asthme·plongée FR

Scuba diving · updated November 2026

Asthma and scuba diving

By Dr Alexandre Muller and Dr

Yes, you can.
But not just any old way.

Asthma is no longer an absolute contraindication to scuba diving. In France, mild or fully controlled asthma, with no moderate or severe attack and no sudden-onset attack, no exercise-induced or cold-induced asthma, and normal spirometry, may allow diving, after review by a respiratory physician (pulmonologist) 1.

I have asthma I am a doctor I am an instructor
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The key points in numbers

Four landmarks to understand the question

Who dives? 8.7%

of the 322 recreational divers in a German-language survey reported asthma, often troublesome and poorly treated 3. Banned or not, some asthmatics dive anyway.

At 10 metres × 2

The pressure has already doubled: the regulator gives you air twice as dense, and your lungs hold twice as much of it. If this air stays trapped, it doubles in volume during the ascent over the last ten metres.

At 30 metres −50%

Maximum ventilation measured in a hyperbaric chamber falls by more than half, because the air breathed is four times as dense 4. Asthma that is troublesome at the surface is more so at depth.

On the day 48 h

without any symptoms before diving; after an attack, up to 7 days if necessary: this is the French rule 5.

Asthma in brief

Asthma is a chronic inflammatory disease of the bronchi. It shows itself through symptoms that come and go (wheezing, breathlessness, chest tightness, cough) and through variable airway obstruction, which clears spontaneously or with treatment 6. About 6% of adults in France have current asthma 7 8.

There are many triggers: allergens, tobacco and pollution, infections, cold, dry air, exercise, certain medicines such as aspirin and anti-inflammatory drugs. Cold, dry air and exercise are precisely those of diving.

The diagnosis rests on spirometry: a lowered FEV1/FVC ratio, and an FEV1 that rises by at least 12% and 200 mL after a bronchodilator. If spirometry is normal, a methacholine test, or an exercise test when symptoms occur on exertion, can reveal bronchial hyperresponsiveness 9.

Normal flow-volume loop and flow-volume loop of an obstructive ventilatory defect Exhaled volume (L) Flow (L/s) 0 Normal: sharp peak Obstructive: low peak PEF FVC FVC
Flow-volume loop, diagram: the normal curve rises to a sharp peak then falls in a straight line; that of an obstructive ventilatory defect has a lower peak and a scooped-out descent. PEF: peak expiratory flow; FVC: forced vital capacity.

Can I dive?

A few questions, an immediate answer

This questionnaire follows the criteria of the FFESSM (the French Underwater Federation) for asthmatics 1. It tells you where you stand and whom to consult; it does not replace the consultation or spirometry, and only a doctor can sign the certificate.

Do you have asthma, or have you ever had it, even in childhood?

Answer the questions

The result appears here as you answer.

Nothing is saved or sent: everything is calculated in your browser.

The pathway, depending on who you are

From the first appointment to the first dive

  1. GP, sports physician or diving doctor

    The first examination

    Questions about your asthma (even past asthma) and your treatments, a full examination with particular attention to the ears, sinuses and teeth 11, and a check for other contraindications 12.

  2. Respiratory physician · compulsory

    Spirometry

    Any history of asthma, even in childhood, goes through the respiratory physician 5. They perform spirometry (flow-volume loop), often with a bronchodilator test, and give a written opinion. The FFESSM offers a letter template for them 13.

  3. Diving doctor, in practice

    The certificate

    The certificate of no contraindication is valid for one year. It becomes void if your health changes or after a diving accident; the certificate for returning to diving after an accident is reserved for a federation, diving or sports doctor 14. For asthma, an FFESSM-accredited diving doctor (médecin fédéral) or one holding a diploma in diving medicine is preferable (see the box below).

  4. You, on every outing

    Dive and monitor

    • No symptoms in the 48 hours before the dive.
    • Peak flow no more than 10% below your best value 4 10.
    • Reliever inhaler on the boat.
    • Spirometry one to three times a year 10.
Who can sign the certificate of an asthmatic? The FFESSM medical regulations voted in 2025 say that the diving certificate “may be issued by any doctor” 14. But the June 2025 list of contraindications marks asthma with an asterisk, which reserves the certificate for a “specific doctor” 12, and the FFESSM letter provides that the respiratory physician sends their conclusions to the federation doctor 13. The safest course: a federation doctor or one holding a diploma in underwater medicine, with the respiratory physician’s opinion in hand.
Take the test Advice for the day of the dive

What pressure does to the lungs

Take the diver down

Ambient pressure1.0 bar
Air held in 6 L of lungs (measured at the surface)6 L
Density of the air breathed× 1.0
Partial pressures O₂ · N₂ (bar)0.21 · 0.79
Why bronchospasm is dangerous during the ascent. Take the diver down: you will see what becomes, during the ascent, of 1 litre of air trapped behind a closed bronchus. The lung cannot withstand this expansion: this is pulmonary barotrauma 21.

Simplified calculation: 1 bar more for every 10 m of water, air at 21% oxygen and 79% nitrogen, Boyle’s law (pressure × volume = constant).

The six effects of diving on breathing

1Pressure and volume

Pressure rises by about 1 bar every 10 metres. The volume of a gas varies inversely with pressure: it is compressed on the descent and expands on the ascent, in the lungs as in the sinuses, middle ear or intestine 4. When scuba diving, the regulator supplies air at ambient pressure: the lungs keep their volume, but they hold more air the deeper one goes. All this air must be able to get out during the ascent.

Thus, in a freediver, 6 litres of intrathoracic gas occupy only 2 litres at 20 metres (3 bar) and 1.5 litres at 30 metres (4 bar). Conversely, a 1-litre pneumothorax formed at 30 metres would occupy 4 litres at the surface: a life-threatening situation. Hence the golden rule: ascend slowly and never hold your breath.

2Denser air

The density of the gas breathed increases with pressure. The work of breathing increases and flows (both inspiratory and expiratory, including FEV1) fall, the more so the deeper one goes: at 30 metres simulated in a hyperbaric chamber, maximum voluntary ventilation falls by more than 50% 4 22.

3Partial pressures

The partial pressure of each gas follows the ambient pressure: at the surface, about 0.79 bar of nitrogen and 0.21 bar of oxygen; at 10 metres, double. More nitrogen dissolves in the tissues and must come out again during the ascent: if it comes out too fast, it forms bubbles, which is decompression sickness 4. It can occur even after a dive that followed the table or the dive computer 23.

4The regulator

The equipment adds dead space and resistance to inspiration and expiration. The work of breathing increases, flows fall and the respiratory rate decreases. The air from the cylinder is also cold 4 and dry 24, two classic triggers of bronchospasm.

5Immersion

Water pressure compresses the chest and abdomen and drives blood from the limbs into the chest (about 700 mL in an adult): lung compliance and vital capacity decrease, the right heart dilates, diuresis increases. Cold produces a similar effect 4 22.

6In the long term

Divers often have larger-than-normal lung volumes, with an FVC that rises more than FEV1. In Norwegian professional divers followed for three years (87 at the start, 81 at the end), mean FEV1 fell slightly, with no demonstrated link to the amount of diving 25. More recent studies diverge 26: in 331 French military divers followed for 24 years on average, lung function does not decline with the number of dives 27.

