Diving with copd

[cdan]

If there any divers out there who are diving with copd, please reply to this thread. I've read that there's not many people with copd who dive...which means there must be a few somewhere. Any information you can give me would be appreciated, ie: precautions to take, meds that work etc.
cdan

[gsclarke]

Hi

I have a lung function problem that for years I have been told is or isn't asthma, is or isn't COPD and so on. It's come up again now because of the diving.

My test results so far (this time) show MILD OBSTRUCTION.

I see the respiratory consultant Monday evening and will be asking a lot of questions, one of which will be how asthma differs from COPD and how it affects the risks in diving.

I'll let you know if I manage to get any answers of interest.

What is your FEV1/FVC %?

[cdan]

thanx for the reply. My last fvc was 86%.....fev 1 was 51%. That was last Feb. Not real promising. If the problem is trapped air, then there must be some sort of action i could take a few minutes before diving the would open the airways so as to NOT trap air on assent, ie: bronchio dialtaors-inhalers, or maybe drugs in pill form taken every day for a couple of days before diving...ie: comolyn, triade, prednisone. Tho prednisone shouldn't be taken that often. I quit smoking 3yrs ago but have been coughing up crap ever since. My pulmonoligist put me on Levaquin last thrusday and the coughing is almost completey gone. There HAS to be something out there that will give me a couple of hours or so of relief so diving would be safe. Anything you can find out would be great. I think it's just a matter of finding a good dive dr that really knows. I know i'm good at 6ft cause i've spent 10min on the bottom of a friends pool with no problems.
thanx, dan

[gsclarke]

I'll let you know what I find out. Don't get too set on it though. I'm trying to steel myself for the worst whilst working hard to see what I need to do to get there.

Dr Clamp, our local dive referee, went to great lengths to point out to me that if one had to use a lot of medication to achieve relief that would mean a no to diving.

Personally I have no answers yet as when medication doesn't work it's good that I'm managing extremely well not taking anything but not so good if I can't get the desired fev1/fvc ratio of 70%. Not sure how I'm going to manage it yet.

Don't quote me but I think it comes down to how easily you can get to 70% FEV1/Predicted (some say 80%) plus 70% of FEV1/FVC. The more medication you have to take to achieve it, the less chance you have of being 'allowed' to dive.

No doubt some-one will jump in if I've got this wrong but I think it's not really a question of avoiding trapping the air. We have to take on extra air as the air compresses. It seems the danger comes if we are so blocked that it can't get out quickly enough.

As for being OK under certain cirumstances, that would help in knowing how you manage with your breathing but that's not the same as what sort of risk do you run of sudden changes blocking it's escape and causing lung damage including things like fatal air embolism.

I am quite confident that if it were just a question of breathing difficulties, I could get to the surface in a controlled ascent without endangering myself or any one else, but it doesn't stop there.

Perhaps one or two of the others with more knowledge could explain a bit better than I have done.

I will let you know what the respiratory consultant says though.

[cdan]

I take advair and spiriva in the morning....inhaled, so i really have no adverse breathing problems durning the day or nite. I take singulair at nite (pill form), but from what i've read....it can cause upper respitory problems, which is the last thing i need. I can get winded when surfing if i don't stay in shape, but never get that 'can't breathe' feeling as with asthma...just out of breath from paddling hard. I'm trying to figure out why and how the air gets trapped and how to eliminate that part. You'd think that if you came up slow enough, the air would be able to escape. Why would it get trapped at 30ft and not at sea level...or is it still getting trapped at sea level but just not expanding? What's trapping it? If i remember right...you're diving now, and without problems? There HAS to be a way around this.......exercise and/or meds. Maybe between the 2 of us we can come up with some answers that may help other divers or 'want to be" divers. :)
dan

[gsclarke]

I take advair and spiriva in the morning....inhaled, so i really have no adverse breathing problems durning the day or nite. I take singulair at nite (pill form), but from what i've read....it can cause upper respitory problems, which is the last thing i need. I can get winded when surfing if i don't stay in shape, but never get that 'can't breathe' feeling as with asthma...just out of breath from paddling hard. I'm trying to figure out why and how the air gets trapped and how to eliminate that part. You'd think that if you came up slow enough, the air would be able to escape. Why would it get trapped at 30ft and not at sea level...or is it still getting trapped at sea level but just not expanding? What's trapping it? If i remember right...you're diving now, and without problems? There HAS to be a way around this.......exercise and/or meds. Maybe between the 2 of us we can come up with some answers that may help other divers or 'want to be" divers. :)
dan
Lol - I WAS diving till I had my lung function tests - just started :mad:

I'll let some-one else answer on the subject of equalizing and reverse blocks. I've done my theory and a fair bit of research, plus I'm asking loads of questions but there is nothing like experience and the advanced theory some of these guys have done.

