Dive Medical Questions

[whitey 2]

Hi, I know there's a lot of wetpixellers who are current or former divemasters. So I have some stream of consciousness questions for you.

 

1/Inability to autoinflate ear drums is an absolute contraindication to diving, according the SPUMS/Australian standards. I find a lot of people are pretty crap at doing this. Do you find there are some students who can't pop there ears above water who equalise OK whilst diving? (including no reverse block on ascent)

 

2/Asthma is an absolute contraindication to diving. Anyone know of anyone, ever,anywhere who actually had a lung overexpansion injury as a result of asthma?

 

BTW, anyone interested in dive safety should have a read of this:

http://www.bsac.org/techserv/increp04/fatalities04.htm

[Giles 1]

Ouch auto-equainflate ya eardrums ..... OUCH

well from the way you described it afterwards you obviously are talking about popping your ears on the surface by following the equalising techniques.

Yes people can equalise fine underwater when not abloe to on the surface, could even be when on the surface they had a cold, when they dived they didn't. BUT it is very likely that they will have lots of troubles if they can't do it on the surface. I am not saying that they weren't doing it right .. but believe it or not the biggestproblem for equalising ears on surface or in water is that people just don't do it right. There are a million ways to mess it up and I don't want to go into them all just take it from me that even if the person thinks they are doign it right, and could be an experienced diver .. they could still be doing something a little wrong. That is why on the surface it won't work, underwaterthey probably just get lucky and it clears itself.

 

Asthma is not a contradiction to diving, in fact allergy based asthma is of no consequence underwater as the air you are breathing is clean so no allergies. Exercise enduced asthma is of consequence, but many in the dive world esp medical dive pro's consider exercise related asthma to be a little bit of a joke, I have even been told by doctors it was a brilliant 80's fad where by people made lots of money on prescriptions, i don't know much about it myself, but i do know that if you are in generally good shape it won't matter as long as you are confortable as you won't be over exercising underwater, not if you intended to enjoy your dive anyway.

 

Lastly, the only reason these have been deemed reasons to not dive is because of the way diving is taught and regulated. I have been a PADI professional for 10 years, i don't agree with their methods and think it is pitiful that they will disregard some people like those with asthma because they think it may be dangerous and haven't investigated the real effects. Yet they will take a 10 year old diving, and they haven't investigated the effects of pressure on their bodies.

 

And the dive fatality stories, most speak for themselves really, don't do stupid things whilst you are ni the most hostile environment known to man!

[whitey 2]

Regarding autoinflation of middle ear: (yep, that's the bit where you blow your nose and the ears pop. Shouldn't be an ouch involved, if there is and air comes out your ear you probably blew a bit hard )

 

Giles, thanks for your reply, I know you've got a lot of bottom time. In Australia, if you can't autoinflate, you supposed to fail your medical. I do wonder if this is a bit harsh and if there's plenty of people who can't do it properly on the surface, but cope OK underwater. Your reply suggests to be the case from your experience, but then you also mention that some of them have a lot of trouble underwater. So maybe it is right after all that they all are prohibited from diving and have to play chess or knit instead.

 

 

Asthma is not a contradiction to diving, in fact allergy based asthma is of no consequence underwater as the air you are breathing is clean so no allergies.

 

Here's the asthma bit from the dive medical standard from Australia:

 

A4.10 Respiratory System

(a) A full history and examination should be normal. Any abnormal findings should be fully investigated.

Such investigations should include provocation testing if any doubt concerning the possibility of bronchial

hyperreactivity exists.

Particular attention must be paid to any condition that might cause retention and trapping of expanding

gas in any part of the lungs during decompression ( e.g. asthma).

 

Asthma is probably the most common reason for failing dive medicals. The concern is that you inhale saline underwater, have asthma attack, air is trapped in lungs....and 'pop' as you ascend.

 

Now, I'm not convinced it actually works like that in the real world - hence my interest in the experiences of people who've actually spent a bit of time underwater. (<edit> - let me rephrase that - my description above is exactly as it occurs in the real world, in those who are sensitive to saline inhalation and have bronchial hyperreactivity ie asthma. It is less clear to me, and of some ineterest, how often these incidents occur, particularly in mild, well controlled asthma 'in the field', so to speak. But anyone reading this thread should be aware that asthma and diving are a potentially lethal combination, and there's a lot of very dangerous advice floating around this thread.)

