Asthma and scuba diving - Absolute contraindication? in all asthma patients?

Physical and psychological fitness are required for scuba diving, leading t o medical contraindications in certain subjects. Asthma, a condition exhibi ting increasing prevalence in the general population is currently considere d an absolute contraindication for scuba diving by the French Federation fo r Submarine Sports and Education (FFESSM). There is however no documented e vidence demonstrating a higher risk in asthmatic divers. Our English-speaki ng colleagues have suggested that certain asthmatic subjects could particip ate in scuba diving sports under certain conditions without a higher risk c ompared with nonasthmatic divers. We recall here the impact of diving on respiratory function and potential c onsequences in asthmatic subjects, proposing that the formal contraindicati on against scuba diving should be maintained for asthmatic patients who exp erience frequent symptoms (step 2 or more of the International Consensus Re port on Diagnosis and Treatment of Asthma) and/or have a baseline obstructi ve syndrome. It would appear reasonable to discuss the contra indication concerning pati ents with rare acute episodes and who have a perfectly normal respiratory f unction. The question of bronchodilator inhalation prior to diving may be a question to debate. However, such a proposal cannot be considered to be va lid unless well-conducted studies of the clinical manifestations are availa ble (frequency and severity of the acute episodes, triggering factors) for the diver candidate. Because of the highly. restrictive nature of the contraindication notificat ion and the absence of arguments backing tip the decision, the question sho uld be put to competent authorities (sports federations, learned societies) in order to ascertain the pathophysiological mechanisms involved and colle ct reliable epidemio-logical data before proposing a consensus discussion. This process may lead to the delivery of scuba diving authorizations for se lected asthmatic subjects without a higher risk than non-asthmatic subjects .