In sum: more work to breathe, lower flows, cold and dry air, a reduced vital capacity. In a diver whose bronchi are already irritable, the margin shrinks.

The risks for the asthmatic

What theory leads us to fear

An attack underwater

Cold, dry air from the regulator, exertion, depth, stress: the whole diving environment can trigger bronchospasm 24; in healthy divers, cold and depth already alter lung function after a single dive 28. And underwater, you cannot take your inhaler.

Pulmonary barotrauma

This is the historical reason for the ban. A closed bronchus traps air in the alveoli; during the ascent, this air expands and tears the lung: pneumothorax, pneumomediastinum (mediastinal emphysema), arterial gas embolism 21 24.

Reduced exercise capacity

Diving can demand intense effort, in a current or an unforeseen situation 29. By slowing the air in the bronchi, asthma lowers maximum ventilation, and so exercise capacity: it eats into that reserve 24.

Decompression sickness

Surveys show no clear excess in asthmatics; only one, in 1991, found a fourfold higher risk, with strong selection bias 30. The mechanism remains debated.

Allergens in the cylinder

In 1999, a diver allergic to pellitory-of-the-wall had a severe asthma attack underwater: his cylinder had been filled by an unfiltered compressor, which had drawn in pollen 31 24.

Immersion pulmonary oedema

The lungs fill with fluid during immersion: breathlessness, cough, frothy sputum. Increasingly recognised, sometimes severe 32; associated with asthma in swimmers, with no independent link demonstrated 33.

And for every diver, asthmatic or not

These risks are not due to asthma: every diver faces them. But several of them also involve breathing, and the asthmatic meets them with bronchi that leave less margin.

1The heart, the leading medical cause of death

In Australia, 126 scuba divers died between 2001 and 2013. In 46 of them (37%), a disease, known or not, may have contributed to the accident. The heart comes first: 32 deaths (25%) are attributed to it, mainly coronary disease and arrhythmias, and perhaps 6 others, without sufficient proof. This is the same proportion as in the United States (26%). A respiratory disease probably contributed to 8 deaths (6%), including 3 asthma cases; but asthmatics are no more numerous in this series than among divers in general. At least 14 of these divers had been declared fit within the year 34. The authors ask that older divers be assessed by a doctor; the recommendations they cite provide for a cardiovascular assessment at 45 years in men and at 55 years in women 34.

For diving can demand intense effort: it requires a heart and lungs free of significant disorder, and sufficient exercise capacity for the planned dive 29.

2Drowning, the outcome of many episodes of illness

Underwater, whatever makes you dizzy, disoriented or unconscious can end in drowning: an episode of illness caused by a disease whose symptoms become more likely at depth 35, narcosis that impairs judgement, or oxygen-induced convulsions, which as a rule lead to it 36. An asthma attack underwater can also lead to panic and drowning 24.

Two rules of caution follow: never dive alone, and take no alcohol, drugs or sedative medicines before diving, whatever the amount: their effects at depth are unpredictable 29.

3Panic, fatigue, current: the human factor

Panic disorder and phobias are among the contraindications to diving 29. Conditions that exhaust or disorient are to be avoided: reduced visibility, a current that demands excessive effort, cold water, solo diving 29.

For the asthmatic, the stakes are twofold: exertion and stress are also triggers of an attack 24. Hence the value of agreeing a signal with your buddy, and of knowing what to do when a diver is not well (see Advice) 37.

4Cold

Hypothermia can set in quickly: it dulls judgement and dexterity, and can cause fatal cardiac arrhythmias in a predisposed person 29. Cold water also increases the risk of decompression sickness 23.

Finally, cold acts on breathing: like immersion, it accentuates the influx of blood into the chest, which reduces vital capacity 4, and the air from the cylinder reaches the bronchi cold and dry. For the FFESSM, cold-induced asthma is a contraindication 5.

5Ears, sinuses, teeth, mask: barotrauma

Ear barotrauma is the most common diving injury, and the risk of barotrauma is greatest between the surface and 10 metres 38, where the pressure doubles.

The ear. On the descent, the air in the middle ear is compressed. Without equalisation (swallowing, yawning, blowing with the nose pinched), the eardrum can bleed or rupture. The inner ear can also be affected: vertigo, tinnitus or hearing loss require urgent medical advice: ENT, but also a hyperbaric centre, since inner-ear decompression sickness gives the same signs 39 23.

The sinuses. Especially the frontal sinuses: pain, sometimes sharp, on the descent or the ascent, sometimes a nosebleed 39.

Teeth and mask. Air trapped near the root of an infected tooth or under a filling hurts when diving. A mask that you forget to equalise on the descent (all it takes is a little breath out through the nose into it) can leave bruises on the face and blood in the whites of the eyes 40. No earplugs, no swimming goggles: the pressure behind them cannot be equalised 39 40.

For the allergic diver: do not dive with a blocked nose, or with uncontrolled allergic rhinitis 39.

6Decompression sickness

At depth, nitrogen dissolves in the blood and tissues, the more so the higher the pressure. During the ascent, it comes out again; if it comes out too fast, and sometimes even when the table or dive computer has been followed, it forms bubbles, which block vessels, compress tissues and trigger inflammation and clotting. Mild forms affect the joints and skin; severe ones, the spinal cord, brain, heart or lungs. It occurs in about 2 to 4 recreational dives per 10,000 23.

  • What increases the risk, during the dive: a rapid ascent, cold water, fatigue, dehydration 23.
  • Afterwards: exertion, flying, going up to altitude (mountain pass roads, mountain lakes). Excess nitrogen stays dissolved for at least 12 hours: dives made on the same day add up 23.
  • In the diver: age, obesity, an abnormal passage of blood from the right heart to the left heart (shunt) 23.
  • What protects: ascending at the speed indicated by your dive computer or table (9 to 18 metres per minute at most, depending on the source), making a safety stop (“palier de sécurité”) of 3 to 5 minutes at around 3 to 4 metres, not flying within 12 hours after a no-stop dive, nor within 18 to 24 hours after several dives or dives with decompression stops 29.

What to do? Signs appear within the hour in half of victims, within 6 hours in 9 out of 10 23. Joint pain, tingling, weakness, dizziness, breathing difficulty or great fatigue after a dive: oxygen by mask without waiting, and raise the alarm (in France: 196 or VHF channel 16 at sea, 15 or 112 on land; elsewhere: VHF channel 16 at sea and the local emergency number on land, 112 throughout the EU), even if the dive computer was followed (see Advice and the map of hyperbaric chambers) 23 37 41.

In the asthmatic, surveys show no clear excess (see above).

7Nitrogen narcosis

Beyond 30 metres on air, nitrogen acts as an anaesthetic, in the manner of nitrous oxide. This is “rapture of the deep”: you think and move less well, mood and behaviour change, as after drinking, and this impaired judgement can lead to drowning. Beyond about 90 metres, hallucinations and loss of consciousness are possible 36; in France, diving on air is in any case limited to 60 metres 10.

It wears off on ascending: the treatment is an immediate but controlled ascent. For very deep dives, part of the nitrogen is replaced by helium, which does not have this effect 36.