 

[/i]

[Giles 1]

Rob the trouble is that these rules are either made up by diving people like SSi or PADI when it comes to certifications, or a local medical board. I worked in Australia for a while in Diving, and I am pretty sure you go by local medical laws. Which is fine, except for the people at the medical board who make up the rules probably don't dive and have made the rules up from what they understand to be the risks from a text book.

When it comes down to it there has not been that much research done into recreational diving, the fact of the matter is that accidents happen. My boss in Australia had one rule, if they want to dive you will take them diving. We had our own doctor on call via telephone so when we were on the barrier reef and found out about a condition a possible diver had we could ask him, asthma was never a reason to stop them from diving .. unless they were on heavy medication and it was exercise enduced. i.e. without meds taken every 10 mins or so an asthma attack would happen. A lot of people have an inhaler and use it when they get out of breath (which could be fixed by getting in better shape).

The rules / laws are set to keep organisations who can be sued safe, not necessarily to keep the individual safe. Just like the courses now adays are set up to make the organisations as much money as possible not to teach the students as much information as possible. It sad, but thats the way it is.

If someone has astma and have been told they can'tdive, find a diving doctor, a doctor who either specialises in it, or is a doctor who happens to dive, they will tell you for sure, and they will also be able to help you out with the ear nose and throat problems. The point i was trying to get across is that a LOT of people just don't equalise right. I can be completely blocked up and still get down because I know how to make it work if i have to, i am normally very lucky.

Two biggest mistakes equalising are not pinching the nose very well (through the mask it can be tricky for various reasons, or two .. believe it or not .. people breath through their mouth while equalising hence they are not equalising.)

If you do have regular problems equalising .. both on land and in water .. i would hazard a guess you have a heavey or loud breathing at night sometime snooring. This can be fixed surgically. Some people just have shallow ducts in their sinuses and air passageways, these need to be kept as clear as possible for diving, so keep hydrated and healthy.

Sudafed can help too to clear out airways for equalisation, but here's what I feel about this. I know they come in 24 hour dosages, but what happens if it works while you are going down .. you equalise fine, but on the way back up .. it wears off and you can't ascend, you have a choice .. ascend and blow your ear drums, or wait while someone ascends gets either another pill for you to take and then wait for that to kick in .. or for them to bring down a hyperdermic needle and pierce your eardrums so you can ascend (which I have seen have to be done).

 

So i think if i was to pick a key element in all of that, if you need medication, something other than your own helath and physical abilities to be able to do something then maybe you should really consider not doing it, if however you can do these things on your own abilities even if it does mean a change of lifestyle you are probably better doing it that way. People train to go on a ski holiday .. why don't they to go on a dive holiday?

(me saying this makes me such a hypocrit, but I am lucky that my body doesn't have any ailments that make me unfit for diving)

[scubag 0]

OK guys,

According to the RSTC, Asthma is a Relative Contraindiction to diving. With a proper examination and lung volume testing, it is possible to recieve medical approval to dive in some circumstances. However, Active RAD (reactive airway decease) is an absolute no go and although I have seen numerous examples of doctors in resort areas who will sign a medical clearance, I as an experienced PADI instructor with over 1000 certifications and never a student injured, I would not and will not ever accept an asthmatic as a student, regardless of pressure from a dive shop owner. I have known 2 other good instructors (PADI and NAUI) who have had student fatalities due to asthma attacks and subsequent embolism (both students had doctors medical approval), and it ruined their lives and careers. Dive shops and their instructors should never be allowed to determine whether a student is medically qualified to dive, only a qualified doctor and the proper testing can provide the answers a student and their instructor need.

 

Hope that helps,

 

Douglas Kaufman

PADI Course Director CD-31169

[ReeferBen 0]

Not that I have as much time as the others to post a story, but I have asthma and so does my brother and sister. We are all new divers that have been certified for three years or so and just around 100 dives. FWIW I have never had any asthma problems while diving. In fact when I take my trips to the tropics all my asthma clears up. That and the use of advair I never have problems. Even when I got stuck in a stiff current with my sister and we both had to swim against heavy current back to the boat a few hundred yards and we were fine. I don't think it is a real issue when diving as long as you can mantain it well.

