Abstract
An increasing number of children and adolescents is diving with Self-Contained Underwater
Breathing Apparatus (SCUBA). SCUBA diving is associated with health risks such as
pulmonary barotrauma, especially in children and in individuals with airflow limitation.
As no data has been published on the effects of open-water diving on pulmonary function
in children, the objective of this study was to evaluate the effects of SCUBA dives
on airflow in children. 16 healthy children aged 10–13 years underwent spirometry
and a cycle-exercise challenge while breathing cold air. They subsequently performed
dives to 1-m and 8-m depth in random order. Pulmonary function was measured before
and after the exercise challenge and the dives. There were statistically significant
decreases in FEV1, FVC, FEV1/FVC, MEF25 and MEF50 after the cold-air exercise challenge
and the dives. Changes in lung function following the exercise challenge did not predict
the responses to SCUBA diving. In 3 children the post-dive decrements in FEV1 exceeded
10%. These children had a lower body weight and BMI percentile. SCUBA diving in healthy
children may be associated with relevant airflow limitation. A low body mass might
contribute to diving-associated bronchoconstriction. In the majority of subjects,
no clinically relevant airway obstruction could be observed.
Key words
pulmonary function - exercise-induced asthma - bronchial responsiveness - bronchial
challenge
References
- 1
Benton PJ, Woodfine JD, Westwood PR.
Arterial gas embolism following a 1-m ascent during helicopter escape training: a
case report.
Aviat Space Environ Med.
1996;
67
63-64
- 2 Beyer C, Winkler B, Meidert A. Scuba diving with children and adolsecents (Tauchen
bei Kindern und Jugendlichen). In: Tetzlaff K, Klingmann C, Muth C, Piepho T, Welslau W
(eds). Checklist Preparticipation Examination for Diving (Checkliste Tauchtauglichkeit).
Stuttgart: Gentner; 2009: 38-47
- 3
Carlsen KH, Engh G, Mork M, Schroder E.
Cold air inhalation and exercise-induced bronchoconstriction in relationship to metacholine
bronchial responsiveness: different patterns in asthmatic children and children with
other chronic lung diseases.
Respir Med.
1998;
92
308-315
- 4
Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, MacIntyre NR,
McKay RT, Wanger JS, Anderson SD, Cockcroft DW, Fish JE, Sterk PJ.
Guidelines for Methacholine and Exercise Challenge Testing-1999. This official statement
of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999.
Am J Respir Crit Care Med.
2000;
161
309-329
- 5
D’Alessandro A, Kuschner W, Wong H, Boushey HA, Blanc PD.
Exaggerated responses to chlorine inhalation among persons with nonspecific airway
hyperreactivity.
Chest.
1996;
109
331-337
- 6
DAN. Report on decompression illness, diving fatalities and project dive exploration.
The DAN annual review of recreational scuba diving injuries and fatalities based on
2001 data Divers Alert Network, Durham, NC
2003;
- 7
Dujic Z, Eterovic D, Denoble P, Krstacic G, Tocilj J, Gosovic S.
Effect of a single air dive on pulmonary diffusing capacity in professional divers.
J Appl Physiol.
1993;
74
55-61
- 8 Fischer KF. Pocket Book of Technical Formulae (Taschenbuch der technischen Formeln.
3rd Edition).. Fachbuchverlag Leipzig; 2004
- 9
Foresi A, Corbo GM, Valente S.
Airway responsiveness to exercise and ultrasonically nebulized distilled water in
children: relationship to clinical and functional characteristics.
Respiration.
1988;
53
205-213
- 10
Godfrey S, Springer C, Bar-Yishay E, Avital A.
Cut-off points defining normal and asthmatic bronchial reactivity to exercise and
inhalation challenges in children and young adults.
Eur Respir J.
1999;
14
659-668
- 11
Gotshall R, Fedorczak LJ, Rasmussen JJ.
Severity of exercise-induced bronchoconstriction during compressed-air breathing via
scuba.
SPUMS J.
2004;
34
178-182
- 12
Grismer JT, Goodwin MH.
Field study of ventilation in volunteer scuba divers during head-out immersion.
Undersea Biomed Res.
1983;
10
311-320
- 13
Harriss DJ, Atkinson G.
International Journal of Sports Medicine – Ethical Standards in Sport and Exercise
Science Research.
Int J Sports Med.
2009;
30
701-702
- 14
Knight J.
Free ascent training.
SPUMS J.
1978;
8
55
- 15
Koskela H, Tukiainen H.
Facial cooling, but not nasal breathing of cold air, induces bronchoconstriction:
a study in asthmatic and healthy subjects.
