Technical info. re lung function

[gsclarke]

Hi

I am hoping you guys can help put something into context for me.

I recently passed my Padi Scuba Certification with no issues at about 7 metres and want to continue further BSAC training at my local club.

I have what is considered mild upper respiratory asthma (or not - medical opinion is divided and has been for 30 years as it doesn't respond to treatment). I have no breathing issues other than VERY ocassional slight wheezing which I can correct using simple breathing techniques (Buteyko Breathing). I take no medication and the only symptom I have is a cough which is quite controllable underwater.

My problem is a poor lung function test. Although I can swim 25 metres without needing a breath and hold my breath with no air in my lungs for a minute or more without ill effect, my peak flow is only about 250, it was about 320 10 years ago - I am a 54 year old female.

Clearly I need to see a dive consultant to see where I stand with this but I am trying to understand the inplication of the poor peak flow if my breathing is otherwise OK.

It is unlikley to be exercise or stress induced, possibly allergy based.

Is it simply a question of the likliehood of an asthma attack that should be my main concern (which is remote) or would poor peak flow in iteslf cause a problem if I was otherwise untroubled by it?

I have contacted Dr Margaret Clamp to see if she can suggest how good my peak flow should be before it is worth me seeing her.

Any pointers anyone can give me would be a great help.

Many thanks

[Rod Bateman]

Lots of Asthma related Q's and A's on this link.

http://www.e-med.co.uk/diving/dive_questions.php?sub_cat=27

[Paul Morris]

I have contacted Dr Margaret Clamp to see if she can suggest how good my peak flow should be before it is worth me seeing her.

Any pointers anyone can give me would be a great help.

Its not just about Peak flow. You need to speak to a diving doctor with an interest in Asthma. It will depend on factors such as provocation, is your asthma triggered by excercise, cold, salt water (spray) inhalation.

I had to take a full lung function test (spirometry) to check me out when I started. The excercise test nearly killed me, but I wouldn't have died of asthma apparently.... :eek:

Try looking up Dr Peter Glanvill (who did me) or Dr PJ Farrell, both are UK Sport Diving medical council members and have conducted research and published papers on asthma & diving.

http://www.uksdmc.co.uk/main/Medical%20referees.htm

The two mentioned are based in the south west, but a telephone call might suffice, or help by providing advice to your local referee.

Cheers,
Paul.

[gsclarke]

Thanks for that info. I have emailed Dr Peter Glanvill and also had a reply from Dr Eden at e-med.

Since posting I have also spoken to Dr Clamp who has a slightly more rigid view than Dr Eden.

The bad news is that I need to get over 70% on the FEV/FVC ratio and it can't be done with heavy steroid usage such as in stage stage 3 asthmatics.

The good news is that these medications never work for me anyway. (mmm is that good news? :confused: )

I am looking for alternative explanations and lifestyle changes to make the grade I think. It seems weird to me that my peak flow (about 240-250 with or without steroids) is so poor as is my FEV1 at 1.75, yet my breathing is fine and my FEV/FVC ratio is 67% which doesn't seem so much below what I need?

Or am I kidding myself? :mad:

[Paul Morris]

Or am I kidding myself? :mad:
Not necessarily. Fitness (and I hope you're not a smoker), may help.

I wouldn't consider myself fit, but have always been a non-smoker, and had age on my side. The key though is likely to be provocation factors.

My spriometry was "normal" I was then excercised until I couldn't stand, had cold salty water sprayed in my face, and had to run round the surgery on a cold November day. Then, I was propped up in front of the machine and had to repeat the test. The retest had to be within a certain percentage I forget (maybe 5 or 10%) of the original value.

Any significant decrease in function would indicate I was susceptible to the risk factors introduced by diving (cold, wet, physical excersion).

Luckily I was within a couple of percent. I would of failed a HSE commercial diving medical because I wasn't fit enough and my BMI was over 30, but I was OK for sport diving.

Good luck, hope it works out. Oh, and if you're an asthmatic smoker - do yourself a favour and pack it in. Its generally bad news when diving due to the effect of Carbon Monoxide on oxygen transport under pressure, but you should see a marked improvement in your FEV!

[gsclarke]

Thanks Paul

No I'm not a smoker. I gave up 20 years ago. I started about age 25 smoking one or two menthol a day but mid 80's shared an office with some-one smoking the same brand which sent my own consumption rocketing. I gave up shortly after.

I have ME which means I tire easily but I have a good control of that. Whilst I will never go diving several times a day or every day for a week or more, I physically could cope well with 3 or 4 dives a week in say a holiday environment. I guess it's all about knowing your limitations. Any relapse occurs 36-48 hours after any excessive exertion so no danger to my buddies etc.

I am actually reasonably fit. Outside of any relapse sitaution (when obviously I couldn't dive) I can swim a mile freestyle albeit slowly and I think that statistics say about only 2% of the population can do that!

Can you remember what your FEV/FVC % was? I would be interested to know what people with borderline results ended up with and whther they find it affects them.