[mrbubbles 0]

As a physician, diver-photo addict, i feel compelled to respond here. Asthma is a serious condition. People die from asthma, often from not taking sound medical advice, following direction,or not taking there condition seriosly. I would first not take a divemasters recomendation. See a physician quailified in evaluating and treating asthma, for your individual case. Also refer to the dan information on their web site. Diving is an optional activity, not worth dying for.

[critter 0]

I am also a physician, photographer/diver for many years. Mr bubbles is correct go see a physician qualified to treat asthma . Every case is unique and cannot be evaluated on a forum like this. FYI this is such a thing as excercise induced asthma and allergic mediated asthma but I am not going to get into it here.

 

Tony

[whitey 2]

Australian standards are some of the strictest in the world with regards to medical certification for diving. Here's a copy of the SPUMS recreational standards for anyone who's interested:

 

http://www.google.com.au/search?q=cache:2m...+%2Bspums&hl=en

 

Asthma and diving are certainly a risky combination. Anyone with asthma would not pass a dive medical here in the first instance (unless they see Giles' consult-by-phone doc! :roll: ). Further investigation with saline inhalation provocation testing would generally be required. I'd agree with Mrbubbles comments above, and besides the point that asthma itself can be deadly, it's important for divers to note that there are specific problems with asthma and diving (in particular, the risk of potentially fatal lung overexpansion injury and air embolism as Douglas refers to above).

 

Having said all that, I feel bad for those who fail dive medicals for mild to non existant asthma, or an inability to pop their eardrums properly, and in particular was wondering if those gumbies who just don't seem to be able to perform a simple valsalva manoeuver in the doctor's office actually managed to survive with eardrums intact underwater.

 

And Giles, I'm not letting you operate on my nose!

[frogfish 5]

I've cannot "auto-inflate" above water, and never could, but now have no trouble equalizing. When I was first learning to dive, it was a bit of an issue. For me, the trick is to perform an initial valsalva (no chin/jaw movements work for me) in the water but while still on the surface. As long as there is a pressure differential between my head and chest, it works. Subsequent equalizations are easy after that.

 

Being barred from beginning diving because I was unable to perform a valsalva or auto-inflate eustacian tubes on dry land would have really pissed me off. More dive nazi-ism, I'd say.

[critter 0]

Those standards are almost 15 years old! Things have advanced in medicine a little bit since then. Quite a few medicines have been approved for usage since that time and now are over the counter.

 

Tony

[whitey 2]

The standards I linked to were last revised in 1999, 4-5 years ago, so they're reasonably contemporaneous. Whether the specifics of treatment for any of the conditions mentioned have changed since the standards were published doesn't really alter the question of whether or not having these conditions should preclude someone from diving.

 

Here's some more interesting reading (if you're interested in this sort of thing - hey, it does make a change from chatting about lenses!)

 

(from the Medical Journal of Australia):

http://www.google.com.au/search?q=cache:md...%2Bdiving&hl=en

 

The most interesting part is the sample questions at the bottom of the article which list various scenarios, how many dive doctors would pass each candidate, and what the correct response (according to Australian Standards) should be.

 

"Diving medicine is an area in which strong opinions are held, but in which evidence is almost totally lacking.", as the article states. Which is one of the reasons it's interesting to hear feedback and opinions from those who spend a lot of time underwater, and in particular those who've spent time training others to dive.

[yahsemtough 0]

OK guys,

According to the RSTC, Asthma is a Relative Contraindiction to diving. With a proper examination and lung volume testing, it is possible to recieve medical approval to dive in some circumstances. However, Active RAD (reactive airway decease) is an absolute no go and although I have seen numerous examples of doctors in resort areas who will sign a medical clearance, I as an experienced PADI instructor with over 1000 certifications and never a student injured, I would not and will not ever accept an asthmatic as a student, regardless of pressure from a dive shop owner. I have known 2 other good instructors (PADI and NAUI) who have had student fatalities due to asthma attacks and subsequent embolism (both students had doctors medical approval), and it ruined their lives and careers. Dive shops and their instructors should never be allowed to determine whether a student is medically qualified to dive, only a qualified doctor and the proper testing can provide the answers a student and their instructor need.

