Diving & wellness: diving & smoking
I always make a new year’s resolution list. I actually quite successfully seem to follow this list throughout the year. My secret? Not making a never-ending list‚ but just keep it to one or two points. And… I have a try out period before; I never really start my new year’s resolutions on the 1stof January. I know‚ they aren’t really new year’s resolutions this way‚ are they? But what does it matter whether you start the 1st of January‚ the 1st of December‚ or the 24th of November‚ when you are changing your life for the better?
I have to admit that thinking of new year’s resolutions felt somewhat different this year. Having positive thoughts‚ trying to think about changing my life for the better‚ having any motivation‚ was a harder task than usual. Twenty-twenty was a year full of challenges: the COVID-19 pandemic‚ a widening gap in economic inequality‚ an intensified political division‚ a continuing worsening climate crisis‚ just to name a few. But nonetheless the difficulties the world is going through today‚ that make it hard to hope in anything‚ I’m convinced we shouldn’t let our spirit be taken away from us. So‚ even if it felt differently‚ I didn’t want to let my motivation be sucked into that black hole of depression. And to be honest‚ the point on my list I want to talk to you about really HAD to be changed‚ because it is in extreme contrast with a life dedicated to scuba diving.
It is not one of the most original new year’s resolutions‚ but the importance of this resolution‚ especially in the world of scuba diving‚ compensates for that: To quit smoking. Smoking and scuba diving are two things that just don’t match. We all know that. But do we know why? What negative effects does smoking specifically have in divers?
The negative long-term health effects of smoking in the general population are largely known; From an increased risk of developing various types of cancer‚ the increased risk of cardiovascular disease‚ airway damage‚ respiratory distress and permanent pulmonary loss of function. One can imagine that these health issues don’t have a positive influence on scuba diving physiology.
The effects of smoking on the cardiovascular and respiratory system do interact in a negative way on safe diving practices.
Let’s start with a brief list of specific negative effects of smoking on diving‚ which I’ll give a bit more information about in the paragraphs to follow:
- Smoking can cause bronchial constriction and respiratory problems when breathing cold‚ dry air while diving.
- Alveolar damage results in less effective gas exchange and higher risk of developing decompression sickness when diving.
- Scuba diving demands more from our lung function‚ which might be too much to cope with for the lungs of a smoking diver.
- Obstructive plugs can create closed airspaces and lung overexpansion injuries in a diver during a diving ascend.
- Atherosclerotic plaques create a perfect niche in the blood vessels for nitrogen accumulation and bubble formation during diving.
- During diving inert gas washout is compromised due to nicotine induced vasoconstriction and increased hematocrit
- More viscous blood may cause blood vessel damage and a higher risk of developing decompression sickness when diving.
- Carbon monoxide inhibits the transportation of oxygen to the body tissues‚ which is highly unwanted in a demanding activity as scuba diving.
First‚ let see the effects of smoking on the respiratory system and diving. Irritants present in cigarette smoke make individuals more susceptible to lung tissue inflammation and infection. In addition‚ these irritants present in cigarette smoke induce a chronic inflammation of the alveoli and airways and may cause bronchial constriction. This tightening of the airways in smokers‚ comparable to the bronchial reactions in asthma patients‚ makes breathing more difficult. For a scuba diver this means that cold and dry air‚ like the compressed air from scuba diving cylinders‚ can cause such a bronchial constriction‚ which will give him breathing problems while diving.
The long-term effects of smoking on the lungs include the development of chronic bronchitis and emphysema. At the level of the alveoli‚ gas exchange occurs‚ where the main movement is O2 from the lungs into the blood and CO2 from the blood into the lungs. As more and more alveolar damage is done and the more blood capillaries in the walls of the alveoli are lost over the years due to smoking‚ the less effective the gas exchange will be between the lungs and blood. In a more difficult term‚ there will be a “ventilation-perfusion abnormality”. This means for a diver that pulmonary exchange in decompression during his dive is not optimal; oxygen uptake is impaired and nitrogen gas washout is limited. The lung’s function to act as a bubble filter during a dive is comprised and therefore the risk of decompression sickness in smoking divers is increased.
