[Guidelines on asthma in extreme environmental conditions]

[Diving and asthma: Literature review]

INTRODUCTION

Scuba diving has long been contraindicated for asthmatics. Recommendations are evolving towards authorisation under certain conditions. Our objective was to review the literature on the risks associated with scuba diving among asthmatics and about recommendations on this subject.

MATERIALS AND METHODS

We used the MEDLINE and LiSSa databases, until June 2018, in French, English or Spanish language, with the keywords "asthma AND diving" and "asthme plongée" respectively. References to the first degree were analyzed.

RESULTS

We have included 65 articles. Risk of bronchospasm is well documented, particularly in cold and/or deep water, or in the event of exposure to allergens (compressor without filter). Nonasthmatic atopic divers may be at greater risk of developing bronchial hyper-reactivity. Although the theoretical risk exists, epidemiological studies do not seem to show an over-risk of barotrauma, decompression sickness or arterial gas embolism in asthmatics. French, British, American, Spanish and Australian societies agreed on the exclusion of patients with moderate to severe persistent asthma, FEV1<80%, active asthma in the last 48hours, exercise/cold asthma and poor physical fitness.

CONCLUSION

A diver's examination should include a triple assessment: asthma control, number of exacerbations and treatment compliance. Homogenizing the recommendations would improve the framework for the practice of diving among asthmatics and allow larger studies in this population. Communicating the current recommendations remains important to divers, dive instructors and doctors in the context of the development of scuba diving.

[Asthma in the Archivos de Bronconeumología: a review of publications in the year 2009]

A total of 16 articles (Table 1), were published in the Archivos de Bronconeumología in the past year (December 2008 to November 2009), 9 of which were Originals, which was 17.6% of the originals published in that period. Fortunately, the tendency of a decreasing interest in asthma by pneumologists does not seem to have materialised as was feared a few years ago, on the contrary it seems that research is increasing. All articles that appeared in the journal during the period mentioned are reviewed.

Ski mountaineering competition: fit for it?

OBJECTIVE

To examine the physiological characteristics of experienced ski mountaineers and to determine the physical demands of ski mountaineering competition.

DESIGN

Descriptive field study.

SETTING

An international ski mountaineering competition characterized by 20 400 m distance and 1869 m altitude difference that took place in March 2009 in the South Tyrolean Alps (Italy).

PARTICIPANTS

Nine healthy and experienced male ski mountaineers.

INTERVENTIONS

Bioimpedance measurements for body composition definition; maximal exercise testing (Bruce protocol) to determine maximal heart rate (HRmax), maximal oxygen uptake (.VO2max), and ventilatory thresholds (VT1 and VT2) and to define individual exercise intensity zones; HR registration during competition.

MAIN OUTCOME MEASURES

Exercise intensity distribution, occurrence of respiratory symptoms.

RESULTS

Ventilatory thresholds were found on average at 70.5% ± 5.0% (VT1) and 90.9% ± 2.6% (VT2) of .VO2max (68.18 ± 6.11 mL·kg⁻¹·minute⁻¹). The overall exercise intensity, defined by the ratio between mean HR during competition and maximal HR in the laboratory (0.87 ± 0.02), was high. Partial times (% of race time) spent competing in 4 defined performance zones were on average 20.4% ± 17.0% (maximal intensity), 59.8% ± 12.5% (high intensity), 12.8% ± 5.6% (moderate intensity), and 7.0% ± 5.9% (low intensity). Five participants reported respiratory discomfort during competition, with cough being the most frequent symptom. Statistical analysis revealed percent body fat mass to correlate with the partial time performed above VT2 (r = 0.782, P < 0.05); the latter was associated with a worse final placement (r = 0.734, P < 0.05).

CONCLUSIONS

Competitive ski mountaineering is characterized by an important cardiopulmonary strain and requires a high degree of physical fitness.