 

Hope that helps,

 

Douglas Kaufman

PADI Course Director CD-31169

 

Preface-I am not a doctor. I am a Divemaster.

 

My wife has Asthma and dives. We actually met diving. Based on her case I certainly see no basis for the argument against her diving. She was a distance swimmer with the University of Oregon and on the US Waterpolo team. She was swimming laps around the dolphins on our last trip together to the point people found it funny.

 

That said I feel that to broad stroke people out of participating because of having asthma is not fair. Each individual instructor certainly can make his own call on it that is their right. But, there are levels to asthma and if it is allergy or activity induced as far as I know and have seen.

 

I agree, get checked out by a doctor who understands diving and the effects of diving an ensure you are not putting yourself at great risk.

 

I get tired of hearing dive staff get all worried when they hear she has asthma before asking relevant questions and observing. Maybe it is the litigious nature of the US that prompts these types of responses. Get the details before assuming someone is guilty. Based on the General dive organization rules a Doctor has already approved the person for diving, myself as a Divemaster am not qualified to medically question their opinion, in my mind.

 

IMHO

[yahsemtough 0]

mm

[critter 0]

Todd is absolutely correct..I have ok'd some people who have asthma and I have denied some people with asthma. It all depends on the circumstances. It is unfortunate that many people believe in dogma which to me underminds the thinking process of disease states and how they apply to dive medicine.

Two actual cases that I was involved with one asthmatic similar to Todd's wife who has very little trouble with her asthma and is related more to seasonal components and was going to dive in carribean waters who I ok'd for diving. The second case was a young man who was on 3 different inhalers taking oral theophylline (bronchial dilator) and had been hospitalized several times for his asthma. He wanted to dive for the fire department in a nearby town looking for people in murky water that may have drowned. The water temperature being in the 60's with zero viz. I told him with that kind of stress(cold, zero viz, inexperience) and his condition of asthma I could not approve him for diving.

All conditions are individual that is why you need to see a doc....

 

Tony

[whitey 2]

It's OK , Dr Critter, my lungs are doing fine (as long as I make my wife mow the lawn )

 

My interest in the subject is professional rather than personal. We're talking about a subject where there's very little evidence and a great deal of variation between doctors doing the certification.

Standards and attitudes vary also from country to country.

 

Here's a quote from a French article:

 

"Asthma, a condition exhibiting increasing prevalence in the general population is currently considered an absolute contraindication for scuba diving by the French Federation for Submarine Sports and Education (FFESSM). There is however no documented evidence demonstrating a higher risk in asthmatic divers. Our English-speaking colleagues have suggested that certain asthmatic subjects could participate in scuba diving sports under certain conditions without any higher risk compared with non-asthmatic divers"

 

Here's one of the cases from the MJA article I cited previously:

 

"A 40-year-old female general practitioner with asthma for 25 years, taking inhaled budesonide (800mg/day). She has no symptoms at present and last used her salbutamol inhaler six months ago. Spirometry results, normal."

 

48 of 52 docs in the study failed this potential diver, which according to local standards is the correct response (the more interesting thing about that article was how much variation there was on some of the other cases) . The question is what's the evidence here on which to make these decisions, and the answer is there's not a great deal.

[critter 0]

Well here in the states it is a relative contraindication and that is where the science and the art of medicine have to be balanced out. There is no black and white in medicine like other fields, we as humans aren't put together that way. That's where sound judgement has to take over along with medical knowledge. If it were that easy there would be no need to see a doc. Who wants that? .

I gave a talk on this subject about 4 years ago to a group of physicians we all had an interesting discussion...gotta go on a trip..

 

Tony

[whitey 2]

If it were that easy there would be no need to see a doc.  Who wants that? .  

 

Goodness, no. That would be a terrible state of affairs!

 

Having said that, I've decided to act on your advice and have got myself an asthma puffer on Ebay to add to my dive kit. Did I choose a good brand?

 

[bvanant 190]

I was under the impression that asthma was an area where it was up to your personal physician to let you go or not. According to DAN

 

"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.