Eur Respir J.
1995;
8
2088-2093
- 16
Kristufek P, Brezina M, Ciutti P, Strmen J, Mayer M.
Reference values and modelling of lung function development as a transcendent function
of age, body height and mass.
Bull Eur Physiopathol Respir.
1987;
23
139-147
- 17
Lafere P, Germonpre P, Balestra C.
Pulmonary barotrauma in divers during emergency free ascent training: review of 124
cases.
Aviat Space Environ Med.
2009;
80
371-375
- 18
Lemaitre F, Tourny-Chollet C, Hamidouche V, Lemouton MC.
Pulmonary function in children after a single scuba dive.
Int J Sports Med.
2006;
27
870-874
- 19
Morgan WP.
Anxiety and panic in recreational scuba divers.
Sports Med.
1995;
20
398-421
- 20
Noviski N, Bar-Yishay E, Gur I, Godfrey S.
Exercise intensity determines and climatic conditions modify the severity of exercise-induced
asthma.
Am Rev Respir Dis.
1987;
136
592-594
- 21
NSGA. The National Sporting Goods Association
.Sports participation in 1999. Scuba and Snorkelling NSGA, Mt Prospect, IL; 2000
- 22
Panchard MA, Baenziger O, Fuchs H, Haldi H, Oswald H.
Recommendations for the medical assessment of fitness to dive in children (Empfehlungen
für die Beurteilung der Tauchtauglichkeit beim Kind).
Paediatrica.
2006;
17
10-14
- 23
Pickoff AS, Stolfi A, Campbell P.
Temperature dependency of the vagal chronotropic response in the young puppy: an ‘environmental-autonomic
interaction’.
J Auton Nerv Syst.
1997;
64
107-114
- 24
Russi EW.
Diving and the risk of barotrauma.
Thorax.
1998;
53
(S 02)
S20-S24
- 25
Sherrill DL, Lebowitz MD, Knudson RJ, Burrows B.
Methodology for generating continuous prediction equations for pulmonary function
measures.
Comput Biomed Res.
1991;
24
249-260
- 26
Skogstad M, Thorsen E, Haldorsen T, Melbostad E, Tynes T, Westrum B.
Divers’ pulmonary function after open-sea bounce dives to 10 and 50 m.
Undersea Hyperb Med.
1996;
23
71-75
- 27
Smerz R.
Epidemiology and treatment of decompression illness in children and adolescents in
Hawaii, 1983-2003.
SPUMS J.
2005;
35
5-10
- 28
Spahn JD, Covar R.
Clinical assessment of asthma progression in children and adults.
J Allergy Clin Immunol.
2008;
121
548-557
; quiz 558–549
- 29
Taylor SJ, Whincup PH, Hindmarsh PC, Lampe F, Odoki K, Cook DG.
Performance of a new pubertal self-assessment questionnaire: a preliminary study.
Paediatr Perinat Epidemiol.
2001;
15
88-94
- 30
Tetzlaff K, Friege L, Koch A, Heine L, Neubauer B, Struck N, Mutzbauer TS.
Effects of ambient cold and depth on lung function in humans after a single scuba
dive.
Eur J Appl Physiol.
2001;
85
125-129
- 31
Tetzlaff K, Staschen CM, Koch A, Heine L, Kampen J, Neubauer B.
Respiratory pattern after wet and dry chamber dives to 0.6 MPa ambient pressure in
healthy males.
Respir Physiol.
1999;
118
219-226
- 32 Thomas JR, Nelson JK. Measuring research variables. Research Methods in Physical
Activity. Champaign: Human Kinetics Publishers; 1996: 213-248
- 33
Vandenhoven G, Collard F, Schamp E.
Children and diving: medical aspects. 8 year's sports medical follow-up of the first
scuba diving club for children in Belgium.
SPUMS J.
2003;
33
70-73
- 34
Warren JB, Jennings SJ, Clark TJ.
Effect of adrenergic and vagal blockade on the normal human airway response to exercise.
Clin Sci (Lond).
1984;
66
79-85
- 35
Zeitoun M, Wilk B, Matsuzaka A, Knoepfli BH, Wilson BA, Bar-Or O.
Facial cooling enhances exercise-induced bronchoconstriction in asthmatic children.
Med Sci Sports Exerc.
2004;
36
767-771
Correspondence
Bernd E. Winkler
University of Wuerzburg
Department of Paediatrics
Josef-Schneider-Straße 2
97080 Wuerzburg
Germany
Telefon: +49/931/201 27728
Fax: +49/931/201 27242
eMail: bernd.e.winkler@googlemail.com