Pulmonary Function of Recreational Divers: A Cross Sectional Study

Abstract

Long term effects on respiratory function have been found in adult professional divers and have indicated the development of small-airway disease. The aim of this report was to investigate pulmonary lung function and breathing pattern of recreational divers, especially in young subjects. Pulmonary function was measured in 84 air divers (aged 8 - 38 years) and in a matched control group of 89 subjects (aged 8 - 34 years). Static lung volumes, dynamic lung volumes and flows, transfer factor for carbon monoxide (T_Lco), maximal static pressures and CO₂ rebreathing test were measured. We observed no significant differences for all lung function parameters between divers and non divers in children and adolescents. Adult air divers showed a significant decrease in T_LCO in absolute values (5.74 vs 6.26 ml × min^-1 × mmHg^-1 × l^-1, p = 0.03) and normal values and no significant difference in % predicted (112 vs 119 %), a higher maximal inspiratory pressure at functional residual capacity (-92 vs -74 cm H₂O, p < 0.05) and at residual volume (-108 vs -88 cm H₂O, p < 0.05) than adult controls. Adult divers also had a decreased resting respiratory frequency (13 c × min^-1 vs 17 c × min^-1 respectively, p < 0.01) and a higher carbon dioxide threshold (52 mm Hg vs 49 mm Hg respectively, p < 0.05) than adult controls. No significant differences occurred between adults divers and non divers for obstruction parameters. In this study, no airway obstruction or transfer factor reduction was observed in young recreational divers. Lower CO₂ threshold and higher inspiratory pressure were obtained in adult recreational divers compared to controls.