 

This is similar to the diabetes debate, where for many years T1 diabetes was contraindicated and now it is more liberal. We have been looking at some kids with diabetes and last summer there was a small group of T1 kids who learned to dive at dive camp in the Bahamas.

 

BVA

[Giles 1]

I was under the impression that asthma was an area where it was up to your personal physician to let you go or not. According to DAN

 

And what does your personal Physician know about diving !!

it works both ways when you say a divemaster doesn't know medicine.

 

Doctors prevent a lot of people from doing things they don't know a lot if anything about.

People like Divemasters only prevent people because they are trying to stop themselves from getting sued (in an americanised society).

 

Wouldn't it be nice if people could just be informed of the inherent risks of activities and then make their ownmind up as to choose to do it or not ?

[pmooney 6]

What an interesting set of opinions.

 

Firstly let me state that in all of my years ( the last 25 ) involvement in the Diving Industry I have never been pressured by an employer or operator and have never pressured any one else on this matter in spite of the financial consequence of that come from denying a diver - lost income which can be real tough if it's in the quiet time.

 

Once the dreaded box has been ticked - you need to follow the process through to completetion and accept the outcome.

 

They must visit a hyperbaric specialist for clearance to dive. It's easy in Cairns as there are about 10 of them here.

 

 

It is never a pleasant thing to tell someone who has their heart set on doing a course, or completing an introductory dive that they need medical clearance.

 

Never pleasant to be questioned what would you know ........... I travelled around the world to do this ............. You have ruined my holiday ............. I 'll tell every one about you and you second rate...............

 

All these things have been said many times in the past and will continue.

 

I would ask people to think about the unpleasant side asthma induced salt water aspiration .

 

Consider the first responder - it's never pleasant for him even with a successful outcome. Never pleasant for the other people out having a day's diving. Never pleasnt for any person involved and that is with a positive outcome.

 

What about the worst case - a life changing experience for the victim ( dead ), , fine you might say, what about the people involved in trying to save the person.................. what about their buddy ...........

 

I think that some people are less suited to diving than others, and that some people just shouldn't dive.

 

Let the Hyperbaric specialist's decide on an individual basis.

 

 

Here a few notes on the subject.

 

South Pacific Medical Society - Workshop on Asthma.

 

Introduction

 

The Society's workshop on asthma and diving was held as part of the 1995 Annual Scientific Meeting at Castaway Island, Fiji. The open forum component of the workshop was prefaced by a series of presentations (a single written submission was received from Dr Douglas Walker) which are published in this issue of the Journal.

 

Considerable consensus was apparent from these presentations. In particular, it was clear that there are few controlled data on which to base risk assessments for asthmatics who dive (let alone a consistent definition of asthma) and that some data sets (e.g. BSAC survey) were of little or no value (at the least being rich in selection bias).

 

Drs Fred Bove and Andy Veale agreed that what data did exist suggested that the relative risk for those asthmatics who dived was about twice that of the non-asthmatic population (not withstanding the observation that these data did not reach statistical significance) and that it was important to remember that this was in effect a doubling of a very low rate of injury and illness.

 

Dr Sandra Anderson described various provocation tests and in particular, exercise and hypertonic saline challenges. The most interesting aspect of her presentation was the report that regular budesonide (Pulmicort) inhalation eliminated the hyperresponsiveness in many asthmatic patients. The fitness of such a patient to dive is obviously difficult to determine. It is noteworthy in this context that the Undersea and Hyperbaric Medical Society (UHMS) has just conducted a similar workshop and it was agreed at this forum that asthmatics who are well-controlled (i.e. not responsive to exercise or salt water) on inhaled steroids are "fit for recreational diving".

 

The utility of provocation testing was also discussed in their presentations by Drs Cathy Meehan, Graham Simpson, Peter Chapman-Smith and Robyn Walker. Despite the differences in approach, it was clear that there was a significant false negative rate in asthmatics (and especially those on regular steroid medication). Again, it is worth mentioning the UHMS Workshop, at which there was considerable support for exercise as the primary form of provocation testing (remembering that inhalation of hypertonic saline is a "model" of exercise-induced asthma).

