Selasa, 17 Maret 2015

Asthma and Diving

Asthma and Diving
I have asthma, and use a bronchodilator before diving. I experience exercise-induced asthma about once every two years, if that, and have had no problems in 40 dives. I lied to get certified, but now I wonder: How much danger am I in?
via email
Telluride, Colo.
When it was suggested that the dive community reconsider its stance on asthma and diving at Divers Alert Network's 26th diving accident and hyperbaric medicine course in May 1995, a hot debate ensued. Asthmatics have bronchial airway obstruction, some more than others. If you remember your diving physics when you were certified, you know that Boyle's law is operative; as the depth and pressure change the volume of an air-filled space has to change (it gets smaller as you descend, larger as you ascend). While breathing compressed air, an asthmatic with obstructed airways can suffer pulmonary barotrauma or a burst lung on ascent. This can lead to arterial gas embolism with devastating brain and heart damage, possibly death (see:
The recommendations that you read on my web page come from the Undersea and Hyperbaric Medical Society's workshop on asthma. I believe that they are conservative and for safety's sake, should be used.
Larry Martin, M.D., offers the following advisory: "A history of bronchial asthma is disqualifying if there have been any attacks within two years, if medication is needed for control, or if bronchospasm has ever been associated with exertion or inhalation of cold air."
It's always a mistake to omit information from your certifying agency and your dive instructor. These rules and guidelines are placed there for your protection (and the agency's). It doesn't mean that they are fixed in cement and cannot be altered if it can be shown that you are not in any danger. It would seem that with 40 dives that you have pretty much found out that it was OK for you to dive safely (given no out-of-air situations). I recommend that you get your lungs checked out carefully before resumption of diving—mainly to rule out terminal airway disease. Possibly a spiral CT scan or a methacholine provocative test would be beneficial in determining any obstructive manifestations.
What does all of this mean to asthmatics who dive, or want to start? Hopefully, the changing perception of asthma and diving will encourage more asthmatics to seek appropriate medical clearance for diving from a doctor with experience in dive medicine. This should result in the screening out of those asthmatics who should not dive under any circumstances, while allowing proper instruction and education of the rest.

sumber :

Tayang ulang oleh dr.erick supondha (hyperbaric and diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta, indonesia, 021 99070050