8Oxygen toxicity

Essential as it is, oxygen becomes toxic under pressure. Thresholds differ between sources: the MSD Manual places accidents beyond a partial pressure of 1.3 to 1.4 bar, i.e. 52 to 57 metres on air, and shallower with a nitrox, which is richer in oxygen 36; in France, the French Sports Code (Code du sport) sets the maximum at 1.6 bar and limits air to 60 metres 10. With a nitrox of 32% oxygen, 1.6 bar is reached at 40 metres.

The convulsive seizure, with loss of consciousness, can occur without any warning sign. When signs precede it (twitching of the lips or face, apprehension or anxiety, tunnel vision), the oxygen pressure must be lowered without delay, which means ascending. Exertion, cold and carbon dioxide build-up shorten the time before the seizure, which is shorter in immersion than in a hyperbaric chamber 10. Underwater, this seizure as a rule leads to drowning 36.

High oxygen pressures also irritate the bronchi: the French recommendations of 2020 consider it desirable not to expose uncontrolled or poorly controlled asthma to them 10.

9Carbon dioxide and carbon monoxide

Carbon dioxide builds up when ventilation is poor: a regulator that is too stiff, a suit that is too tight, excessive exertion, great depth. It causes breathlessness and drowsiness; in severe forms, it gives nausea, dizziness, headache, confusion, even loss of consciousness. Frequent headaches after diving, or an abnormally low air consumption (a sign that you are breathing too little, for example to “save” your air), should bring it to mind. It clears on ascent: ascend gradually and end the dive 36.

Carbon monoxide comes from the air in the cylinder: a compressor drawing in air near an exhaust, or overheated oil. Nausea, headache, weakness, clumsiness, altered consciousness. The finger pulse oximeter remains normal and does not allow the diagnosis. The treatment is 100% oxygen at high flow, and recompression in a chamber may be considered if there are neurological signs 36. A compressor can also draw in pollen, as in the 1999 story told above 31 24.

10Marine life

Jellyfish and anemones, some molluscs, sea urchins and rays sting or bite, sometimes with venom. All these wounds can become infected by germs specific to the marine environment (Vibrio, Aeromonas, Mycobacterium marinum): a diving wound that reddens or fails to heal deserves to be shown to a doctor. A shark bite is treated as a serious trauma 42.

What the studies say

Plausible fears, fragile evidence

The verdict

Signals of an increased risk, but no solid evidence either way.

In asthmatic divers who meet the fitness criteria, the available studies show no excess of pulmonary barotrauma, arterial gas embolism or decompression sickness; but these are low-response-rate questionnaires and retrospective series, too weak to conclude that there is no risk 30. None has followed a large cohort of asthmatic divers against non-asthmatic ones, and recent reviews speak of a possibly 43 44, even probably increased risk 45, without being able to quantify it. The few accident data available, such as the heavily biased 1991 survey, do not concern asthmatics selected according to current criteria.

Absence of evidence is not evidence of safety. Small lung-function studies point towards caution: in mild asthmatics, a single dive, even a shallow one, can slightly reduce airflow 46 26.

Strength of the evidence

Questionnaire surveys with few respondents, retrospective series, small lung-function studies, almost always in mild asthmatics: no study has followed a large cohort of asthmatic divers 43 24.

And the atopic person without asthma?

More reactive bronchi, with no proof of accidents

Two small studies took non-asthmatic atopic people down to 50 metres. In 9 divers, airway conductance falls, unlike in non-atopic ones 47. In 15 Italian Navy diving candidates, the bronchi become more reactive to methacholine just after the dive, and return almost to normal 24 hours later 48.

These small numbers do not allow us to speak of an accident risk, but justify vigilance: report any new breathing difficulty to the doctor.

Forty years of studies at a glance

rather reassuringrather worryinglandmark or nuance

1930

The origin of the ban

In the 1930s, the US Navy reported fatal pulmonary barotrauma during emergency ascent training from submarines. Any lung disease, asthma included, became a cause of unfitness 30.

1990

104 asthmatic divers, more than 12,000 dives

Among asthmatic divers who answered a magazine questionnaire: a single decompression sickness case, and no pneumothorax or arterial gas embolism reported; 96% said they took a bronchodilator before diving 49 30.

1991

One decompression sickness case per 5,100 dives

A questionnaire sent to 75,000 readers of a diving magazine came back from 279 asthmatic divers (56,334 dives): the calculated risk is 4.2 times that of an unselected population. With so few replies, selection bias is strong 30.

1994

A risk judged comparable, if the asthma is quiet

An asthmatic whose lung function is normal at rest and who shows little reactivity to exercise or cold would have a risk of pulmonary barotrauma comparable to that of other divers; the authors stress that data are lacking 50.

1995

Two gas embolisms in a swimming pool

At depths between 3.5 and 5.5 metres, in two asthmatics who had not told the certifying doctor about their condition 51 30.

1999

Pollen in the cylinder

Severe asthma attack underwater in a diver allergic to pellitory-of-the-wall, whose cylinder had been filled by an unfiltered compressor 31 24.

2003

Guidelines that open the door

The British Thoracic Society publishes criteria allowing selected asthmatics to dive 4; the same year, the FFESSM publishes stricter criteria, which still exclude any preventer treatment 2.

2005

17,386 dives without a serious accident

322 divers from Germany, Austria and Switzerland, 8.7% of whom were asthmatics, often symptomatic and poorly treated. Those with a respiratory disease or respiratory symptoms accounted for 17,386 dives, with no serious accident reported 3.

2012

Even at 5 metres, breathing changes

After a single pool dive, FEV1 and the FEV1/FVC ratio fall in 22 mild asthmatic divers, but not in 15 controls. None had symptoms 46.

2014

The FFESSM lifts the preventer-treatment obstacle

Fully controlled asthma on treatment is accepted: the old rule pushed people to stop their treatment to obtain the certificate 2.

2016

Honduras: a study partly retracted

In tropical sea (10 to 18 m), peak flow falls slightly after the dive, in asthmatics and non-asthmatics alike, and no diver had symptoms 52. After an independent statistical review, the authors themselves withdrew the comparisons between asthmatics and controls (note published in December 2016): the method was not suited to this type of study 53.

2017

Systematic review: signals, little evidence

Seven studies, 560 subjects: five report more diving-related injuries in asthmatics, two none. The authors speak of “indications” of an increased risk 43.

2017

Diving with a known condition

268 Asia-Pacific divers reporting a medical condition, 40 of them asthmatic, accounted for 183,069 dives; incidents related to their condition appear rare, and no asthma attack while diving was reported. But only a third of the divers approached gave usable answers 54.

2018

The review behind this site

65 articles: bronchospasm while diving is well documented; epidemiological studies do not seem to show an excess of pulmonary barotrauma, gas embolism or decompression sickness 30.

2020

Deaths in Australia

Of 126 diving deaths (2001-2013), a respiratory disease was implicated in 8, including 3 asthma cases; the authors estimate that asthmatics are not over-represented. The heart comes first among the diseases implicated 34.

2020

Selecting with mannitol?

In Denmark, 41 asthmatic candidates were tested with mannitol: 68% judged fit, some after strengthening of their treatment. Method not evaluated in real diving, as the authors acknowledge 55.

