Is it Safe for Asthmatics to Scuba Dive?

Part two: Assessing the risk of diving for asthmatics

In this day and age where people do not want to take responsibility for their own actions, the most prudent thing for a dive physician to do when an asthmatic walks into his surgery is to say "Bog off, you're unfit". This happens frequently, and who can blame the doctors? However, while it might be defensive medicine, it is not necessarily good medicine. Indeed, such subjective pronouncements often motivate the candidate to go to another doctor and lie about having asthma.

There is now an alternative informed consent basis of assessment. Fundamentally, this means clearly and comprehensively explaining the risks of diving to the candidate, and letting him make an informed choice about whether to proceed. Those candidates who suffer serious attacks, wheeze relatively often or who use reliever medications regularly, cannot be considered for diving, even on an informed consent basis. On the other hand, previous asthmatics and milder cases may be subject to little extra risk, and it is reasonable to let them, as intelligent adults, make up their own minds on the matter.

Every day of our lives we make decisions that inherently involve weighing risk against benefit. We choose to get on planes, play rugby, ride bicycles on busy roads. We decide the benefit outweighs the risk. There is no reason diving should be any different in this regard.

A sensible approach to the asthmatic dive candidate would be for the physician to first take a detailed history of his problem. This can be followed with tests to check that neither exercise nor the breathing of nebulised salt water (at the same concentration as sea water) provoke airway narrowing. Unfortunately, this process is a time consuming and expensive exercise, but at least it's better than being told to "clear off" without so much as an explanation. If these tests are negative, patients exhibit a clear understanding of the issues and still wish to proceed, then they should be allowed to dive. Back to part one

asthma * Medical Journals * pub med * Entrez * Journal Articles * Citation search * Asthma and the diver * Review * scuba diving absolute contraindications * diabetes * obesity * smoking * heart * cardiac patients * pulmonary barotrauma in divers * identify risk * otolaryngological requirements * epilepsy discussion *