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- Scuba -
5/3/01 re: Scuba diving by asthmatics I am a respiratory therapist and have performing PFTs for many years. I have long heard that scuba diving is contraindicated for patients with asthma. I know pneumothorax is one concern. Recently we had a young patient (age 30) that has moderately severe asthma and has planned a trip to Costa Rica for the sole purpose of scuba diving. The PAC told the patient it was not a good idea but his MD said go. I would like to know where to get the information on this subject as I would definitely like to be better informed. I am enclosing my response to a very recent Ask the Expert question quite similar to yours. I trust that the information in this response will meet your needs.
Opinions about the advisability of scuba diving by asthmatics do vary among those writing about this subject. I have enclosed abstracts of some of this published material. I also consulted Dr. John Weiler of the Univ. of Iowa, former chair of the Sports Medicine Committee of the AAAAI. His response is also enclosed. You can also access the report of the Sports Medicine committee to which he refers.
Dr. Weiler's Response
Nothing is really new about this topic. The bottom line is that asthmatics probably do have a slightly increased risk but the increase is small. There probably is a spectrum. Someone who only had asthma as a child and now has totally normal PFTs may well be a candidate for diving certification. Many physicians will sign for such a patient. On the other hand someone who is on a high potency steroid inhaler, a long acting beta agonist, a leukotriene controller and still is up 3 nights a week with symptoms and has PFTs that are 60% of predicted is probably not a candidate for diving. But some physicians may even argue about the last patient. One concern that is not often mentioned is panic. Even if the asthma does not cause problems panic attacks can be a problem. Another problem that is not often mentioned is sinus disease which can also cause considerable disability.I am conservative. Not all of my colleagues are conservative. In the end both the diving candidate and his or her physician must be comfortable and this can only be determined on a case-by-case basis with a physician participating who fully understand the issues, which should probably include an understanding of diving physiology.
Our report from the Sports Medicine Committee is still probably the best balanced approach to this topic of which I am aware (Wolf SL, Twarog F, Weiler JM, Barron RJ, Lang DM, Wells JH, Zitt M, Virant FS, Katz RM, Banyash LW, et al. Discussion of risk of scuba diving in individuals with allergic and respiratory diseases: SCUBA Subcommittee. J Allergy Clin Immunol 1995 Dec;96(6 Pt 1):871-3)
Ann Allergy 1994 Oct;73(4):344-50
Asthma and diving.
Neuman TS, Bove AA, O'Connor RD, Kelsen SG.
University of California, San Diego School of Medicine.Background: Approximately 10 to 15 million Americans are scuba divers. The prevalence of scuba diving and asthma makes it likely some asthmatics will be interested in scuba diving and some scuba divers will have asthma. Conditions present during scuba diving may provoke airway obstruction in asthmatic patients. Further, asthmatic patients may, in theory, face a greater than normal risk of pulmonary barotrauma from lung overdistension on ascent through the water column.
Objective: The purpose of this paper is to review the theoretical issues underlying the prohibition against scuba diving for asthmatic patients as advanced by most major diving organizations in the United States and critically examine the relevant accident data.
Methods: All reports that dealt with asthma and diving, and all available American accident data including both fatal and nonfatal accidents were reviewed.
Results: Actuarial data on the risk of scuba accidents attributable to asthma do not define several important variables likely to affect accident risk during scuba diving. Despite these limitations, careful review indicates the risks of serious morbidity or mortality during scuba diving appear to be inconsequentially elevated in subjects whose asthma was not characterized.
Conclusions: Additional data are needed to define accurately risks of diving in subjects with different forms of asthma, however, the available data suggest asthmatic patients with normal airway function at rest, and with little airway reactivity in response to exercise or cold air inhalation, have a risk of pulmonary barotrauma similar to that of normal subjects.J Asthma 2000 Dec;37(8):661-5
Value of bronchial challenge in scuba diving candidates.
Badier M, Guillot C, Delpierre S, Fornaris E, Jacquin M.
Laboratoire d'Explorations Fonctionnelles Respiratoires, H pital Sainte Marguerite, Marseille, France.Bronchial challenges were effected with carbachol in 76 subjects who were candidates for a scuba diving group. Bronchial reactivity was assessed through airway resistance and forced expiratory volume in 1 sec (FEV1) measurements. Medical interrogation had revealed symptoms of recent (RA) or ancient (AA) asthma, or allergic rhinitis (AL). Nearly half of the subjects (47%) presented bronchial hyperresponsiveness (BHR), which was much more frequent in the RA group, but whose strength did not depend on clinical presentation. Prevalence of BHR was fairly high (36%) in the AL group. BHR constituted a contraindication to scuba diving because it may promote pulmonary barotrauma.