2023

Same conclusion as in 2016

The same systematic search, repeated in 2022, reaches the same conclusion: a probably increased risk, with insufficient data to decide for an individual patient 45.

2024

Belgium: 140,133 dives

The risk of hospitalisation or recompression chamber treatment is 0.01% per dive. The factors identified are ENT diseases and cardiovascular drugs; asthma is not among them, but there were only 5 asthmatics among 210 respondents: the study cannot conclude for them 56.

2026

Asthma and immersion pulmonary oedema

Among 2,375 Swedish open-water swimmers, asthma is associated with immersion pulmonary oedema (risk × 1.7), but the association disappears once recent respiratory symptoms are taken into account. In swimmers, not divers 33.

The guidelines

In France, then worldwide

France · FFESSM

The fitness criteria

The FFESSM medical commission allows recreational scuba diving for asthmatics who have 13:

  • asthma that is mild, or fully controlled on treatment;
  • no history of moderate to severe or sudden-onset attacks;
  • no exercise-induced or cold-induced asthma;
  • a strictly normal flow-volume loop: FEV1 and FVC > 80% of predicted, FEV1/FVC > 75%, FEF25-75 > 70%.

Contraindications added by the decision tree 5:

  • more than 6 attacks per year;
  • obstructive syndrome, “even if minor”;
  • significant reversibility with a beta-2 agonist.

In the June 2025 list, asthma appears among the “temporary or to be assessed” contraindications 12.

France · 2020

The good practice recommendations

Published in July 2020 by MEDSUBHYP and the French Society of Exercise and Sports Medicine, they are more specific than the federation protocol 10:

  • controlled asthma, treatment at step 1 or 2, normal pulmonary function tests (PFTs) with a pharmacodynamic (reversibility) test: no contraindication;
  • steps 3 and 4: contraindicated according to several authors they cite, with no data at step 3; step 5: a priori incompatible;
  • leukotriene receptor antagonists (montelukast): ruled out, because of their psychiatric adverse effects;
  • cold-induced or exercise-induced asthma: contraindication;
  • bronchial provocation tests: “of no value” in controlled asthma, otherwise on the specialist’s advice;
  • after a mild attack: at least two days, and peak flow or FEV1 back within the target range;
  • asthmatic child, even if controlled: not before 12 years.

Elsewhere in the world

All the societies accept the well-selected asthmatic; they differ on how to select them. Key: allowed · excluded · conditional · not specified.

Criterion FranceFFESSM 2014-2025, recommendations 2020 United KingdomUKDMC, algorithm 2024 AustraliaSPUMS, 2025 InternationalDMSC-UHMS, 2023 NetherlandsRespiratory physicians, 2021
Mild or controlled asthma if respiratory physician approves and PFTs normalafter 2 weeks of peak-flow (PEF) monitoring and an exercise testif provocation test negativeif exercise test negativeif indirect provocation negative
Preventer treatment step 1-2 (2020 recommendations)up to BTS step 3no ceilingto be continuedif symptom-free
Severe or unstable asthma excludedexcludedexcludedexcludedexcluded
Exercise-, cold- or emotion-induced asthma excludedoptimised treatment, then exercise testexcluded if provocation positiveexcludedexcluded (absolute)
Spirometry required FEV1, FVC > 80%; FEV1/FVC > 75%; FEF25-75 > 70%FEV1, FVC, PEF > 80%; FEV1/FVC > 70%FEV1, FVC, PEF ≥ 80%; FEV1/FVC ≥ 75%no threshold; mild obstruction tolerated if exercise test normalFEV1 ≥ 80%; FEV1/FVC ≥ 70%
Provocation test not requiredexercise, fall < 15%indirect, recommended if spirometry normal, fall < 15%exercise; inhalation tests judged not standardisedindirect, recommended
Wait before diving again 48 h without symptoms, up to 7 days after an attacknormal PEF for 48 hno diving while symptomaticno diving while symptomatic48 h without needing a reliever
Asthmatic child not before 12 yearsno age setexcluded from 10 to 15 yearsnot specifiedexcluded until 14 years

Sources: France 13 5 10; United Kingdom 57; Australia 58 19; international 59; Netherlands 60 20.

And the 2003 BTS guidelines?

The founding British text has never been replaced, but the British Thoracic Society has moved it to its archive 61. Its criteria are still cited everywhere: no symptoms, normal spirometry, negative exercise test, no symptom requiring a bronchodilator within 48 hours 4.

What has changed

The United Kingdom no longer excludes exercise-induced or cold-induced asthma outright: it treats it, then tests it with exercise 57. Conversely, Australia and the Netherlands have closed the door to asthmatic children 19 20.

Professional diving

The standards of the EDTC (European Diving Technology Committee, 2024) accept only well-controlled asthma in the GINA sense, at step 1 or 2, with normal lung function that is stable on exercise 62.

Practical advice

Before, during and after the dive

Before

  • Take your preventer treatment every day, without stopping it “to pass the medical” 2.
  • Peak flow on the morning of the dive: no more than 10% below your best value 4 10.
  • Have your cylinder filled by a filtered compressor, especially if you are allergic to pollen 31.
  • Keep in good physical condition.
  • No diving with symptoms, a cold, an infection or an allergy flare-up. After an attack, even a mild one: at least 48 hours without symptoms, and up to 7 days if necessary, with peak flow back to normal 5. An attack stronger than usual (emergency department, steroid tablets) calls the certificate into question: see your doctor again before diving 14.
  • No smoking: it worsens asthma and makes it harder to control.

During

  • Tell your buddy and your instructor, and agree a “I can’t breathe properly” signal.
  • Ascend slowly, especially in the last few metres 57.
  • Take more care in cold water, at depth, against a current or when stressed: there is no official limit, but the margin shrinks with each of these factors.
  • Never hold your breath during the ascent.

After

  • Keep your reliever inhaler within reach on the boat.
  • After breathing difficulty or use of the reliever inhaler: no further dive until peak flow has been back to normal for 48 hours 57.
  • Need your inhaler before every dive? That is not routine: it is often exercise-induced or poorly controlled asthma, to be reviewed with your doctor.
  • After immersion pulmonary oedema (breathlessness, cough, frothy or pink-tinged sputum while diving), the Australian and British societies strongly advise against diving again; any return to diving should be decided with a diving doctor 63.

Breathing difficulty while diving: what to do

  1. Signal, stop exerting yourselfMake the agreed signal to your buddy or instructor. Do not panic, do not let go of the regulator.
  2. Ascend, breathing outAt the speed of your dive computer, without ever holding your breath: air trapped behind a closed bronchus expands during the ascent 4. Complete any mandatory decompression stops if the difficulty eases; otherwise, go straight to the surface, skipping any optional safety stop 37.
  3. On the boatRemove the wetsuit, keep the diver seated and leaning forward, give the reliever inhaler. Any difficulty after a dive may be a diving accident: oxygen by non-rebreather (high-concentration) mask, 15 L/min, without waiting, and raise the alarm: in France, 196 or VHF channel 16 at sea, 15 or 112 on land; elsewhere, VHF channel 16 at sea and the local emergency number on land (112 throughout the EU) 37 41.
The inhaler: how many puffs? A mild attack is treated with 4 puffs of salbutamol, one at a time, shaking the inhaler before each puff, with a spacer if possible, repeated according to the response within the hour (GINA 2026, more economical in doses than in the past) 6. The SPLF (2021) provides, for a severe attack, 4 to 10 puffs every 20 minutes during the first hour 9. The GINA rule that reserves oxygen for a saturation below 92% concerns an asthma attack outside diving: after a dive, oxygen is given straight away.