[Matt-75]

One of my friends down in Wales had something similar done to him Paul when he had his medical, he failed first time. But knowing what he had to do to complete it, he adapted a training regime, with really high impact exercise but also some crazy stuff in it (not to be recommended unless your a semi insane welsh person). He ran 4 miles and then swam across some lake or reservoir, i forget which one, but it was in the brecons up Abergavenny way, then did another 4 miles soaking wet back home. Did it for about 3 months, twice a week, and re-did the medical, and passed it. Don't know if he somehow modified his bodies reaction to the cold, but it worked a treat for him.

Obviously dont go that far. But some really heavy duty exercise wont harm you, and you'll find your lung funtion improves a lot.

[Paul Morris]

One of my friends down in Wales had something similar done to him Paul when he had his medical, he failed first time. But knowing what he had to do to complete it, he adapted a training regime, with really high impact exercise but also some crazy stuff in it (not to be recommended unless your a semi insane welsh person). He ran 4 miles and then swam across some lake or reservoir, i forget which one, but it was in the brecons up Abergavenny way, then did another 4 miles soaking wet back home.
Hmm, coincidence not me but I'm also welsh - perhaps its just something they do to us welsh, racial abuse to put us off. Ahh, Welsh medical for Mr Morris, isn't it. :eek:

I used to live not too far away from Abergavenny, was probably Llandegfedd reservoir, or LLangors if it really were Brecon (miles away). Never had the pleasure, but people do dive at Llandegfedd (whether they're supposed to or not, I don't know ;) ).

[gsclarke]

... some really heavy duty exercise wont harm you, and you'll find your lung funtion improves a lot.

mmm unfortunately having ME (chronic fatigue syndrome, I'm afraid some 'heavy duty exercise' would just send me into a relapse ;) then bye bye diving for a few months anyway!

I do try and improve my fitness in a controlled way though and perhaps now is a good time to look at it again. Some-one else mentioned using a powerbreathe to improve lung function. I actually bought one a while ago but didn't use it much. Stupid really having bought it so I will give that another try.

[Matt-75]

You do realise the ME isnt going to help at all with the diving. Diving is stressful and tiring at the best of times. Just one dive a day could leave you wanting a good sleep. Im not saying you wont be able to do it, just that you should bear it in mind.

[gsclarke]

You do realise the ME isnt going to help at all with the diving. Diving is stressful and tiring at the best of times. Just one dive a day could leave you wanting a good sleep. Im not saying you wont be able to do it, just that you should bear it in mind.

Yeah I know :eek:

My view is that I will minimize what I can, eg putting kit on it the water, not standing around kitted up for ages and so, along with a sensible approach to how deep, how long, how often.

I envisage for a while at least making sure we have a suitabley qualified person acoompanying us (me and hubby) even if it means paying extra. The main thing is that I don't put myself or diving buddies in any danger due to tiredness. It will limit me at first because I obviously can't go diving with others and expect them plan around a 30 minute dive to accomdate my problems.

I have enough of a handle on the problem to know that I can cope with pretty much anything in the short term (fatigue wise I mean), the main risks I run being the unexpected which would put me at risk of a relapse a day or two later. Luckily I respond very traditionally to over extertion which is a 36-48 response.

I am very much going to take things slow though. I will be in a learning environment and on a learning curve for quite a while yet.

[PeteM]

Yeah I know :eek:

My view is that I will minimize what I can, eg putting kit on it the water, not standing around kitted up for ages and so, along with a sensible approach to how deep, how long, how often.

I envisage for a while at least making sure we have a suitabley qualified person acoompanying us (me and hubby) even if it means paying extra. The main thing is that I don't put myself or diving buddies in any danger due to tiredness. It will limit me at first because I obviously can't go diving with others and expect them plan around a 30 minute dive to accomdate my problems.

I have enough of a handle on the problem to know that I can cope with pretty much anything in the short term (fatigue wise I mean), the main risks I run being the unexpected which would put me at risk of a relapse a day or two later. Luckily I respond very traditionally to over extertion which is a 36-48 response.

I am very much going to take things slow though. I will be in a learning environment and on a learning curve for quite a while yet.

Nitrox is your friend, particularly if you still dive to air dive plans - reduces fatigue significantly for most people

[gsclarke]

Nitrox is your friend, particularly if you still dive to air dive plans - reduces fatigue significantly for most people

I will remember that. I have no knowledge of how to use Nitrox at all yet although my Padi instructor in Egypt mentioned it might be worth looking at.

[IainC]

I know one ME sufferer who dives.

She sticks to warm water and generally only a few dives, perhaps 4/5 over a week and this works for her. tends to go for shore based holidays therefore, where there is plenty of potential to lounge by the pool or beach.

She isn't asthmatic though.

Iain.

[gsclarke]

That's good to hear and fits in with the sort of thing I hope to be doing.

I don't have any breathing problems so it's a question of finding what I need to do to get passed fit enough and also whether it presents any risk.

I'm getting increasingly frustrated trying to understand the type of asthma I have. I understood from what I'd read and from talking to a number of people that if the asthma is upper respiratory (mine is) that the lungs aren't affected per se and this reduces any risk considerably but having spoken to Dr Clamp again this afternoon, she says if it were that simple I wouldn't have a poor FEV1/FVC ratio. :mad:

Gosh when I started diving I thought it was just the ME I would have to work around but life is getting so complicated!