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Question
Posted : November 24, 2006
I had two lung operations as a teenager because of collapsed lung( spontaneous pnemophorax). Since this time, I am now 56, have remained very healthy and have run marathons. In view of my medical history would it be safe for me to take up scuba diving.

Answer
Posted : November 24, 2006
There is a chance you can dive if all has healed and theres a 0% chance of recurrence. The guidleines are:
An individual who suffers pulmonary barotrauma whilst diving is at risk of developing a pneumothorax (which will often become a tension pneumothorax on ascent as ambient pressure is reduced) and/or surgical emphysema and/or arterial gas embolism. It is therefore recommended that individuals who are believed to be at significantly increased risk of pulmonary barotrauma compared with the general population should not dive. Lung disease which might be expected to cause gas trapping during ascent is particularly likely to predispose to pulmonary barotrauma. However, there is little objective evidence to date that obstructive lung disease per se increase the risk of pulmonary barotrauma in divers. There is some evidence to suggest that pulmonary barotrauma does occur more frequently in divers whose lungs are small and stiff.

Special consideration needs to be given to individuals who have previously suffered pneumothorax or pulmonary barotrauma. Three situations must be considered:

1. Spontaneous pneumothorax. A spontaneous pneumothorax is one which occurs without precipitating trauma.
a. It may occur in (generally older) individuals with severe underlying lung disease (e.g. chronic airways disease) when it is clear that the nature of the lung disease would prevent diving. They are numerically equal to the numbers that occur in young persons (see below) but are more serious due to the lack of pulmonary reserve.
b. It may also occur in fit and healthy young adults who might otherwise be good candidates for diving. They are more frequent in young men than young women (7:1) and they are more common in smothers than non-smokers. In young men, "light" smoking increases the risk seven fold, moderate smoking raises the risk to 20-fold and heavy smoking raises it to 100-fold. Some spontaneous pneumothoraces are associated with forced inspiratory manoeuvres such as hiccuping or the completion of functional tests of total lung capacity or peak inspiratory pressures. Such cases suggest that voluntary high inflations can stretch some parts of healthy lungs beyond their elastic limits. 60% of the spontaneous pneumothoraces are noted in the first 3 hours of the waking day. Almost all are unilateral and affect the right and left lungs with equal frequency, but some 2% are bilateral, probably betraying a defect in the mesothelial barrier separating the two pleural spaces in the antero-superior mediastinum. They rarely occur after the age of 40 years. Recurrence rates after recovery from a first spontaneous pneumothorax are high (-50%), are more commonly ipsilateral than contralateral but are very infrequent after intervals of two years or more. The medical committee has therefore adopted the pragmatic approach of accepting that in individuals with a history of spontaneous pneumothorax who have had a bilateral pleurectomy or who are unoperated upon but had no pneumothorax for five years the risk of pulmonary barotrauma is small and not significantly greater than for many in the general population e.g. smokers. Such individuals may dive provided that a CT scan of the chest and lung function tests, including flow-volume loops, show no reason to suggest that there is significant residual lung disease.

So best see a dive doc local to you.
dr j
Answer provided by Dr Oliver Firth
Dr Ollie Firth
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The views expressed by Dr Firth & Dr Jules are their own and the publishers accept no liability for the advice and views expressed by Dr Firth , Dr Jules, or other users, which are provided as a general service to divers. Users are warned that secondary posts are the views of other users and may not be medically correct.
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