Where are the hyperbaric chambers?

Do not take the casualty to a chamber yourself: raise the alarm first. The emergency services decide where and how the diver is transported 64. At sea in France, call 196 (CROSS, France’s maritime rescue coordination centres) and put out a MAYDAY on VHF channel 16, which is essential if there is no mobile coverage: the CROSS treat any suspected diving accident as a distress situation, and 196 puts you through to the emergency medical coordinator (médecin régulateur) of the maritime medical emergency service (SCMM, Samu de coordination médicale maritime) 41. On land in France, call 15 or 112; elsewhere, the local emergency number (112 throughout the EU) 64. While waiting for help: oxygen by non-rebreather (high-concentration) mask, 15 litres per minute 37. This map is for knowing where the centres are, for instance before a diving trip far from home; in remote areas, a chamber open around the clock is not guaranteed 64.

Map of the hyperbaric centres of metropolitan FranceAjaccio: Centre hospitalier Notre-Dame de la MiséricordeAjaccioAngers: CHU d'AngersAngersAvignon: Centre hospitalier d'Avignon (Henri-Duffaut)AvignonBesançon: CHU de Besançon, hôpital Jean-MinjozBesançonBordeaux: CHU de Bordeaux, hôpital PellegrinBordeauxBrest: CHU de Brest, hôpital de la Cavale BlancheBrestGarches: AP-HP, hôpital Raymond-PoincaréGarchesLille: CHU de Lille, hôpital Roger-SalengroLilleLyon: Hospices civils de Lyon, hôpital Édouard-HerriotLyonMarseille: Hôpital privé Clairval ; AP-HM, hôpital Sainte-MargueriteMarseille (2)Nice: CHU de Nice, hôpital PasteurNicePerpignan: Clinique Saint-PierrePerpignanReims: CHU de Reims, hôpital Maison-BlancheReimsStrasbourg: Hôpitaux universitaires de Strasbourg, hôpital de HautepierreStrasbourgToulon: Hôpital d'instruction des armées Sainte-AnneToulonToulouse: CHU de Toulouse, hôpital PurpanToulouse
Centres: MEDSUBHYP list 65, checked one by one on 8 November 2026; a note flags each centre whose treatment of diving accidents is not, or not fully, confirmed. Base map: IGN 66. Positions: © OpenStreetMap contributors (ODbL).

Metropolitan France (17)

  1. AjaccioCentre hospitalier Notre-Dame de la MiséricordeChamber listed by MEDSUBHYP; we found no hospital page confirming that it treats diving accidents.Hospital website · Google Maps
  2. AngersCHU d'AngersHospital website · Google Maps
  3. AvignonCentre hospitalier d'Avignon (Henri-Duffaut)Chamber moved from the Urbain V private hospital to the general hospital in February 2026; round-the-clock treatment of diving accidents at the new site is not confirmed 67.Hospital website · Google Maps
  4. BesançonCHU de Besançon, hôpital Jean-MinjozChamber listed by MEDSUBHYP; we found no hospital page confirming that it treats diving accidents.Hospital website · Google Maps
  5. BordeauxCHU de Bordeaux, hôpital PellegrinHospital website · Google Maps
  6. BrestCHU de Brest, hôpital de la Cavale BlancheHospital website · Google Maps
  7. GarchesAP-HP, hôpital Raymond-PoincaréTreatment of diving accidents reported by an indirect source, not confirmed by a hospital page.Hospital website · Google Maps
  8. LilleCHU de Lille, hôpital Roger-SalengroHospital website · Google Maps
  9. LyonHospices civils de Lyon, hôpital Édouard-HerriotHospital website · Google Maps
  10. MarseilleHôpital privé ClairvalHospital website · Google Maps
  11. MarseilleAP-HM, hôpital Sainte-MargueriteHospital website · Google Maps
  12. NiceCHU de Nice, hôpital PasteurHospital website · Google Maps
  13. PerpignanClinique Saint-PierreHospital website · Google Maps
  14. ReimsCHU de Reims, hôpital Maison-BlancheHospital website · Google Maps
  15. StrasbourgHôpitaux universitaires de Strasbourg, hôpital de HautepierreHospital website · Google Maps
  16. ToulonHôpital d'instruction des armées Sainte-AnneHospital website · Google Maps
  17. ToulouseCHU de Toulouse, hôpital PurpanHospital website · Google Maps

Overseas (6)

  1. Dumbéa (Nouméa) · New CaledoniaCentre hospitalier territorial Gaston-Bourret (Médipôle de Koutio)Reported out of service in September 2024 for lack of qualified staff; current status unknown: check with the emergency services before diving 68.Hospital website · Google Maps
  2. Fort-de-France · MartiniqueCHU de Martinique, hôpital Pierre-Zobda-QuitmanChamber listed by MEDSUBHYP; we found no hospital page confirming that it treats diving accidents.Hospital website · Google Maps
  3. Mamoudzou · MayotteCentre hospitalier de MayotteTreatment of diving accidents reported by an indirect source, not confirmed by a hospital page.Google Maps
  4. Pirae (Tahiti) · French PolynesiaCentre hospitalier de la Polynésie française (Taaone)Hospital website · Google Maps
  5. Pointe-à-Pitre – Les Abymes · GuadeloupeCHU de la GuadeloupeChamber listed by MEDSUBHYP; we found no hospital page confirming that it treats diving accidents.Google Maps
  6. Saint-Pierre · RéunionCHU de La Réunion, site SudHospital website · Google Maps

Special cases

The questions we are asked

I had asthma as a child, and nothing now

Any history of asthma, even a long-past one, goes through the respiratory physician 5. Normal spirometry and the absence of symptoms will often be enough to settle the doubt.

My child has asthma: can they dive?

Scuba diving starts at 8 years old at the FFESSM, with depths limited by age: 6 metres for the Bronze and Silver Diver awards (Plongeur de bronze, d’argent), 12 metres for the Gold Diver award (Plongeur d’or), and Level 1 from 12 years 18.

For the asthmatic child, the French recommendations of 2020 do not recommend diving before 12 years, even if the asthma is controlled 10. Australia excludes it from 10 to 15 years, the Netherlands until 14 years 19 20. The health questionnaire for minors does not exempt them from a certificate for scuba diving 69, and the UCPA (a French outdoor-holiday organisation) refuses on diving holidays any minor with suspected asthma 70.

Do I need a certificate for an introductory dive?

No: the certificate is required neither for an introductory dive, nor for the PE12, the Pass Découverte or the first “étoile de mer” (FFESSM beginner levels) 14. But no certificate does not mean no contraindication: uncontrolled, exercise-induced or cold-induced asthma, or symptoms on the day, also rule out an introductory dive. Tell the instructor.

Can I take my inhaler before diving?

Opinions differ. The British committee considers it “perhaps a good idea” half an hour beforehand 57; the FFESSM takes no position. No study has measured the risk of cardiac arrhythmia when diving; at high doses, salbutamol can cause it 6.

