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#1200
beta blockers and pulmonary edema
Dutch - 12/12/2013 6:26 AM
Category: Health & Safety
Replies: 2

To preface this story, beta blockers are a class of medicine used to help control high blood pressure and many thousands, if not millions, of people use them daily.

I received a scary message from an diving friend recently. One that sent chills down my spine and thoughts racing through my brain. It sent me on a journey of online research and turned up some quite unclear and often contradictory information. What it did give me was a decided feeling of how little we know about drugs and diving and how deadly that lack of knowledge can be.

As you know, I like to hang out in and around the water. Due to that addiction to water environments, I like to stay up to date on many things from new sailing or dive gear to medical information and treatments that have to do with diving. Pretty much anything really. After my recent re-posting of @MMVittone great article about "Drowning doesn’t look like drowning" mariovittone.com/2010/05/154/ , my friend wrote me a PM and related his short story that started everything rolling. (disclaimer:names may have been changed to protect the not too innocent)

In short..." almost died from pulmonary edema. The physician feels it happened because I was on a beta blocker. He has seen 7 similar cases in two years. (emphasis is mine just so this number sticks with you-john) A very good dive operation and medical clinic pulled me through. The observation is by the well known hyperbaric physician in CozDr. Pascuale Piccolohe first saw it in a 30 year old free diver on a beta blocker for blood pressure. One of the staff said they had seen this happen to someone about my age (62) a month agoalso on a beta blocker. According to Dr. Piccolo, DAN has been reluctant to acknowledge his observations."

So, here was a commonly prescribed class of drugs that thousands, if not millions, of people use daily to control blood pressure around the world. And it possibly has unforeseen consequences when coupled to diving (and thus pressure changes but more on that later). This caused me some worry as I had not heard of this supposed interplay and off I went, killing many hours of my time trying to find some clear evidence of just what was happening. And it was not there...

So, I asked people involved with diving and hyperbaric medicine what they had seen, heard or experienced. Only one of some 200 instructors that I contacted in Pms had even heard of beta blockers and diving as contra-indicative. And he had heard it only in relation to free diving, not scuba. And one doctor, involved with my diving insurance company Aquamed aqua-med.de/ and diving medicine, Dr. Anke Fabian, did offer some guidance when I asked her about her take on this...

In short, our conversation went like this...

me, “have you seen incidence of pulmonary edema related to beta blockers and diving?”

Anke, “yes - I have seen this many times especially in divers above 45 years .

Therefore: we don’t recommend diving on Betablockers in the second half of life”

me, “Anke, another question if I may. Do you know of anyone who may be doing research into this? I was wondering if there were any markers or such when this was happening. As in, is the onset gradual so that if noticed by a trained dive pro, the diver could be warned and stop diving before things got bad?”

Anke, “don’t know any research about it

the first signs are heavy breathing under water with the feeling not to get enough oxygen. If you have a diver who is on betablocker medication and older than 35 years - start a controlled ascent when observing these symptoms.

Basically heavy breathing is a non specific symptom and can be caused by a million of things - but in divers on betablockers - it would make me alert”

Ok, I asked her two questions there, so sue me...But there is take home information here that you need to know and act on!

Dive professionals, this is a new and very necessary bit of info you need to ask your diving charges->are you on beta blockers?

And this is something extra for you to watch->heavy breathing in the group on beta blockers.

And I would guess this would need to be both before, during and after dives for reference and trigger-to-action. And when triggered, follow Anke’s instructions about a controlled ascent...

Interestingly, the instructors I questioned almost all commented on the medical form that students fill in when they take diving lessons. It was mentioned that if any of the answers comes up Yes, then a diving doctor should be consulted. What none of them commented about was what I think would be/is a pretty common situation, someone who already has a diving certificate and later in life starts taking beta blockers. If the prescribing doctor is not a diver, a diving doctor and/or is not aware his charge is a diver, the disconnect could be fatal.

Now, I am not saying that we should alarm everyone. I am just saying that there needs to be a level of caution which is a bit higher than what we see concerning this particular subject. I, for one, could have been using beta blockers for years to control high blood pressure had I not found alternative methods to remain calm and deal with it...drop out of the rat race, change diet and eat healthy, meditation just to name a few that I practice. But if you can’t do any, some or all of these or other alternatives, you might want to suspend any diving activities if you are taking beta blockers until more is known or you are off of them.

In an added twist to the incident story of my friend, he just mentioned this in passing! "think we need more awareness of the potential problems that they can cause. When I noted on my dive accident report that I was coughing at depth, the nurse (who is Dr. Piccolo’s wife) ask how long I had noticed that I coughed at depth. I said, "about 10 years" and she asked "How long have you been on beta blockers?" "About 10 years. And I thought it was just my allergies and usual sinus crud."

So dive pros, another trigger to wake you up and pay attention to your charges, "cough at depth"

And using my logic (yes folks) I am thinking that this is probably not dry air exposure to the lungs which is causing the edemas but pressure differences/changes. Make sense to you? It happens in free divers as well as scuba, so the only real common factor that I am seeing here is pressure differences/changes. So, what does this have to do with real life? I am wondering how flying affects beta blocker users now as well!
#20384
LatitudeAdjustment - 12/12/2013 6:39 AM
Here’s a list of Beta blockers: medicinenet.com/beta_blockers/article.htm
#1200
Subscribed
Dutch - 12/12/2013 9:16 AM
Thanks for adding that list!