Continued from page 1
In this day and age where people do not want to take responsibility for their own actions,
most prudent thing for a dive physician to do when an asthmatic walks into his surgery is to say "Bog off, you're unfit". This happens frequently, and who can blame doctors? However, while it might be defensive medicine, it is not necessarily good medicine. Indeed, such subjective pronouncements often motivate candidate to go to another doctor and lie about having asthma. There is now an alternative informed consent basis of assessment. Fundamentally, this means clearly and comprehensively explaining risks of diving to candidate, and letting him make an informed choice about whether to proceed. However, there are some important provisos. In context of asthma, most dive physicians would agree that more active asthma, greater risk in diving. Those candidates who suffer serious attacks, wheeze relatively often or who use reliever medications regularly, cannot be considered for diving, even on an informed consent basis, because rightly or wrongly, risks are perceived to be too high.
On other hand, previous asthmatics and milder cases may be subject to little extra risk, and it is reasonable to let them, as intelligent adults, make up their own minds on matter. Every day of our lives we make decisions that inherently involve weighing risk against benefit. We choose to get on planes, we choose to play rugby, we choose to ride bicycles on busy roads, all because we decide benefit outweighs risk. There is no reason diving should be any different in this regard, although dive candidates are much less well-informed about its inherent risks than they are about these other intuitively obvious risk situations. It is dive physician's role in this setting to sufficiently educate candidates so they can make an informed choice.
A sensible approach to asthmatic dive candidate is to first take a detailed history of his problem. The obvious active asthmatics are told they cannot dive, and reasons are clearly explained. Asthmatics who have not experienced symptoms of asthma or have not used medication for years are usually able to dive without any special investigations.
The most problematic are mild asthmatics i.e. those candidates who wheeze once or twice a year when they have colds; or who wheeze a little in spring when certain pollens are around, etc. With these candidates, a long discussion about potential risks in diving implied by their asthmatic history, is usually followed with tests to check that neither exercise nor breathing of nebulised salt water (at same concentration as sea water) provoke airway narrowing. If these tests are negative and patients exhibit a clear understanding of issues and wish to proceed, then we should be happy for them to dive. Unfortunately, to conduct and document this process properly is a time consuming and expensive exercise, but at least it's better than being told to "clear off" without so much as an explanation.
Sheldon Hey is the founder of Dive The World (http://www.DiveTheWorldThailand.com)and has been an passionate scuba diving professional for many years. Sheldon and the Dive The World Team would love to share their experience with you to ensure your next diving trip meets all your expectations. Follow this link if you would like to read more about Sheldon’s scuba diving experiences.
