Under the sea: Can you SCUBA dive with asthma?

Last updated: May 2018

With 9 million Americans taking part in SCUBA diving (yes, nine million1—that’s 2.7% of the population), you may know someone who SCUBA dives, or have been curious about it yourself. I somewhat regularly drive by a SCUBA shop, and while I’m not super interested in trying SCUBA diving, I did wonder if the old consensus on the exclusion of asthmatics from SCUBA diving was still true. Historically, it was thought that SCUBA diving, for a number of reasons, posed too much of a risk for people with asthma. Fortunately for adventure-seeking asthmatics, that might not be the case any longer—as long as you are willing to go through some medical testing to ensure your safety underwater.

A 2016 article from the Journal of Clinical Reviews in Allergy and Immunology conducted a review of the available literature on SCUBA diving for participants with asthma. Without getting too technical, because that’s what the full text is for, here’s what you should know before you reach out to your local diving organization about your under the sea journey with asthma:

  • You may be required to undergo a medical diving evaluation. This will include1:
    • Medical history
    • Spirometry (lung function testing), results should be normal
    • Bronchoprovocation testing should be “passed”—this means that FEV1 (lung function) should not fall more than 15% when tested with exercise, hypertonic saline, or cold air.1 A fine mist of saline (sea water) may be produced under normal diving conditions by the air tanks, thus breathing should not be impacted by hypertonic saline.2
    • Allergy testing—which may seem ridiculous going underwater and all, but SCUBA tanks are often contaminated with pollen from being outdoors, and this pollen may also be on the inside of the oxygen tanks, potentially causing big problems underwater.
    • A medical evaluation may also include FeNO (fractional exhaled nitric oxide) tests to determine the level of inflammation present in the lungs.
  • People with exercise, cold air, and/or emotion induced asthma should not SCUBA dive.1
  • If you have needed your rescue inhaler within 48 hours, you should not SCUBA dive.1

Research has also indicated that SCUBA diving can have a long-term impact on lung function, in even healthy individuals—when divers were compared with police officers over 6 years, the divers experienced a decline in lung function.1 These physiological changes that occur with diving regularly in even non-asthmatics, could be potentially dangerous in people with asthma.

If asthma is well controlled on normal therapy (including inhaled corticosteroids and long-acting bronchodilators), the risk of diving should be comparable to those of a diver without asthma.2 This is determined by normal responses to bronchoprovocation testing—lung function remains relatively stable when “challenges” as described above are done.

If you feel that your asthma is well control and stable, and you want to get up-close and personal with sea life, and you feel that you can pass the tests above, it is worthwhile to check with your doctor about SCUBA diving. I feel that it might be a fairly small subset of people with asthma that might qualify to SCUBA dive, however, even if the criteria are pretty rigid, it is MUCH better than simply being told NO from the get go like in years past!

Do you have any interest in trying SCUBA diving? Have you tried SCUBA diving? Let us know how it impacted your asthma.

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