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This is information for all, Quotes will be used also from GM post of Asthma
in the UK and the Skin Diver article, and what I have come up in the short
time of a quick look through all the med books at my finger tips.
Quick run down of Asthma:
How to find out if you have asthma:
Asthma is sometims hard to diagnose because it can resemble other
respiratory problems scuh as but not limited to emphysema, bronchitis, or
even lower respiratory infecction. For that reason asthma is underdiagnosed
- many people with the disease do not know that they have it - and therfore
undertreated. Sometims the only symptom is cronic cough, especialy at
night, or coughing or wheezing may occur only with exercise. some people
think they have recurrent bronchitis, since respiratory infections usually
settle in the ches in a person predisposed to asthma.
To dignose asthma and distinguish it from other lung disorders, Drs relyon a
combination of medical history, physical exam, and certain lab test (blood
work). These test also include spirometry (measurement of air in and out of
the lungs) Peak Flow monitoring (another lung function test) Chest X-ray and
alergy test.
What does a attach feel like and what causes it:
Asthma episode feels somewhat like taking a deep breath of cold air on a
winter day. Breathing becomes harder and may hurt, and ther may be
coughing. Audible wheezing or whistling sounds may be herd, or listening to
the chest, you will hear airmovement and the same wheezing in the upper
lobes all the way to the lower parts of the lungs.
Reason this occurs is because the airwayof the lungs are getting narrow.
The muscles of the airway tighten, the inner lining of the airway swell,
membranes (the lining) secrete extra mucus, which form plugs that further
block the aire passes. It is know that the plugs will block off some of the
very small airways, not allowing O2 or C02 to diffuse accross from the lung
to the blood stream and vise versa.
MOST IMPORTANT !!! Generally people with asthma can and should exercise when
they are felling well and only if a Doctor will allow it (depending on the
type and severity of the asthma). "SPECIAL" care may be needed when air is
cold or during pollen season. It is suggested that you consult a dr before
starting any type of regulare exercise, but the person should start slow and
build up slowly. This is to be between the Doctor and the person to decide
what is best for them.
Morbity
Mortality - 5000 deaths ber year: 1 death per 2400 asthmatics per year
Hospitalization - 500,000 per year: 4 admisions per 100 asthmatics per year
Emergency Care - 1,500,000 per year: 12 ER vistis per 100 per year
Asthma is a common illness that causes considerable morbidity and death
despite powerful, scientifically validated methods to control asthma.
Mortality rate for asthma in the US is lower than any other country int he
world, by a sizable margin. Much of the gross morbidity caused, could be
avoideable if the widely documented undertreatment of moderate and severe
asthmatics by physicians.
REF:
N Engl J med 1992, Asthma in the US; 326:862-866
Evans R, 1993, Allergy principles and practice 4th 1109-1136
Asthma management preceding ER visit, Arch inter med, 1992 152:2041-2044
Bousget J, 1996; 98:514-521, nonselected population adult patients
Quotes only...........
Asthmatic amateur diversin the UK
Intro:
"we do not see asthmatics at the hyperbaric treatment centres in the U.K.
adn hence out practices ork. in 1994 the reality of the situtions woas
investigated."
Methods:
Referees were randomly selected.
data was pooled to provide the prevalence figures.
BHA and the Royal Navy were asked to give #'s of decompression illness and
gass embolism) treated from 1989 - 1993 (4 year study) and # of asthmatics seen.
Results:
out of 25BSCA referees - 19 replied.
813 active divers of which 31 were asthmatics.
402 cases of dsbaric illness were treated in the time frame of 1989 - 1993
of which 9 were asthmatics.
Discussion:
the U.K. NSDMC are happy with existion guidlines in allowin carefully
selected asthmatics to dive as that there is no evidence that asthmatics are
more at risk of decompression illness.
Alert Diver found 279 of whom 26% had been hospitalixed for asthma; of these
6% had been hospitalised 6 times or more, which increased risk of
decompression illness.
The authors commented thta the risk needs quntifing according to the
severity of the asthma.
The asthmatics who are allowed to dive have been educated as to the safest
way of diving? (GM, do you know what these instructions are? please share if
you know).
The U.K. NSDMC is reviewing the old BSCA standard to bring it into line with
the British TS guidelines for treatment of asthma
Skin Diver
Currently the Dive Med communtiy is rethinking the medical hazards of
asthma and compressed air diveing. An attempt to identify the asthmatics
that can dive with relative safetly is being worked on.
From ST medical Forum:
states that doctors are having a different out look on Asthmatics, and they
are trying to come up with base lines that can be followed to allow certain
asthmatics the capability to dive.
The potential diver must be made aware that they are facing a relative risk
of and event that occurs in less thatn 1 in 250,00 dives.
So far this is suggested:
1. exercise or cold induced asthmatics shuld not dive
2. normal screeing of FEV1/FVC, and should be above 85% of predicted.
3. if an attack has occured, check with screening spirometry and no diving
until it returns to normal.
OK, now that that is in black and white, here are things for all of us to
ponder, as to the asthmatic.
1) the mortality rates on land are high, but according to what all this has
said, in the water it is not so bad. Infact it has stated #'s that are much
less than what has been reported by the ER's, and doctors compaired to what
has been reported by the chambers. Could this be due to the fact that we
use to not let asthmatics dive, and there # in the diving commuity is very low?
2) I agree with what the reports say, but the test were only over a 4 year
period, any thoughts on that one?
3) What effects on breathing mixed gases at depth does it have on the lungs
of an asthmatic, and anyone else that dives nitrox (does it destroy any of
the lung, 21% over the years of our life do deminish our lungs)?
4) 85% is the cut off for asthmatics, from "Personal" test that I have seen
done, the avarage asthmatic's PFT is very border line. Is it worth the
chance to him/her to take the chance.
5) All the chambers have noted people comming into the chamber, what about
the average diver, how many small attacts have happened under water, but
have not been documentated or noted.
I have learned something here with this, but there are still alot of
unanswered questions and what if's. This is the very last post on this
subject that I will post, I will be more than happy to chat about this via
e-mail, but now on to other exciting thing in the world. For you that have
bumped words with me, these few words to you, safe diving, and I do wish you
good luck, and look forward to more chats.
L8r
Lungs
aka Jeoff Freed, CRTT
Orange City, Fl
PADI Divemaster
www.totcon.com/users/lungs
A bad day diving Beats a Good day at work!!
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