBA diving has grown in popularity, with millions of divers enjoying the sport worldwide. However, people with asthma are generally advised not to dive. This advice is ignored by large numbers of asthma sufferers.

In a new study, Israeli researchers reviewed the scientific literature to evaluate the risks asthmatics take when diving.

They found that although there is some indication that asthmatics may be at an increased risk of pulmonary barotrauma (burst lung), the risk seems to be small.

Thus, under the right circumstances, they concluded that patients with asthma can safely dive without any apparent increased risk of an asthma-related event. They added that decisions on whether or not diving is hazardous must be made on an individual basis and be founded upon an informed decision shared by both patient and physician.

Journal Reference: Sade K et al. [Asthma and scuba diving: can...[PMID: 17476937]

I know some people who overcome their asthma when they grew up. Try to treat your kid now that she's still young. She might grow up to be a healthy lady soon.

Thanks For sharing nice Article. Such a best information for me. Your Asthma and diving article is best and get more info about Asthma.