|
53
tion screening for an asthmatic is
fairly straightforward. The prospec-
tive asthmatic diver should have
normal spirometry both before and
after exercise. No further testing is
needed. For long-term smokers with
a quantitatively significant smoking
history such a strategy is also prob-
ably appropriate. For the occasional
smoker who is asymptomatic and
who has a normal physical exam,
pulmonary function testing is not
warranted. From a numerical point
of view, the greatest underlying
medical risk to middle-aged divers
is previously undiagnosed coronary
artery disease. Anyone who is going
to be involved in diving activities
should undergo a clinical evalua-
tion for the risk factors for coronary
artery disease. If clinically impor-
tant risk factors for coronary artery
disease are present, a more thor-
ough evaluation looking for occult
coronary artery disease should be
considered.
AD
MEET the experts
Claus-Martin Muth, M.D., Ph.D.,
is professor of anesthesiology and head of
the Division of Emergency Medicine at the
Department of Anesthesiology of University
Hospital Ulm (Germany), Ulm University
Medical School. He served as a Diving
Medical Officer (DMO) in the German Navy
at the Naval Medical Institute and is a div-
ing Instructor and consultant in diving and
hyperbaric medicine. He has published
numerous peer-reviewed scientific papers
and edited several textbooks in the field of
diving and hyperbaric medicine.
Tom Neuman, M.D.,
is a co-editor
of the 5th edition of Bennett and Elliott’s
Physiology and Medicine of Diving and was
the editor-in-chief of the Journal of Under-
sea and Hyperbaric Medicine. Neuman is
on the American Board of Preventive Medi-
cine committee responsible for formulating
the Board Examination in Undersea and
Hyperbaric Medicine. In 2011, Neuman
was selected to be the DAN/Rolex Diver
of the Year. Neuman does research in gas
exchange, exercise physiology and the
causes of diving fatalities.
PICK
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©2013ANDREW SALLMON
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