From the Guidelines
Contraindications for scuba diving and free diving include several medical conditions that make these activities dangerous or potentially fatal, and individuals with these conditions should consult with a physician knowledgeable in dive medicine before attempting diving activities.
Conditions that Contraindicate Diving
Some of the conditions that are contraindications for diving include:
- Seizure disorders
- Untreated heart conditions like coronary artery disease, heart failure, or arrhythmias
- Pulmonary diseases such as asthma or COPD, as indicated by the British Thoracic Society guidelines 1
- Recent surgeries (especially chest, ear, or abdominal)
- Pregnancy
- Untreated psychiatric disorders
- Lung bullae or cysts, which increase the risk of barotrauma 1
- Previous spontaneous pneumothorax, unless treated by bilateral surgical pleurectomy and associated with normal lung function and thoracic CT scan performed after surgery 1
- Active tuberculosis, as it is a potentially transmissible disease that may cause residual impairment of lung structure and function 1
- Cystic fibrosis, which is often associated with abnormal pulmonary function and increased risk of pneumothorax 1
- Fibrotic lung disease, which reduces lung compliance and impairs gas transfer 1
Relative Contraindications
Relative contraindications that require medical evaluation include:
- Controlled diabetes
- Hypertension
- Previous ear surgeries
- History of pneumothorax
- Certain medications like narcotic pain relievers, sedatives, and some antidepressants
- A cardiac ischemic risk assessment should be performed for scuba and free divers with established atherosclerotic cardiovascular disease who may be at increased risk for cardiovascular complications while diving 1
Importance of Medical Evaluation
It is essential for individuals with these conditions to consult with a physician knowledgeable in dive medicine before attempting diving activities, as underwater pressure changes can worsen existing conditions, potentially causing barotrauma to air-filled spaces in the body, decompression sickness, or oxygen toxicity 1.
Recent Guidelines
Recent guidelines from the American Heart Association and American College of Cardiology suggest that routine screening for PFO or ASD should not be performed for recreational scuba and free divers, and the presence of a PFO is not a contraindication to recreational scuba diving 1.
Shared Decision Making
Recreational diving for scuba and free divers with established cardiovascular disease can be considered with shared decision making (SDM), which includes the additional risks of a cardiovascular event occurring while underwater, thus increasing risks to other members of the dive team 1.
From the Research
Contraindications for Scuba Diving or Free Diving
- Asthma: Individuals with asthma may be at risk for respiratory complications while diving, as the pressure changes can trigger asthma attacks 2, 3, 4.
- Chronic Obstructive Pulmonary Disease (COPD): Similar to asthma, COPD can increase the risk of respiratory problems while diving, and the pressure changes can exacerbate symptoms 2, 3, 4.
- Uncontrolled Hypertension: Diving can increase blood pressure, which can be problematic for individuals with uncontrolled hypertension, putting them at risk for cardiovascular complications 5, 6.
- Other Medical Conditions: Certain medical conditions, such as heart disease, stroke, or other cardiovascular conditions, may also be contraindications for scuba diving or free diving, as the physical and pressure stresses of diving can increase the risk of complications.
Specific Considerations
- Age: Older adults (over 65 years) may be at higher risk for complications while diving, particularly if they have underlying medical conditions 5, 4.
- Obesity: Obesity can increase the risk of respiratory and cardiovascular complications while diving 5.
- Comorbidities: Individuals with multiple comorbidities, such as diabetes, hypertension, and COPD, may be at higher risk for complications while diving 5, 4.