Above all, asthma that needs the inhaler to cope with the effort of diving looks like exercise-induced asthma, which is a contraindication in France. Talk to your doctor.

What about montelukast (Singulair)?

The French recommendations of 2020 rule out leukotriene receptor antagonists in divers, because of their psychiatric adverse effects reported by the ANSM (the French medicines agency) in 2020 10, and the European standard for professional divers asks that they be avoided or monitored 62. The British committee, for its part, accepts them 57.

Nitrox, rebreather, trimix?

The assessment of the asthmatic is the same whatever the gas or the equipment; no study covers the asthmatic using nitrox or a rebreather. One nuance: high oxygen pressures irritate the bronchi, and the 2020 recommendations consider it desirable not to expose uncontrolled or poorly controlled asthma to them 10. For hypoxic trimix, the certificate must come from a federation doctor, a doctor holding a diploma in underwater medicine or a sports physician 14.

I have allergies, but no asthma

No contraindication linked to asthma; however, do not dive with a blocked nose (ears and sinuses). Two small studies show that the bronchi of atopic divers react more just after a deep dive, a transient effect in one of them 47 48. Any new cough or breathing difficulty should be reported to the doctor.

I dive abroad, with PADI or SSI

These organisations use an international questionnaire. Since 2020, it asks for a medical opinion in case of asthma, wheezing or severe allergy in the last 12 months, if they limit your physical activity 71. The examining doctor’s guidance then prefers an exercise test 59. These rules differ from the French rules. Even if this questionnaire does not send you to the doctor, the risks remain the same: do not go diving without having been assessed, and bring your latest spirometry report.

What is immersion pulmonary oedema?

An accident in which the lungs fill with fluid during immersion: breathlessness, cough, frothy or pink-tinged sputum. Increasingly recognised in France, it is sometimes severe: a reference centre treated 288 cases in 14 years, severe in nearly a third of them 32. In open-water swimmers, asthma is associated with it, but the association disappears once recent respiratory symptoms are taken into account 33. After an episode, the Australian and British societies strongly advise against resuming scuba diving 63.

What about freediving?

This site deals with scuba diving; so does the FFESSM’s thinking on asthma 2. For freediving (breath-hold diving), ask your doctor’s opinion.

How many people have asthma?

In France, about 6% of adults have current asthma: 5.8% in the Constances cohort (volunteers, 2013-2014) 7, 6 to 7% according to Santé publique France (the French national public health agency) 8. Worldwide, about 5.4% of 5-to-69-year-olds had current asthma in 2019 (confidence interval 3.2 to 9%) 72.

Are there tests other than spirometry?

Yes. Spirometry measures the bronchi at rest; but irritable bronchi can be normal at rest and close up on exercise, in the cold or in dry air. Provocation tests look for this hyperresponsiveness: the bronchi are provoked, then the fall in FEV1 is measured.

There are two families. The methacholine test acts directly on the bronchi (see below). The so-called indirect tests (exercise, dry-air hyperventilation, hypertonic saline, mannitol) make the cells of the bronchi release inflammatory mediators: they are more specific for ongoing bronchial inflammation. Exercise and saline have a further advantage: they expose the diver to what they will really encounter, since the regulator can project a fine mist of seawater, that is, hypertonic salt water. And since inhaled corticosteroids reduce hyperresponsiveness within a few weeks, these tests also make it possible to judge the effect of the treatment 58.

The exercise test, the closest to diving

This is the test preferred by the United Kingdom and by the international examining-doctor guidance 57 59. The 2024 British protocol: a step test (the Chester test, where a metronome sets the pace: level 4, then level 5 for 5 minutes), with heart-rate monitoring, ideally breathing the dry air of a diving cylinder; then spirometry at 5, 10, 15 and 30 minutes, compared with the pre-exercise result 73. The American consensus it cites calls for quickly bringing the heart rate to 80-90% of maximum and holding it there for 4 to 6 minutes 73. A fall of less than 15% is reassuring 57.

The test is done in a clinic or laboratory, never outdoors: after a risk assessment, in particular cardiac, with a clinician trained in resuscitation, suitable equipment and the means to give a bronchodilator 74.

The same document recalls what makes exercise truly provocative: running rather than cycling, for at least five minutes, cold dry air, and taking account of the last exertion, since a recent effort can distort the test (refractory period) 73. In France too, the SPLF prefers the exercise test to methacholine when symptoms occur only on exertion 9.

Dry-air hyperventilation

The person breathes dry air very fast: this tests, in concentrated form, the weakness that the dry air of the cylinder awakens. Australia accepts it among the indirect tests 58. We found no study evaluating it for fitness to dive, and the Dutch respiratory physicians consider its value, compared with the exercise test, “not clear” 60.

Hypertonic saline

The person inhales a mist of 4.5% saline. Along with the exercise test, this is the one that Australia puts forward, because it approximates the seawater mist of the regulator 58. The international guidance, for its part, ranks it among the inhalation tests that it considers not standardised enough for diving 59.

Mannitol, not available in France

An inhaled powder given in increasing doses. Less sensitive than methacholine but more specific for asthma, it is not available in France 9. In Denmark, 41 candidates in whom asthma was suspected were tested with mannitol using a stricter threshold, a 10% fall: 21 were fit straight away, 7 more after strengthened treatment, that is 28 out of 41 (68%). The authors acknowledge it: this method has not been compared with real accidents 55.

Methacholine, the diagnostic test

In France, this is the test that the SPLF recommends to look for asthma when spirometry is normal 9. For diving, it is less convincing: the international guidance considers inhalation tests (histamine, saline, methacholine) not standardised enough to judge a diver 59. The Danish national recommendation, cited by the Copenhagen study, accepts it at the same 10% threshold as mannitol 55.

Who asks for what?

  • France: the FFESSM does not require a provocation test: only the flow-volume loop is systematic, the rest is left to the clinician’s judgement 2. The 2020 recommendations consider that it “has no value” in controlled asthma followed by a flow-volume loop with reversibility testing one to three times a year; elsewhere, they reserve it for the specialist who could not conclude from the history, examination and functional tests 10.
  • Australia: test recommended in case of asthma, wheezing or treatment in the last ten years, or unexplained cough, when spirometry is normal (if abnormal, diving is advised against straight away). A fall of more than 15%, or a gain of more than 15% after a bronchodilator, leads to advice against diving; the test can be repeated once the asthma is controlled 58.
  • United Kingdom: exercise test, fall of less than 15% 57.
  • Netherlands: indirect test (cycling or step test) recommended in every asthmatic; positive on treatment, it leads to fitness being refused, and the test can be repeated after treatment adjustment 60.
  • International questionnaire (PADI, SSI): the doctor’s guidance prefers the exercise test 59.

The full table is in Guidelines.

Sources

Every figure points back here

National and international guidelines, literature reviews and original studies. Each reference states what we read of it (full text or abstract) and when.

