COPD FAQ
My doctor recently diagnosed me with mild COPD. Can I still dive with this condition? What are the risks?
Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), encompasses a variety of respiratory health problems, including chronic bronchitis and emphysema. Regardless of what form of COPD a person may have, there are implications for diving and risks of which the person should be aware.
Chronic bronchitis is defined clinically as a productive cough that persists for periods of up to three months and occurs one or more times a year for at least two years. During these periods, the risk of infection, including pneumonia, is high. The inflammation of the bronchial passages and increased mucus production that characterize these periods are uncomfortable: Patients report wheezing, difficulty breathing and feeling as though they cannot get enough air.
For divers, the inflammation and excess mucus lead to the possibility of trapping dense compressed gas at depth. Upon ascent the gas will expand in volume, potentially leading to pulmonary barotrauma, which could include pneumothorax (collapsed lung) and, in the worst case, arterial gas embolism (AGE). Of these, AGE is the most immediate threat to life, but a complicated pneumothorax can also be fatal.
Emphysema is defined clinically as permanent abnormal enlargement of the air spaces within the lungs due to the deterioration of the alveoli. These enlarged spaces are conducive to trapping air at depth, which creates the same possibility of pulmonary barotrauma as chronic bronchitis.
For medical management purposes with regard to medications and other therapies, physicians classify COPD as mild, moderate, severe or very severe, as determined by severity of airflow obstruction. Even with the clinical designation of mild there is measurable obstruction beyond what is considered safe among pulmonology experts trained in dive medicine. For these reasons, diving with COPD — even mild COPD — is not recommended.
Chronic bronchitis is defined clinically as a productive cough that persists for periods of up to three months and occurs one or more times a year for at least two years. During these periods, the risk of infection, including pneumonia, is high. The inflammation of the bronchial passages and increased mucus production that characterize these periods are uncomfortable: Patients report wheezing, difficulty breathing and feeling as though they cannot get enough air.
For divers, the inflammation and excess mucus lead to the possibility of trapping dense compressed gas at depth. Upon ascent the gas will expand in volume, potentially leading to pulmonary barotrauma, which could include pneumothorax (collapsed lung) and, in the worst case, arterial gas embolism (AGE). Of these, AGE is the most immediate threat to life, but a complicated pneumothorax can also be fatal.
Emphysema is defined clinically as permanent abnormal enlargement of the air spaces within the lungs due to the deterioration of the alveoli. These enlarged spaces are conducive to trapping air at depth, which creates the same possibility of pulmonary barotrauma as chronic bronchitis.
For medical management purposes with regard to medications and other therapies, physicians classify COPD as mild, moderate, severe or very severe, as determined by severity of airflow obstruction. Even with the clinical designation of mild there is measurable obstruction beyond what is considered safe among pulmonology experts trained in dive medicine. For these reasons, diving with COPD — even mild COPD — is not recommended.
Posted in Dive Safety FAQ
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6 Comments
THANKS FOR THE INFORMATION AND FOR ANSWERING MY QUESTION, I HAVE SEVERE EMPHYSEMA AND CHRONIC BRONCHITIS AND COPD PLUS CONGESTIVE HEART FAILURE I'M 58 YEARS OLD I HAD BEEN WONDERING IF YOU COULD SCUBA DIVE HAVING A LUNG CONDITION LIKE MINE, NOW I KNOW THAT YOU CANNOT AND ARE PLAYING A GAME WITH YOUR LIFE IF YOU TRIED IT. THANK YOU ALL. MIKE HARTSOOK JOHNSON CITY TENNESSEE USA.
This information has been very helpful but talks about diving at depths.
What about shallow diving with mild COPD, such as a max depth of about 6 feet for the purpose of inspection and some bottom cleaning on a boat or checking out a reef. Would this be considered reasonably safe?
I have been diving for 3 years now and have been just diagnosed with COPD. I have been told I have had it since before I gave up smoking 25 years ago. I exercise regularly 3 to 4 times a week. I am a rescue diver. My diagnosis is on the cusp of moderate. Any thoughts with this profile about continuing to dive. I am very comfortable under water, dive no deeper than 30 metres only occasionally. Am usually around 20 meters.use mainly nitric 32%
Much obliged for your enquiry.
COPD stands for Chronic Obstructive Pulmonary Disorder which is a more global term for the conditions previously known as Emphysema and Chronic Bronchitis. The most common cause of COPD is smoking over a prolonged period of time. Essentially what happens is the alveoli (little sacs) of the lungs are progressively destroyed which then reduces the surface area of the lung for gaseous exchange. Physically this results in hyperinflation of the lungs, breathlessness, prolonged expiration phase and susceptibility to lung infections, obviously dependent on the grade or severity. Exertion amplifies the effects.
In the diving context the issue is with air trapping in the lungs and the reduced functional capacity of the lungs. Air trapping from the obstructive problem can lead to lung over pressurisation injuries especially in the context of the ascent phase of the dive. The reduced functional capacity can lead to hypoxia and problems with gaseous exchange during the dive.
Generally COPD is considered to be a relative contraindication to diving depending on the severity.
The good news for you is that when one stops smoking the damage stops and even though the existing damage can’t be undone there is an improvement in lung function. Exercise also does help in this regard.
In your email you don’t mention how the diagnosis was made: Clinical, X-Rays, Lung Function Tests or all of the above together? Furthermore there is no mention of whether you are on treatment? This information would be important to give a more detailed answer to your query.
In terms of your situation it appears that you have been diving with no concerns despite the diagnosis of COPD. Based on this it is likely that you would be able to continue.
However it would be wise to either consult with a Diving Physician either on your own or in conjunction with your Doctor to evaluate your specific fitness to dive and whether any restrictions would be applicable.
I trust that this response is helpful.
Thank You Kindly,
Dr Rob Schneider
How about freediving, spearfishing with chronic bronchitis
The principles, physics and physiology apply to all types of diving. Thus, the considerations for breath-hold diving would be very similar. The British Thoracic Society, although a few old, produced a well rounded and informative publication for lung considerations and diving in the recreational space.
I have attached some extracts that would guide a diving physician’s considerations. The full article is also attached for referencing purposes.
The comments by Dr Schneider on the blog in November 2021 would thus also apply to free diving. The risks, harmful effects and life-threatening dangers are all relevant.
Hope you find the reference and background useful information useful.
Dr Ajit Daya