Key words

Lung function - hyperbaric - diving

References

• 1 Barthelemy P, Michaud A, Buestel C, Sebert P. Plongeurs sous-marins amateurs. Caractéristiques ventilatoires, cardiovasculaires et d‘aptitude à l‘effort.  Médecine du Sport.. 1991;  65, 3 124-127
• 2 Barthelemy P, Mialon P, Sebert P, Scheydeker J L. Anomalies de la fonction respiratoire chez les pompiers-plongeurs sous-marins de la protection civile.  Rev Pneumol Clin. 1990;  46 271-276
• 3 Berkenbosch A, Bovill J G, Dahan A, DeGoede J, Olievier I CW. The ventilatory CO₂ sensitivities from Read’s rebreathing method and the steady-state method are not equal in man.  J Physiol. 1989;  411 367-377
• 4 Bermon S, Magnie M N, Dolisi C, Wolkiewiez J, Gastaud M. Decreased pulmonary diffusing capacity of divers over a 6 year period.  Eur J Appl Physiol. 1997;  76 170-173
• 5 Bermon S, Lapoussière J M, Dolisi C, Wolkiewiez J, Gastaud M. Pulmonary function of a firemen-diver population: a longitudinal study.  Eur J Appl Physiol. 1994;  69 456-460
• 6 Black L F, Hyatt R E. Maximal respiratory pressures: normal values and relationship to age and sex.  Am Rev Respir Dis. 1969;  69 696-702
• 7 Cotes J E, Dabbs J M, Hall A M, Heywood C, Laurence K M. Sitting height, fat-free mass and body fat as reference variables for lung function in healthy british children: comparison with stature.  Annals Human Biol. 1979;  6 307-314
• 8 Cotes J E, Davey I S, Reed J W, Rooks M. Respiratory effects of a single saturation dive to 300 m.  Brit J Int Med. 1987;  44 76-82
• 9 Dembert M L, Beck G J, Jekel J F, Mooney L W. Relations of smoking and diving experience to pulmonary function among U.S. Navy Divers.  Undersea Biomed Res. 1984;  11 299-304
• 10 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
• 11 Froeb H F. Ventilatory response of scuba divers to CO₂ inhalations.  J Appl Physiol . 1960;  16 8-10
• 12 Kerem D, Daskalovic Y I, Arielli R, Shupak A. CO₂ retention during hyperbaric exercise breathing 40/60 nitrox.  Undersea & Hyperbaric Med. 1995;  22,4 339-346
• 13 Kerem D, Melamed Y, Moran A. Alveolar PCO₂ during rest and exercise in divers and non-divers breathing O₂ at 1 ATA.  Undersea Biomed Res. 1980;  7 17-26
• 14 Knudson R J, Lebowitz M D, Holberg C J, Burrows B. Changes in normal expiratory flow-volume curve with growth and aging.  Am Rev Respir Dis. 1983;  127 725-734
• 15 Lally D A, Zechman F W, Tracy R A. Ventilatory responses to exercise in divers and non-divers.  Respir Physiol. 1974;  20 117-129
• 16 Maio D A, Farhi L E. Effect of gas density on mechanics of breathing.  J Appl Physiol. 1967;  23 687-693
• 17 Mercier J, Ramonatxo M, Vago P, Prefaut C. Optimisation de la méthode d'hypercapnie progressive par la détermination du seuil de sensibilité.  C R Soc Biol. 1986;  180 574-579
• 18 Quanjer H, Tammeling G J, Cotes J E, Pedersen O F, Peslin R, Yernault J C. Lung volumes and forced ventilatory flows.  Eur Respir J. 1993;  6 5-40
• 19 Read D JC. A clinical method for assessing the ventilatory response to carbon dioxide.  Austr Ann Med. 1967;  16 20-32
• 20 Reuter M, Tetzlaff K, Steffens J C, Gluer C C, Faeseke K P, Bettinghausen E, Heller M. Functional and high resolution computed tomographic studies of divers lungs.  Scand J Work Environ Health. 1999;  25 67-74
• 21 Seely J E, Guzman C A, Becklake M R. Heart and lung function at rest and during exercise in adolescence.  J Appl Physiol. 1974;  36 34-40
• 22 Skogstad M, Thorsen E, Haldorsen T. Lung function over the first 3 years of a professional diving career.  Occup Environ Med. 2000;  57 390-395
• 23 Skogstad M, Haldorsen T, Kjuuss H. Pulmonary and auditory function among experienced construction divers: a cross sectional study.  Aviat Space Environ Med. 1999;  70 644-649
• 24 Tetzlaff K, Staschen C M, 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
• 25 Tetzlaff K, Neubauer B, Reuter M, Friege L. Atopy, airway reactivity and compressed air diving in males.  Respiration. 1998b;  65 270-274
• 26 Tetzlaff K, Friege L, Reuter M, Mutzbauer T, Neubauer B. Expiratory flow limitation in compressed air divers and oxygen divers.  Eur Respir J. 1998a;  12 895-899
• 27 Tetzlaff K, Staschen C M, Struck N, Mutzbauer T S. Respiratory effects of a single dive to 50 meters in sport divers with asymptomatic respiratory atopy.  Int J Sports Med. 2001;  22 85-89
• 28 Thorsen E, Risberg J, Segadal K, Hope A. Effects of venous gas microemboli on pulmonary gas transfer function.  Undersea & Hyperb Med. 1995;  22 347-353
• 29 Thorsen E, Segadal K, Kambestad B K. Mechanisms of reduced pulmonary function after a saturation dive.  Eur Respir J. 1994;  7 4-10
• 30 Thorsen E, Segadal K, Kambestad B, Gulsvik A. Divers' lung function: a small airways disease?.  Brit J Ind Med. 1990;  47 519-523
• 31 Thorsen E, Segadal K, Myrseth E, Passche A, Gulsvik A. Pulmonary mechanical function and diffusion capacity after deep saturation dives.  Brit J Indust Med. 1990;  47 242-247
• 32 Thorsen E, Kambestad B K. Persistent small-airways dysfunction after exposure to hyperoxia.  J Appl Physiol. 1995;  78,4 1421-1424
• 33 Thorsen E, Segadal K, Kambestad B, Gulsvik A. Pulmonary function one and four years after a deep saturation dive.  Scand J Work Environ Health. 1993;  19 115-120
• 34 Thorsen E, Ronnestad I, Segadal K, Hope A. Respiratory effects of warm and dry air at increased ambient pressure.  Undersea Biomed Res. 1992;  19 73-83
• 35 Wilson S H, Cooke N T, Edwards R HT, Spiro S G. Predicted normal values for maximal respiratory pressures in caucasian adults and children.  Thorax. 1984;  39 535-538
• 36 Zapletal A, Motoyama E K, Van de Woestijine K P, Hunt V R, Bouhuys A. Maximum expiratory flow-volume curves and airway conductance in children and adolescents.  J Appl Physiol. 1969;  26 308-316
• 37 Zapletal A, Paul T, Samanek M. Normalni hodnoty statickych plinich objenu a ventilace u deti a mladistvych.  Cs Pediatr. 1976;  31 532-539