As for what's trapping it - in asthma it's usually akin to mucous plugs or thickening of the airway. However one thing I've found out is that the lungs have so many areas that that cause problems, usually blockages, but the name they attach to it depends where and how the problem occurs and it's often just a name for a set of defined test criteria rather than a disease per se. A bit like saying you have a headache, yes but what sort of headache.

I've been chatting to a GP helpline attached to my health care insurance. The GP there tells me some people may call what I have asthma, some will say not as it doesn't repond to steroids. Some will say I have COPD and others will say it's not severe enough for that. The point is that over the years some-one has defined a set of criteria to match a given term but it's often not quite that black and white. Tests probably won't give the answer for me. The consultant will simply tell me it's whatever according to where he draws the lines. All I can do is try and see the best man I can.

I saw a very good chart a couple of days ago that shows how they analyse Spirometry readings to identify the type of problem. If I can find it again I will post the link.

Edited: http://www.ccjm.org/pdffiles/Mazzone1003.pdf

[cdan]

so why did you quit diving ?? were u having problems, and if so.....what problems? Or did u just quit because of the function test? How deep have you been? I think this is going to be an uphill battle. Let's keep in touch and share info. Hopefully i'll get some answers from the dive clinic at UCSD on tuesday. i'll let u know. :)
dan

[gsclarke]

so why did you quit diving ?? were u having problems, and if so.....what problems? Or did u just quit because of the function test? How deep have you been? I think this is going to be an uphill battle. Let's keep in touch and share info. Hopefully i'll get some answers from the dive clinic at UCSD on tuesday. i'll let u know. :)
dan
Well I haven't quit yet but basically if you tick any of the health questions then a diving medical is required and then, for lung problems, you need to achieve certain results on lung function tests to get 'permission' to dive.

You'll see from other posts that not everyone thinks it should be quite so black and white but my opinion is that once you achieve the basic criteria on your lung function tests, ie you are 'allowed' to dive, then it should be an informed decision made by yourself and your buddies (and maybe your family) as to if, when and in what circumstances you dive.

Since no-one has jumped in on the equalization yet, here is some basic stuff from the PADI course. I'll do my best but just accept that this is a beginners understanding and I may have it wrong :o

At the surface at sea level, the pressure is 1 bar, at 10 meters it is 2 bar, at 20 meters 3 bar and so on. So at ten meters the pressure compresses your lungs (and other air spaces eg ears, sinus's and mask) to a half, and it continues compressing as you go deeper. With the lungs, the air you breath fills the space made, so at 10 meters your lungs hold double the volume (but compressed) and that extra air has to 'escape' as you ascend.

This is why a golden rule is NEVER hold your breath. However with lung problems, you could get the same effect as holding your breath to some degree depending on the severity of the problem, sudden changes underwater, medication wearing off etc.

In answer to your question question about how deep I dived, I only went to 7 meters but experienced no breathing problems, in fact no problems at all on my first dive.

On my second dive I was a little stuffed up when I woke, very minor with my nose quite clear but I was aware of it being harder to equalize and I did cough on that dive.

It would suit me fine if that was a sort of advance warning signal, eg I could choose to abort a dive if I experienced problems (annoying but manageable)but I think it's more complicated than that.

Although yet to be proved, I think my problems are relatively minor and like other asthmatics, it will come down to potential severity of symptoms if it comes on quickly under water.

Having said all that, just keep in mind I'm a newbie. It's great to air my frustrations and talk to some-one like myself that is frustrated by health issues but do double check anything I say.

At the end of the day you will have to locate your local dive referee and get past their medical. Even if you want to take the risk, no-one will let you join a club or take a course unless you lie. That's not to be recommended although I've seen some dive centers on holiday more or less hint at it being best not to tick any boxes that might cause problems.