  1. FFESSM, Commission médicale et de prévention nationale (CMPN). Pathologies et terrains particuliers à évaluer : asthme et plongée (conditions autorisant la pratique, modèle de courrier au pneumologue, texte des recommandations). Documents posted online on 26 February 2021; text of the recommendations dated 14 June 2014. Full text read on 7 November 2026
  2. Lemmens B, Bervar J, Coëtmeur D, Nasr M, Zaegel M (FFESSM, CMPN). Asthme et plongée : texte des recommandations (argumentaire). 14 June 2014. Full text read on 7 November 2026
  3. Tetzlaff K, Muth CM. Demographics and respiratory illness prevalence of sport scuba divers. Int J Sports Med 2005;26(7):607-10. doi: 10.1055/s-2004-821229 · PMID 16195996. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  4. British Thoracic Society Fitness to Dive Group, Subgroup of the British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines on respiratory aspects of fitness for diving. Thorax 2003;58(1):3-13. doi: 10.1136/thorax.58.1.3 · PMID 12511710. Full text read on 7 November 2026
  5. FFESSM, CMPN. Asthme et plongée : conditions autorisant la pratique de la plongée (arbre décisionnel). Posted online on 26 February 2021. Full text read on 7 November 2026
  6. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2026 Strategy Report. May 2026. Relevant sections read on 7 November 2026
  7. Delmas MC, Bénézet L, Ribet C et al. [Prevalence of asthma among adults in France, data from the Constances cohort study]. Rev Mal Respir 2021;38(8):797-806. doi: 10.1016/j.rmr.2021.05.007 · PMID 34099358. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  8. Santé publique France. L’asthme en France : synthèse des données épidémiologiques descriptives. Updated 6 September 2019. Full text read on 7 November 2026
  9. Raherison-Semjen C, Guilleminault L, Billiart I et al. Mise à jour des recommandations (2021) pour la prise en charge et le suivi des patients asthmatiques adultes sous l’égide de la Société de pneumologie de langue française (SPLF) et de la Société pédiatrique de pneumologie et allergologie (SP2A). Version courte. Rev Mal Respir 2021;38:e1-e13 (long version: 38:1048-83). doi: 10.1016/j.rmr.2021.08.004. Relevant sections read on 7 November 2026
  10. MEDSUBHYP et Société française de médecine de l’exercice et du sport (SFMES). Recommandations de bonne pratique pour le suivi médical des pratiquants d’activités subaquatiques sportives et de loisir. 1st edition, July 2020. Chapters “asthma” and “children” read on 7 November 2026
  11. Code du sport. Articles L231-2-3 (certificat de moins d’un an), D231-1-5 (disciplines à contraintes particulières, dont la plongée subaquatique) et A231-1 (examen médical spécifique). Consolidated version of 8 October 2026. Articles read on 7 November 2026
  12. FFESSM, CMPN. Liste indicative des contre-indications à la plongée en scaphandre autonome. June 2025 version. Full text read on 7 November 2026
  13. FFESSM, CMPN. Asthme et plongée : modèle de courrier pour le pneumologue. Posted online on 26 February 2021. Full text read on 7 November 2026
  14. FFESSM. Règlement médical fédéral. Voted in 2025. Full text read on 7 November 2026
  15. FFESSM. Le certificat médical (modèle de certificat d’absence de contre-indication). Template, June 2026 version. Full text read on 7 November 2026
  16. Stanojevic S, Kaminsky DA, Miller MR et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022;60(1). doi: 10.1183/13993003.01499-2021 · PMID 34949706. Full text read on 7 November 2026 (accepted manuscript)
  17. Wingelaar TT, van Ooij PA, Endert EL. The lower limit for FEV(1)/FVC in dive medical assessments: a retrospective study. Diving Hyperb Med 2021;51(4):368-372. doi: 10.28920/dhm51.4.368-372 · PMID 34897602. Full text read on 7 November 2026
  18. FFESSM, Commission technique nationale. Manuel de formation technique : cursus jeunes bulles, jeunes plongeurs, adolescents. June 2026 version. Pages 1 to 5 read on 7 November 2026
  19. Elliott E, Smart D, Lippmann J et al. South Pacific Underwater Medicine Society (SPUMS) position statement regarding paediatric and adolescent diving. Diving Hyperb Med 2024;54(4):338-343. doi: 10.28920/dhm54.4.338-343 · PMID 39675742. Full text read on 7 November 2026
  20. Nederlandse Vereniging voor Duikgeneeskunde (NVD). Standpunt kinderen en duiken. 2020. Full text read on 7 November 2026
  21. Russi EW. Diving and the risk of barotrauma. Thorax 1998;53(Suppl 2):S20-4. doi: 10.1136/thx.53.2008.s20 · PMID 10193343. Full text read on 7 November 2026
  22. Tetzlaff K, Thorsen E. Breathing at depth: physiologic and clinical aspects of diving while breathing compressed gas. Clin Chest Med 2005;26(3):355-80, v. doi: 10.1016/j.ccm.2005.05.001 · PMID 16140132. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  23. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Maladie de décompression. The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  24. Adir Y, Bove AA. Can asthmatic subjects dive? Eur Respir Rev 2016;25(140):214-20. doi: 10.1183/16000617.0006-2016 · PMID 27246598. Full text read on 7 November 2026
  25. Skogstad M, Thorsen E, Haldorsen T. Lung function over the first 3 years of a professional diving career. Occup Environ Med 2000;57(6):390-5. doi: 10.1136/oem.57.6.390 · PMID 10810128. Full text read on 7 November 2026
  26. Tetzlaff K, Thomas PS. Short- and long-term effects of diving on pulmonary function. Eur Respir Rev 2017;26(143):160097. doi: 10.1183/16000617.0097-2016 · PMID 28356403. Full text read on 7 November 2026
  27. Ulm J, Blatteau JE, Aigle L et al. Impact of Self-Contained Underwater Breathing Apparatus Diving on French Military Divers' Lung Function: A Retrospective Cohort. CHEST Pulm 2025;3(4):100158. doi: 10.1016/j.chpulm.2025.100158 · PMID 42548509. Methods and results read on 7 November 2026
  28. Tetzlaff K, Friege L, Koch A et al. Effects of ambient cold and depth on lung function in humans after a single scuba dive. Eur J Appl Physiol 2001;85(1-2):125-9. doi: 10.1007/s004210100421 · PMID 11513305. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  29. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Précautions en plongée sous-marine et prévention des accidents de plongée. The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  30. Muller A, Rochoy M. Plongée sous-marine et asthme : revue de littérature. Rev Pneumol Clin 2018;74(6):416-26. doi: 10.1016/j.pneumo.2018.10.002 · PMID 30442511. Full text read on 7 November 2026
  31. D'Amato G, Noschese P, Russo M. Pollen asthma in the deep. J Allergy Clin Immunol 1999;104(3 Pt 1):710. doi: 10.1016/s0091-6749(99)70350-7 · PMID 10482854. Paywalled letter, no abstract; described from Adir and Bove 2016
  32. Kociuba M, Morin J, Marchi J et al. Clinical severity of immersion pulmonary edema: A 14-year cohort study. Am J Emerg Med 2026;110:103-110. doi: 10.1016/j.ajem.2026.08.017 · PMID 42624046. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  33. Kristiansson L, Seiler C, Braman Eriksson A et al. Suggested Novel Risk Factors for Swimming-Induced Pulmonary Edema: Asthma and Limited Open Water Swimming Experience. Chest 2026;170(2):477-487. doi: 10.1016/j.chest.2026.02.039 · PMID 41903839. Full text largely read on 7 November 2026