Lung function in terms of capacity (FVC) and forceful coughing (FEV1) are significantly reduced in smokers. During a dive‚ the chest wall compliance of a diver is reduced as a result of water pressure and diving equipment like a wetsuit and BCD. In addition‚ a diver’s lung compliance and volume during a dive is reduced as a result of fluid shifts in the body. On the other hand‚ the energy it takes to breathe for a diver increases as the density of breathing gasses increases during diving at higher ambient pressures. The lungs of a smoking diver risk to be unable to cope with the more demanding situation underwater during a dive.
Cilia are microscopic hairs that line the respiratory tract and fan and carry foreign particles and mucus from the lungs. Irritants present in cigarette smoke impede ciliary function. The increased mucus production and inability to clear it away due a reduced lung function and ciliary function risks to form an obstructive plug in an airway. Together with a smoker lung’s increase in dead air space and chronic bronchitis‚ these can cause closed air spaces in the lungs. A closed air space in the lungs during diving may cause serious lung overexpansion injuries during diving ascends. A mechanism that is comparable to a reversed block that might develop in the sinuses and ears when diving with a cold.
Let’s not forget the effects of smoking on the cardiovascular system and diving. Our blood vessels work together with the lungs to ensure adequate oxygen delivery to the organs. It also ensures the transportation of waste material like carbon dioxide back to the lungs to be filtered back out. In diving‚ it also plays a crucial role in inert gas elimination and thereby diminishing the risk of bubble formation and decompression sickness.
Atherosclerotic plaques in the blood vessels are found more often in smokers. These fatty deposits seem to be a perfect location for inert gasses‚ like nitrogen‚ to accumulate and create a likely site for bubble formation‚ congregation and growth in the blood vessels. A diver with atherosclerosis would therefore seem more susceptible to bubble formation and decompression illness during his dives.
Blood vessel peripheral constriction caused by the nicotine present in cigarettes‚ further compromises inert gas washout. Also‚ the increased hematocrit (which simply means a greater number of red blood cells per volume) makes the blood more viscous and less able to flow fluidly. This thicker blood‚ apart from compromising inert gas washout‚ may also cause damage to the endothelial wall. Together with platelet aggregation and fibrinogen production caused by nicotine‚ these creating again a perfect niche for inert gas bubble formation.
Then there is the carbon monoxide impact. Carbon monoxide‚ present in cigarette smoke‚ binds 250 times better to hemoglobin on our red blood cells than oxygen. It inhibits the transportation of oxygen to the body tissues‚ which during an activity as diving is of course and absolutely unwanted phenomenon.
And these are just a few simplified examples… I didn’t even mention the higher risks of cardiovascular events due to smoking‚ that‚ when occurring in a situation like diving‚ result in very poor patient outcome; permanent morbidity if not death.
Having the physical reserve to cope with the various additional demands that are placed on the body in the underwater environment during diving is of crucial importance. And this ability is clearly comprised when the pulmonary and cardiovascular system have been damaged by cigarette smoke.
Smoking and scuba diving are not a good combination.
So‚ I was put in front of a difficult choice: to quit smoking or to quit scuba diving.
… Of course‚ I wasn’t! Scuba diving forever!
It was just a matter of gathering enough motivation‚ willingness‚ strength‚ discipline and… do it! 24th November 2020‚ the start of my most important new year’s resolution.
Esther
P.s.
For the non-smokers who read this: Please‚ don’t start to over-criticize and judge your smoking diving buddy now. Don’t underestimate the addictive effect of cigarette smoking. Rather try to encourage your diving buddy‚ inform about the risk and advise in a constructive manner.
For the smoking divers who read this: Don’t worry‚ I haven’t become that annoying judging “smoke-hater” now. I’ll still be very happy to dive with you!