Having had friends that managed to invalidate their insurance (hiring a bike, not from diving), I can tell you that even a relatively minor accident can cause MAJOR problems abroad, financial and otherwise. Imagine the scenario where you break a leg on a dive boat, get air lifted to hospital, then your insurance declines because you shouldn't have been diving to begin with. :eek:

[cdan]

I understand the mechanics of the trapped air and lung issue. I guess my question is: how deep is safe? And there really doesn't seem to be an answer to that. I'll ask more questions tomorrow at the UCSD dive medical. I already knew that checking ANYthing would open a can of worms but i don't think i want to die just yet. It doesn't seem that it can really be black and white unless you're having severe breathing problems at sea level. Were you just starting a dive course when you decided to get the lung function test? Have you already been certified? You say it was harder to equalize on the your 2nd dive. You mean to equalize the pressure on your ears? I don't know that i would consider that a lung or trapped air problem.....but, what do i know? I can't even start a dive course w/o having the medical signed off. My family dr knows ALL about my health so there's no way he'd sign me off anyway. This is VERY frustrating. Mostly because it seems NO one has the answer. It's all based on 'maybe's" You'd think after all these years, someone would have come up with a series of tests that would tell you for sure wether or not you were trapping enough air to hurt yourself....and at what depth. Even if you ARE trapping air...you'd think that a slower assent would solve the problem. The air can't be trapped forever. Maybe 20ft a min instead of 60 ??
dan:confused:

ps... some other things you might want to look into. Leukotriene pathway modifiers ie: Accolate and Zyflo, also Romoflast...which is only available in Europe at the moment.

update 10-24-06
assent rate doesn't matter according to UCSD Dr. It's a good thing i had my last ct scan with me. After giving me the physical he said i seemed fine...but....i didn't lie about anything, possible copd, past smoking etc. After the spirometery test he said he'd make his decision based on the report that went with the ct scan...which i just faxed to him. So........ i'm holding my breath till next week.

update: 10-25
dr called back. function test results too low to approve. FVC-73 FEV1-56.2 PEF-64.8.... so... they put me on hi dose of Flovent for 30days. He seems to think that might improve the results enough to pass me. We'll see.

[gsclarke]

Hi

I got the all clear last night despite figures that wouldn't have got past a dive referee.

I trust Prof.Pavord completely. He is just about the best respiratory consultant in our area. I couldn't believe my luck when he said he was a diver and also asthmatic.

I too have to have a CT scan amongst numerous other tests (6 lots of blood last night).

However he has no problems at all with me diving so Egypt here I come!!!

I hope you get the all clear soon.

[Adrian Kelland]

Hi

I got the all clear last night despite figures that wouldn't have got past a dive referee.

I trust Prof.Pavord completely. He is just about the best respiratory consultant in our area. I couldn't believe my luck when he said he was a diver and also asthmatic.

I too have to have a CT scan amongst numerous other tests (6 lots of blood last night).

However he has no problems at all with me diving so Egypt here I come!!!

I hope you get the all clear soon.
AIUI, only a medical referee can sign off the UKDSMC medical. Is Prof Pavord providing some kind of info for the referee?

Adrian

[gsclarke]

Yes he is. :D

[Adrian Kelland]

Yes he is. :D
Then all is progressing nicely. :)

Adrian

[cdan]

good for you...just be careful and watch for any warning signs, especially in the chest area. What were your FCV, PEF and FEV1 scores? You'll have to send me some pics from your dives. You're in England?

[Cheryl Waiwright]

I have just been diagnosed with copd but have not had a lung function test yet. So far I have only had one encounter with diving where I had a problem. I was in very cold spring water. Could anyone tell me if there is a reason I should not dive if I feel comfortable with it?

[Janos]

I have just been diagnosed with copd but have not had a lung function test yet. So far I have only had one encounter with diving where I had a problem. I was in very cold spring water. Could anyone tell me if there is a reason I should not dive if I feel comfortable with it?

I believe it is because you can get air trapped in your lungs, which swells on ascent causing the alveoli to burst. The bubbles can enter the blood stream causing a bend.

You wouldn't be able to tell this is happening - you would feel fine - because humans haven't evolved to detect pain caused by overexpansion injuries.

In your shoes I certainly wouldn't dive until I've spoken to a proper diving medical referee. There's a list here:

http://www.uksdmc.co.uk/index.php?option=com_content&view=category&id=7&Itemid=3

Janos