 

 

 

SPUMS policy statement on the prevalence of asthma in Australasian diving candidates

 

1 A history of asthma is common in diving candidates.2 The assessment of risk for a diving candidate with a history of asthma should be conducted by a medical practitioner who has had training in diving medicine (i.e. suitable for admission to the SPUMS list).

 

 

 

SPUMS policy on the importance of asthma in diving

 

1 Asthma is a potential cause of morbidity and mortality in divers. The level of risk in this context needs to be measured.2 Diving may precipitate (an) asthma (attack).3 Asthmatics may have limited exercise capacity and are at risk of shortness of breath, panic and drowning on the water surface.4 Asthmatics who dive may be a self-selected (i.e. survivor) population and hence their experience may not be representative of the risks of diving for the general asthmatic population.5 Current information (from descriptive databases) suggests that the relative risk for asthmatics who dive (compared with non-asthmatics) for a decompression illness is about 2.

 

 

 

SPUMS policy on the assessment of risk for a diving candidate with a history of asthma.

 

1 The determination of risk for diving in someone with a history of asthma requires a gradation of the severity and currency of their asthma.2 Risk stratification for someone with a history of asthma who wishes to dive will require a thorough history and examination and often lung function testing, which may include provocation testing (and especially with exercise and/or hypertonic saline). This may need to be repeated if the person elects to dive.3 Provocation testing with exercise and/or hypertonic saline (rather than with histamine and methacholine) may be more specific for asthma that is of concern in diving. The significance of a positive result is more easily understood by the diver.4 As the risk for diving in someone with a history of asthma is uncertain, permanent records should be retained as part of a SPUMS-sponsored study.

[whitey 2]

Bvanant, it does appear that in the US it's up to your personal physician to decide. They're likely to follow the DAN guidelines as it's a US-based organisation. For asthma, DAN guideline will allow you to dive in some circumstances. There's significant country to country variation, however. According to the DAN site, UK is the most lax and Australia the most stringent when it comes to asthma, although as I've noted the French appear to consider it an absolute contraindication.

 

Giles asks:

"And what does your personal Physician know about diving !!

it works both ways when you say a divemaster doesn't know medicine."

 

Maybe a little, maybe a lot. I note the DAN course in is Little Cayman, and involves a two tank dive every afternoon. It sounds like fun! Australian docs are supposed to attend a 5 day course to become official SPUMS docs. As the MJA study shows, there's little consistency amongst dive docs when presented with the same case, despite this (fairly limited) training.

 

The problem in making dive fitness assessments again comes down to the evidence on which to make the assessments. The UHMS and SPUMS guidelines are expert opinion, which in medical parlance is called 'Level 5 Evidence'. Here's a hint - on the scale of 1 to 5, this is not the best sort. In the case of the SPUMS guidelines, I note it's a bunch of guys getting together in Fiji:

 

"Considerable consensus was apparent from these presentations. In particular, it was clear that there are few controlled data on which to base risk assessments for asthmatics who dive (let alone a consistent definition of asthma) and that some data sets (e.g. BSAC survey) were of little or no value (at the least being rich in selection bias). '

 

"Drs Fred Bove and Andy Veale agreed that what data did exist suggested that the relative risk for those asthmatics who dived was about twice that of the non-asthmatic population (not withstanding the observation that these data did not reach statistical significance) "

 

ie. "We don't really have any data at all on which to base this guideline."

 

I've decided that this thread - as the expert opinion of a group of divemasters, divers and physicians - should be elevated to the status of "Level 5 Evidence", and in future the WETPIXEL Expert Panel Consensus Guidelines for Diving with Asthma and Dodgy Ears (WEPCGDADE, but I'm working on a cooler sounding acronym) will hopefully be mentioned in dive medicine journals along with the the SPUMS, UHMS and BSAC efforts.

 

[Craig Ruaux 0]

Allow me to make an incidental observation:

 

I have been amazed at the difference in "asthma" between the US and Australia. I know that asthma represents a spectrum of reactive airway diseases, but it seems that the threshold at which someone is described as "asthmatic" differs greatly between the two countries.

 

It seems to me that many many people over here (meaning the US, and in Eurpoe as well) have a seasonal, fairly mild bronchospasm disorder that causes mild shortness of breath. And they call this asthma (or seasonal asthma). There is also a huge number of people here who have "seasonal allergies", particularly in the south (where I live, and have developed "seasonal allergies", much to my chagrin).

