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Clinical Reviews in Allergy & Immunology

, Volume 50, Issue 1, pp 18–22 | Cite as

SCUBA Diving and Asthma: Clinical Recommendations and Safety

  • Christopher A. CoopEmail author
  • Karla E. Adams
  • Charles N. Webb
Article

Abstract

The objective of this article is to review the available studies regarding asthma and SCUBA (self-contained underwater breathing apparatus) diving. A literature search was conducted in MEDLINE to identify peer-reviewed articles related to asthma and SCUBA diving using the following keywords: asthma, allergy, and SCUBA diving. SCUBA diving is a popular sport with more than 9 million divers in the USA. SCUBA diving can be a dangerous sport. Bronchospasm can develop in asthmatic patients and cause airway obstruction. Airway obstruction may be localized to the distal airway which prevents gas elimination. Uncontrolled expansion of the distal airway may result in pulmonary barotrauma. There is also the risk of a gas embolism. Asthmatic divers can also aspirate seawater which may induce bronchospasm. Pollen contamination of their oxygen tank may exacerbate atopic asthma in patients. Diving may be hazardous to the lung function of patients with asthma. Despite the risks of SCUBA diving, many asthmatic individuals can dive without serious diving events. Diving evaluations for asthmatic patients have focused on a thorough patient history, spirometry, allergy testing, and bronchial challenges. For patients that wish to dive, their asthma should be well controlled without current chest symptoms. Patients should have a normal spirometry. Some diving societies recommend that an asthmatic patient should successfully pass a bronchial provocation challenge. Recommendations also state that exercise-, emotion-, and cold-induced asthmatics should not dive. Asthmatic patients requiring rescue medication within 48 h should not dive.

Keywords

Asthma Allergy SCUBA diving 

References

  1. 1.
    Koehle M, Lloyd-Smith R, McKenzie D et al (2003) Asthma and recreational SCUBA diving: a systematic review. Sports Med 33(2):109–116CrossRefPubMedGoogle Scholar
  2. 2.
    Wilmshurst P (1998) Diving and oxygen. BMJ 317(7164):996–999PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Dear, G. Asthma and diving. Divers Alert Network. [Online] September 17, 2014. [Cited: September 16, 2014.] www.diversalertnetwork.org/medical/articles/Asthma_Diving
  4. 4.
    Neuman TS, Bove AA, O’Connor RD et al (1994) Asthma and diving. Ann Allerg 73(4):344–350PubMedGoogle Scholar
  5. 5.
    D’Amato G, Noschese P, Russo M et al (1999) Pollen asthma in the deep. J Allergy Clin Immunol 104(3 Pt 1):710CrossRefPubMedGoogle Scholar
  6. 6.
    Astarita C, Gargano D, Di Martino P (2000) Pollen trapped in a scuba tank: a potential hazard for allergic divers. Ann Intern Med 132(2):166–167CrossRefPubMedGoogle Scholar
  7. 7.
    Ivkovic D1, Markovic M, Todorovic BS (2012) Effect of a single pool dive on pulmonary function in asthmatic and non-asthmatic divers. Diving Hyperb Med 42(2):72–77PubMedGoogle Scholar
  8. 8.
    Skogstad M1, Thorsen E, Haldorsen T et al (2002) Lung function over six years among professional divers. Occup Environ Med 59(9):629–633PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Cirillo I1, Vizzaccaro A, Crimi E (2003) Airway reactivity and diving in healthy and atopic subjects. Med Sci Sports Exerc 35(9):1493–1498CrossRefPubMedGoogle Scholar
  10. 10.
    Weiss LD, Van Meter KW (1995) Cerebral air embolism in asthmatic scuba divers in a swimming pool. Chest 107(6):1653–1654CrossRefPubMedGoogle Scholar
  11. 11.
    Tetzlaff K, Muth CM (2005) Demographics and respiratory illness prevalence of sport scuba divers. Int J Sports Med 26(7):607–610CrossRefPubMedGoogle Scholar
  12. 12.
    Moon, Richard E. The case that asthmatics should not dive. Undersea and Hyperbaric Medical Society, Inc., 1995 pp. 45-80Google Scholar
  13. 13.
    Farrell PJ, Glanvill P (1990) Diving practices of scuba divers with asthma. BMJ 300(6718):166PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Weaver LK1, Churchill SK, Hegewald MJ et al (2009) Prevalence of airway obstruction in recreational SCUBA divers. Wilderness Environ Med 20(2):125–128CrossRefPubMedGoogle Scholar
  15. 15.
    Martini A1, Sbardella D, Bertini L (2012) Airway inflammation in professional divers: FeNO as a marker. Undersea Hyperb Med 39(5):901–907PubMedGoogle Scholar
  16. 16.
    Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 1999 Dec; 160(6):2104-17Google Scholar
  17. 17.
    Anderson WJ1, Short PM, Williamson PA et al (2012) Inhaled corticosteroid dose response using domiciliary exhaled nitric oxide in persistent asthma: the FENOtype trial. Chest 142(6):1553–1561CrossRefPubMedGoogle Scholar
  18. 18.
    Badier M1, Guillot C, Delpierre S et al (2000) Value of bronchial challenge in scuba diving candidates. J Asthma 37(8):661–665CrossRefPubMedGoogle Scholar
  19. 19.
    Meehan C, Bennett M (2010) Medical assessment of fitness to dive—comparing a questionnaire and a medical interview-based approach. Diving Hyperb Med 40(3):119–124PubMedGoogle Scholar
  20. 20.
    Ong LM, Bennett MH, Thomas PS (2009) Pulmonary dysanapsis and diving assessments. Undersea Hyperb Med 36(5):375–380PubMedGoogle Scholar
  21. 21.
    Gorman D, Veal A (1995) SPUMS policy on asthma and fitness for diving. South Pacific Underwater Medicine Society, MelbourneGoogle Scholar
  22. 22.
    South Pacific Underwater Medicine Society. Suggested assessment for the diver with asthma. SPUMS. [Online] September 17, 2014. www.spums.org.au/public-file-download/full-spums-medical
  23. 23.
    Harrison D, Lloyd-Smith R, Khazei A et al (2005) Controversies in the medical clearance of recreational scuba divers: updates on asthma, diabetes mellitus, coronary artery disease, and patent foramen ovale. Curr Sports Med Rep 4(5):275–281CrossRefPubMedGoogle Scholar
  24. 24.
    Walker RM. SPUMS annual scientific meeting 2006: are asthmatics fit to dive? Diving Hyperbaric Med, 2006, pp. 213-219Google Scholar
  25. 25.
    Committee, UK Sport Diving Medical. Asthma and diving. British Sub-Aqua Club. [Online] September 16, 2014. www.bsac.com/page.asp?section=1533&sectionTitle=Respiratory+condition
  26. 26.
    Martin, L. Should asthmatics not SCUBA dive? Scuba diving explained, questions and answers on physiology and medical aspects of scuba diving . Flagstaff : Best Publishing Company, 1997, p. Section OGoogle Scholar
  27. 27.
    Corson KS. Risk assessment of asthma for decompression illness. Undersea Biomed Res. 1991, pp. 16-17Google Scholar
  28. 28.
    Bove AA, Davis, J. Bove and Davis’ diving medicine. 2004, pp. 441Google Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Christopher A. Coop
    • 1
    Email author
  • Karla E. Adams
    • 1
  • Charles N. Webb
    • 1
  1. 1.Department of Allergy and ImmunologyWilford Hall Ambulatory Surgical CenterSan AntonioUSA

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