[Asthma and diving with a cylinder].

Undersea diving is an activity that is practised more and more in holiday clubs. There is no precise legislation on the causes of unfitness of the amateur, in contrast to the professional diver, where the medical criteria are strict and controlled. When diving with a cylinder, on descent, the ventilatory load increases with increase of the ambient pressure and dynamic resistance in the airways increases. "As with an insufficient respiration on the surface, a healthy subject when diving has a ventilatory ability that is drastically reduced". Moreover with cylinder ventilation, the diver has available a reserve of gas under pressure from which he inspires with the aid of a breathing apparatus (regulator): he breathes dry gas that is dried before compression in the reservoirs, chilled by the relief valve on leaving the reservoir. This inhalation of cold, dry air associated with a hyperventilation during the descent produces ideal conditions to trigger exercise induced asthma. All subjects who present a bronchial hyperreactivity have the risk when diving with a cylinder of triggering a bronchospasm that is identical with that of a sporting asthmatic. During surfacing: the re-surfacing diver runs the risk of an accident of pulmonary suppression if he does not expire sufficiently during his return to the surface: the mass of intrapulmonary air of the resurfacer dilates and the excess of volume is exhaled by the diver: a volume of air of 5 l at 10 m depth corresponds to a volume of 10 l on the surface. Therefore the airways must remain free: an obstruction of the peripheral airways associated with an urgent re-surfacing produces a very rapid thoracic dilation which is responsible for pulmonary barotrauma (pulmonary barotrauma is frequently lethal with 30% of accidental deaths).