 

Things may have changed from when I was a young aussie, but the asthma kids always used to be way sicker than the asthmatics I meet nowadays. I think that the Australian environment tends to provide less of an allergen load than the US, and the lower severity "asthmas"/allergic reactive airway diseases just aren't seen as much in Oz. So when we hear someone say they have asthma, we think of the weedy kid in the back of the bus going blue and dying because someone stole his ventolin inhaler, when the person actually has mild shortness of breath during the late spring early summer...

 

Of course, I'm just a disreputable veterinary gastroenterologist, and my observations should be taken as just that :wink:

 

 

EDIT: After I posted this, I looked more closely at Whitey's post above, and see that the experts seem to think the same thing...

 

"Considerable consensus was apparent from these presentations. In particular, it was clear that there are few controlled data on which to base risk assessments for asthmatics who dive (let alone a consistent definition of asthma) and that some data sets (e.g. BSAC survey) were of little or no value (at the least being rich in selection bias). '

 

"Drs Fred Bove and Andy Veale agreed that what data did exist suggested that the relative risk for those asthmatics who dived was about twice that of the non-asthmatic population (not withstanding the observation that these data did not reach statistical significance) "    

 

(not withstanding the observation that these data did not reach statistical significance) ROFL I wish I could write back to editors sometimes and say "But I am Dr Craig Ruaux BVSc PhD MRCVS MACVSc DiplECVCP and thus you should accept what I say, not withstanding the observation that these data did not reach statistical significance. That would be sweeeeeet.

[scubag 0]

Not to get too involved with the experts and doctors here, that's not my area of expertise. Just a quick mention of several troubling aspects to this issue from an instructors viewpoint that I have personally witnessed.

 

Parents have a moral obligation to protect their children from hazards they may not understand. In the US, parents review and sign a medical waiver with their kids, a doctors physical is not required unless a customer answers "YES" to a pre-existing medical condition listed on the form. I have seen numerous examples of parents improperly filling out forms and intentionally denying knowledge of existing medical conditions in order for their kids to participate in diving. These conditions included asthma, heart problems, blood, brain and mental disorders in adition to the more usual "My son just turned 12 last week" when he actually just turned 8. Parents all seem to think that their kids are bigger, stronger, smarter and healthier than other kids and therefore the normal rules just don't apply to them, regardless of the risks involved. The only qualified person who is able to judge the health of candidate to dive is a professional physician with knowledge and training specific to asthma and diving. In Mexico our shop refered candidates to a local asthma specialist and diver whom we supplied with related medical medical books from DAN, a signed note from the hotel's house doctor "This person Jon Doe etc is OK to dive" would not be suficient. This is why instructors should help their students by A. Finding a local specialist to refer your students to. B. Calling the physician and setting up the apointment for their students needing medical clearance. C. Providing the physician with the needed RSTC medical clearance guidlines and forms, and D. Follow up with a call to the physicians office and ask to have the clearance form faxed back to the dive shop directly. This prevents the student or their parents from signing the form themselves (which I have also had happen to me).

 

Proper medical oversight of the diving business protects our students, shops, ourselves, and the diving business as a whole. Even a small dive center pays thousands of dollars per year in liability insurrance for their stores, staff, and boat operations. Failure to properly utilize established industry protocols (forms, medical clearance) hurts all dive profesionals by raising our liability rates and by telling the general public that we are irresponsible and do not care about our students and our industry.

 

Douglas Kaufman

PADI Course Director CD-31169

[bvanant 190]

Giles: Actually, my personal physician is a diver and has spent at least one year sabbatical at Duke with the DAN guys. Your recommendation that you tell people the risks and let them decide is OK only if you think the people who are making the decisions are capable of understanding the risks which in most cases they are not. We make medical devices for a living and you would be surprised at what people will do with things even though we try to explain to them as best we can how to use the things. I would suggest that most folks do not have the slightest ability to understand relative risks (this is well published) and that allowing divemasters to make medical decisions about disease states is ludicrous. Maybe all docs are not capable of understanding the vagaries of diving but most divemasters that I have met are equally incapable of making medical judgements.

 

Bill