Can You Scuba Dive if You Have Asthma? A Deep Dive into the Risks and Considerations

The short answer is: it depends. While asthma was once considered an absolute contraindication to scuba diving, current research and evolving medical understanding suggest that some individuals with well-controlled asthma may be able to dive safely, provided they undergo thorough medical evaluation and adhere to strict diving protocols.

Asthma and Scuba Diving: A Complex Relationship

Asthma, a chronic respiratory disease characterized by airway inflammation and bronchospasm, presents several potential risks to scuba divers. The marine environment, with its cold temperatures, increased humidity, and potential irritants like salt spray, can trigger asthma symptoms. Moreover, the physiological stresses of diving, including increased respiratory effort, elevated partial pressures of gases, and the risk of pulmonary barotrauma (lung over-expansion injuries), can exacerbate these risks.

However, advancements in asthma management, improved diagnostic tools, and a greater understanding of the physiological effects of diving have led to a more nuanced approach. Individuals with mild, well-controlled asthma who are asymptomatic at rest and during exercise may be considered for diving after a comprehensive assessment.

Risks Associated with Asthma and Diving

Several potential risks need to be considered when assessing the suitability of an asthmatic individual for scuba diving:

• Bronchospasm: This sudden narrowing of the airways can trap air in the lungs, leading to pulmonary barotrauma upon ascent. This is arguably the most significant risk.
• Airway Hyperreactivity: Asthmatics are prone to airway hyperreactivity, meaning their airways are overly sensitive to triggers, which can include cold air, exercise, and inhaled irritants encountered while diving.
• Exercise-Induced Asthma (EIA): Physical exertion during diving can trigger asthma symptoms, leading to difficulty breathing underwater.
• Difficulty Equalizing Ear Pressure: Asthma, especially when poorly controlled, can lead to upper airway inflammation, making ear equalization more challenging. Failure to equalize can result in ear barotrauma.
• Panic and Anxiety: Breathing difficulties caused by asthma can trigger panic and anxiety, which can further compromise breathing and decision-making underwater.

Evaluating Fitness to Dive: A Rigorous Process

Determining whether an asthmatic individual is fit to dive requires a thorough medical evaluation by a physician experienced in diving medicine. This evaluation typically includes:

• Medical History: A detailed review of the individual’s asthma history, including the severity of symptoms, frequency of exacerbations, triggers, and medication use.
• Pulmonary Function Tests (PFTs): These tests measure lung volumes, airflow rates, and the responsiveness of the airways to bronchodilators. Key PFT parameters include FEV1 (forced expiratory volume in one second) and FVC (forced vital capacity). A significant improvement in FEV1 after bronchodilator use may indicate airway hyperreactivity.
• Exercise Challenge Test: This test assesses lung function during exercise to identify exercise-induced asthma. Divers should be able to achieve a high level of exertion without experiencing significant bronchospasm.
• Bronchoprovocation Test: This test involves inhaling a substance like methacholine to assess airway hyperreactivity. A positive test, indicating increased sensitivity to the inhaled substance, may contraindicate diving.
• Physical Examination: A thorough physical examination to assess overall health and identify any other conditions that could increase the risk of diving.

Managing Asthma While Diving: Precautions and Best Practices

For individuals with well-controlled asthma who are cleared for diving, several precautions are essential:

• Medication Adherence: Strict adherence to prescribed asthma medications, including both controller and reliever medications, is crucial. Divers should carry their reliever medication (e.g., albuterol inhaler) with them, even if they do not typically use it.
• Pre-Dive Assessment: Before each dive, divers should assess their asthma control and avoid diving if they are experiencing any symptoms.
• Dive Planning: Dive plans should be conservative, with shallow depths, short durations, and minimal exertion.
• Buddy System: Diving with a buddy who is aware of the diver’s asthma and trained in emergency procedures is essential.
• Environmental Considerations: Avoid diving in cold water, areas with strong currents, or environments with potential irritants.
• Proper Breathing Techniques: Mastering proper breathing techniques, such as slow, deep breathing, can help minimize the risk of bronchospasm.
• Abort the Dive: If any asthma symptoms develop underwater, the diver should immediately abort the dive.

