Do the Two Make A Risk Factor For Decompression Illness?
Most scuba divers know that consuming alcoholic beverages prior to diving could cause dehydration. This in turn can increase the risk for decompression illness (DCI), also known as "the bends" or "caisson disease." During basic open-water training, divers are commonly taught to avoid alcohol until after the day's diving is complete, and even to consider avoiding alcohol until the entire dive vacation is over.
Even when diving in economically developing countries, many dive operations will not serve alcohol to divers until after the dive. But what about tobacco?
Smoking seems to be much less taboo among divers. I have observed divemasters and other experienced divers smoke cigarettes just before diving, during the surface interval, and after completing the dive series.
Most smokers are likely aware of the health implications of consuming tobacco but choose to smoke despite the risks. However, divers who smoke are likely not aware of its possible effect on DCI. Does Smoking Increase the Risk of DCI?
A review of the medical literature as it pertains to scuba diving and tobacco use provides very little information on whether smoking increases the risk of DCI. There is reason to believe that medical conditions caused by cigarettes (e.g., emphysema or atherosclerosis, a narrowing of the blood vessels by hard plaque and cholesterol deposits) could predispose a diver to a serious dive injury such as arterial gas embolism or decompression sickness, the two forms of DCI. Some of these smoking-related diseases can be present without the diver's knowledge. It is conceivable, then, that seemingly healthy smokers might be at greater risk for DCI.
An internet search using two popular search engines (Google and Yahoo) returns some information, but consists largely of opinion articles that typically recommend against smoking and diving for the reasons cited above. Until recently, there have been no studies specifically addressing the possible relationship between cigarette smoking and DCI.
The Smoking & Diving Study
Data collected by Divers Alert Network (DAN) on divers with DCI include information on the severity of divers' symptoms and their smoking history. Between the years 1989 and 1999, more than 4,000 records of DCI were obtained. These records were carefully reviewed and analyzed by researchers at Duke University and DAN. The conclusions, which have been recently published in the December 2003 edition of Aviation, Space and Environmental Medicine (volume 74, page 1271), suggest that smoking cigarettes, independent of other risk factors, may cause divers with DCI to manifest more severe symptoms than non-smokers.
DCI encompasses a range of symptom severity, from mild itching and / or joint pain to convulsions, unconsciousness and death. The above-mentioned study, entitled "Cigarette Smoking and Decompression Illness Severity: A Retrospective Study in Recreational Divers," revealed that heavy smokers (more than 15 pack-years) tended to develop more severe symptoms of DCI than lighter smokers, who in turn had more severe symptoms that nonsmokers. A pack-year is defined as smoking a pack of cigarettes per day for a year.
Heavy Smokers See A Difference
When heavy smokers (i.e., divers who smoked a lot, not overweight smokers) were compared to nonsmokers, the heavy smokers who manifested DCI were almost twice as likely to have more severe symptoms than mild symptoms. Approximately 37 percent of injured heavy smokers showed severe symptoms, whereas only about 24 percent of nonsmokers manifested severe symptoms. About 20 percent of the injured nonsmokers showed only mild symptoms of DCI, while 14 percent of heavy smokers presented with mild symptoms.
This study did not prove that smoking predisposed divers to DCI. It did show, however, that if a diver develops DCI, the severity tends to be greater in smokers. Smoking could be a direct cause of this, perhaps by way of changes in blood vessels or the lungs.
Smoking Associated With Other Risks?
While statistical methods were used to adjust for almost all conceivable risk factors for DCI, an alternative explanation is that smoking may be linked to some other risk factor. Further research and data are needed to confirm the theory that divers who smoke cigarettes have an increased risk of DCI. To obtain this information, one would need to know the percentage of both smokers and nonsmokers who develop DCI, information that is not yet available.
Divers may be willing to accept the long-term risks of smoking on their overall health. Perhaps the risks of cancer, lung disease or heart disease seem so remote that smokers assume that they will quit eventually before developing these diseases. With regard to diving, the notion that smoking cigarettes may be associated with more severe DCI symptoms could provide yet another reason not to smoke
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