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Health Matters
no smoke
cough. This is annoying in principle, especially underwater, but
unfortunately it is not the only consequence. (figure 1)
Air trapping: after a longer
abuse of cigarettes, the mucus
production leads to structural
alterations in the lung tissue.
This is the case even if the
lung function test remains in
the normal range for quite a
long time. This is a particularly
Scuba diving has a high share of
dangerous area because the
smokers among its community
mucus causes undetected
– many of whom even claim it
strictures and local blockages in
helps reduce their air consumption.
which the expanding air can get
Diving doctor dr anke reveals the
trapped while ascending.
added and often hidden dangers
when divers light up.
This means the walls of the
small air sacs are distended, and
enlarged. We call those widened
alveoli ‘bullae’. The final stage is a
A smoker’s life is more at risk and more-often-than-not shorter than
‘lung emphysema’, with chronic
the life of a non-smoker. That’s nothing new. Each smoker sacrifices
hyperinflation of the lungs (excessive inflation or expansion of the
approximately seven to ten years of their life to the cigarette industry,
lungs) and reduced oxygen diffusion.
paying for this choice not only with a lot of money but also with
In medical terms this is called COPD (chronic obstructive pulmonary
disease). It is a chronic disease of the lungs caused by a permanent
If the smoker is practising a form of sport – in which the lung and
irritation from cigarette smoke. In the contrary to asthmatic disorders,
the airways hold a key role, such as in diving – each person has to
it can only partly be compensated and treated by medication.
question their smoking habit. Latest worldwide evaluations among
Smaller and even multiple ‘bullae’ can not be detected by a normal
divers suggest that 40 per cent have been or still are smokers. Thus
X-ray. (figure 2). They only show in a computer tomogram (CT) (figure
the rate of smoking divers is exceeding the worldwide average rate of
). To determine one’s ability to dive, it is essential to investigate if
smokers, which is currently between 25 and 0 per cent.
those areas are still connected to the ventilation and aeration. This
Every smoking diver is fond of his ‘deco-cigarette’. It is even more
requires a high resolution computer tomogram in spiral thin layers,
tasty coming with the ‘deco-beer’, particularly while recalling the
which is done first in inspiration while holding the breath and then in
adventures of the dive with his buddies. Some don’t even wait to
expiration while holding the breath. This is the only method of giving
climb out of their wetsuit before lighting up.
a reliable statement about the functional increase and decrease of
the air volume within those areas and herewith the given risk of an
Smokers are generally well aware of the risks, however – all the
air-trapping or even a barotrauma of the lungs (figure 4). At the time
catchwords, slogans in the health industry and most of all the raised
where the lung of a smoking diver develops bullae, the lung function
index finger of the notorious non or ex-smokers out there. The
is mostly still in the normal range and the diving smoker is able to
nagging and lessons – it doesn’t stop.
perform his normal type of sports such as swimming, jogging or
So, bearing all this in mind, I shall neither raise an accusing index
cycling without any problems or shortness of breath. The changes are
finger, nor shall I draw your attention to the shocking pictures of
very slow and creep along inconspicuously.
cancerous lungs blackened by tar or amputated smoker’s legs.
I rather prefer to point out and explain the slow changes of the
lungs, which first creep along subtly as the years are passing by,
nevertheless, are definitely leading to extreme dangers. Some of
which very likely to cause a serious problem underwater.
Fig. 1
Inhalation of tobacco
smoke: beside nicotine, cigarette
smoke contains carbon monoxide
and more than 4,000 additional
chemical substances. Many of
these are known to cause cancer.
Anything between 20 per cent up
to 80 per cent of those substances
are penetrating the lung tissue and
Medical examination: Within the dive medical examination
are dissolved, accumulated and
the doctor has to examine the lungs exactly and thoroughly. An
metabolised in different ways. Tar
auscultation (sound test) over all segments of the lungs is obligatory,
substances in the lungs develop
however, the breathing sounds around the ‘bullae’ will appear
the typical black spots.
normal. Therefore, the doc won’t be able to identify such problems
Inhalation of tobacco smoke leads to an increase in the production
this way. A lung function test will show bigger structural damages,
of mucus in the airways. The production of mucus is basically a
larger smoke-induced losses or acute functional constrictions
natural defence mechanism to protect the bronchial system from
such as asthma. If there are pathological findings even in a simple
poisons and toxic micro particles, but the mucus holds high risks for
spirometrical lung-function test (flow-volume measurement, figure
the diver. This mucus has a stringy chewy consistency. It blocks the
5 and 6), a thorough pulmonological investigation must follow up
small airways and alveoli (air sacs). The result is the typical smoker’s
the questionable results. This more extensive lung function test is a
Issue 4 January - February ‘10
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