Legal and Insurance Implications

It’s crucial for divers with asthma to be aware of the legal and insurance implications. Some dive operators may have specific policies regarding divers with asthma, and failure to disclose the condition could invalidate insurance coverage. Transparency and honesty are essential.

FAQs: Asthma and Scuba Diving

FAQ 1: What constitutes “well-controlled” asthma for diving purposes?

Well-controlled asthma generally means the individual experiences infrequent symptoms (less than twice a week), normal lung function (FEV1 >80% predicted), no nocturnal symptoms, and minimal need for reliever medication. However, the definition can vary based on individual circumstances and the physician’s assessment.

FAQ 2: Can I use my inhaler underwater?

No. Standard metered-dose inhalers are not designed for underwater use. Underwater delivery systems for asthma medication exist, but their use requires specialized training and equipment. It’s crucial to abort the dive if symptoms develop.

FAQ 3: Are certain types of asthma medications better for divers?

Long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS) are commonly used as controller medications. Your physician will determine the best medication regimen based on your individual needs. It is critical to discuss all medications with a physician knowledgeable in diving medicine.

FAQ 4: Does asthma severity impact diving suitability?

Yes. Severe asthma, characterized by frequent symptoms, impaired lung function, and frequent exacerbations, generally contraindicates diving. Mild, well-controlled asthma is more likely to be compatible with diving, but only after thorough evaluation.

FAQ 5: Can childhood asthma affect my ability to dive as an adult?

Even if asthma symptoms have resolved during adulthood, a history of childhood asthma can still increase the risk of airway hyperreactivity. A thorough evaluation is necessary to assess current lung function and airway responsiveness.

FAQ 6: Are there specific dive sites that are better or worse for asthmatics?

Dive sites with warm, calm waters and minimal currents are generally preferable. Cold water and strong currents can trigger asthma symptoms. Enclosed spaces, like caves or wrecks, could pose challenges if breathing difficulties arise.

FAQ 7: What should I do if I experience an asthma attack underwater?

Immediately signal your buddy, initiate a controlled ascent (if possible), and abort the dive. Upon surfacing, seek immediate medical attention. Ensure your buddy knows how to assist in an emergency.

FAQ 8: Can diving worsen my asthma in the long term?

The long-term effects of diving on asthma are not fully understood. However, repetitive exposure to irritants and the physiological stresses of diving could potentially exacerbate airway inflammation. Regular monitoring of lung function is crucial.

FAQ 9: Are there alternative water sports safer for asthmatics?

Swimming, snorkeling, and surfing are generally considered safer alternatives to scuba diving for asthmatics. These activities involve less physiological stress and do not require breathing compressed air.

FAQ 10: How often should I be re-evaluated for diving fitness if I have asthma?

Annual re-evaluation by a physician experienced in diving medicine is recommended, especially if there have been any changes in asthma control or medication use. More frequent evaluations may be necessary if symptoms worsen.

FAQ 11: Can the use of Nitrox impact my asthma?

Nitrox, while decreasing nitrogen narcosis risks, doesn’t directly impact asthma physiology. It’s crucial to focus on dive profile and environmental factors when planning dives with asthma, regardless of the gas mix used.

FAQ 12: Where can I find a physician specializing in diving medicine?

The Undersea and Hyperbaric Medical Society (UHMS) is a valuable resource for finding physicians with expertise in diving medicine. Consult their website or contact them directly for referrals in your area.

Conclusion

Diving with asthma is not without risk, but it is not always impossible. Careful assessment, meticulous planning, and strict adherence to medical advice are essential for mitigating potential complications. The ultimate decision regarding diving fitness should be made by a physician experienced in diving medicine, in consultation with the individual diver. Safety should always be the top priority.