  34. Lippmann J, Taylor DM. Medical conditions in scuba diving fatality victims in Australia, 2001 to 2013. Diving Hyperb Med 2020;50(2):98-104. doi: 10.28920/dhm50.2.98-104 · PMID 32557410. Full text read on 7 November 2026
  35. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Revue générale des accidents de plongée sous-marine. The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  36. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Intoxication gazeuse en plongée sous-marine (oxygène, narcose à l'azote, gaz carbonique, monoxyde de carbone). The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  37. FFESSM, Commission médicale (CMPN) et Commission technique (CTN). Que faire si votre binôme (ou un plongeur) ne va pas bien pendant la plongée ? [What to do if your buddy (or a diver) is unwell during the dive?]. July 2025. Full text read on 7 November 2026
  38. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Revue générale des barotraumatismes. The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  39. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Barotraumatisme de l'oreille et des sinus. The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  40. Moon RE (Duke University Medical Center), reviewed by Birnbaumer DM. Barotraumatisme dentaire, de masque et oculaire. The MSD Manual, professional edition in French, full review June 2025. Full text read on 8 November 2026
  41. FFESSM. Alerter les secours en mer : 196 ou VHF canal 16 (CROSS) [Raising the alarm at sea: 196 or VHF channel 16 (CROSS)]. FFESSM fact sheet. Full text read on 7 November 2026
  42. Barish RA, Arnold T, reviewed by Birnbaumer DM. Revue générale des morsures et piqûres d'animaux marins. The MSD Manual, professional edition in French, full review January 2025. Full text read on 8 November 2026
  43. Ustrup AS, Ulrik CS. Are recreational SCUBA divers with asthma at increased risk? J Asthma 2017;54(8):784-791. doi: 10.1080/02770903.2016.1263861 · PMID 27905823. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  44. Gore MD, Dixon G, Stanton AE. Is it safe to SCUBA dive with asthma? Expert Rev Respir Med 2019;13(11):1069-1077. doi: 10.1080/17476348.2019.1666003 · PMID 31509025. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  45. Ledford DK. Self-contained underwater breathing apparatus diving and asthma: Where are we in 2023? Ann Allergy Asthma Immunol 2023;130(4):463-469. doi: 10.1016/j.anai.2023.01.023 · PMID 36801439. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  46. Ivkovic D, Markovic M, Todorovic BS et al. Effect of a single pool dive on pulmonary function in asthmatic and non-asthmatic divers. Diving Hyperb Med 2012;42(2):72-7. PMID 22828813. Full text read on 7 November 2026
  47. Tetzlaff K, Staschen CM, Struck N et al. Respiratory effects of a single dive to 50 meters in sport divers with asymptomatic respiratory atopy. Int J Sports Med 2001;22(2):85-9. doi: 10.1055/s-2001-11336 · PMID 11281622. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  48. Cirillo I, Vizzaccaro A, Crimi E. Airway reactivity and diving in healthy and atopic subjects. Med Sci Sports Exerc 2003;35(9):1493-8. doi: 10.1249/01.MSS.0000084424.67486.5B · PMID 12972867. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  49. Farrell PJ, Glanvill P. Diving practices of scuba divers with asthma. BMJ 1990;300(6718):166. doi: 10.1136/bmj.300.6718.166 · PMID 2105799. Letter not automatically accessible (protected PDF); described from the 2018 review
  50. Neuman TS, Bove AA, O'Connor RD et al. Asthma and diving. Ann Allergy 1994;73(4):344-50. PMID 7944003. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  51. Weiss LD, Van Meter KW. Cerebral air embolism in asthmatic scuba divers in a swimming pool. Chest 1995;107(6):1653-4. doi: 10.1378/chest.107.6.1653 · PMID 7781362. Full text behind a paywall, not accessible; abstract read on 7 November 2026
  52. Lawrence CH, Chen IY. The effect of scuba diving on airflow obstruction in divers with asthma. Diving Hyperb Med 2016;46(1):11-4. PMID 27044456. Subgroup comparisons withdrawn by the authors in December 2016 (see the partial retraction). Full text read on 7 November 2026
  53. Lawrence CH, Chen IY. Partial retraction of Lawrence CHD, Chen IYD. The effect of scuba diving on airflow obstruction in divers with asthma. Diving and Hyperbaric Medicine. 2016 March;46(1):11-14. Diving Hyperb Med 2016;46(4):262. PMID 27966207. Full text read on 7 November 2026
  54. Lippmann J, McD Taylor D, Stevenson C et al. Diving with pre-existing medical conditions. Diving Hyperb Med 2017;47(3):180-190. doi: 10.28920/dhm47.3.180-190 · PMID 28868599. Full text read on 7 November 2026
  55. Ustrup A, Pedersen SK, Suppli Ulrik C. Assessment of fitness for recreational scuba diving in candidates with asthma: a pilot study. BMJ Open Sport Exerc Med 2020;6(1):e000624. doi: 10.1136/bmjsem-2019-000624 · PMID 32095266. Full text read on 7 November 2026
  56. Tournoy KG, Vandebotermet M, Neuville P et al. Modelling the risk factors for accidents in recreational divers: results from a cross-sectional evaluation in Belgium. Diving Hyperb Med 2024;54(4):287-295. doi: 10.28920/dhm54.4.287-295 · PMID 39675736. Full text read on 7 November 2026
  57. UK Diving Medical Committee (UKDMC). Asthma (page d’information) et Asthmatic Diver Algorithm. Algorithm revised on 17 August 2024. Page and algorithm read on 7 November 2026
  58. South Pacific Underwater Medicine Society (SPUMS). The SPUMS diving medical 2025: guidelines on medical risk assessment for recreational diving (annexe « Suggested assessment for the diver with asthma »). 6th edition, September 2025. Full text read on 7 November 2026
  59. Diver Medical Screen Committee. Diving Medical Guidance (guide destiné au médecin examinateur). Version of 31 May 2023. Pulmonary chapter read on 7 November 2026
  60. NVALT, section de physiologie pulmonaire (Pays-Bas). Position paper : Ademhaling onder bijzondere omstandigheden – duiken, vliegen en hoogte. 15 February 2021. Full text read on 7 November 2026
  61. British Thoracic Society. Guideline Archive (la recommandation de 2003 sur la plongée y est classée « Archived »). Page accessed on 7 November 2026. Full text read on 7 November 2026
  62. European Diving Technology Committee (EDTC). Fitness to Dive Standards: medical assessment for work under pressure (plongée professionnelle). 2nd edition, December 2024. Full text read on 7 November 2026
  63. Banham N, Smart D, Wilmshurst P et al. Joint position statement on immersion pulmonary oedema and diving from the South Pacific Underwater Medicine Society (SPUMS) and the United Kingdom Diving Medical Committee (UKDMC) 2024. Diving Hyperb Med 2024;54(4):344-349. doi: 10.28920/dhm54.4.344-349 · PMID 39675743. Full text read on 7 November 2026
  64. Lambiase L. Should I call DAN or EMS first? Alert Diver (DAN Europe), 23 May 2025. Full text read on 8 November 2026
  65. MEDSUBHYP. Carte des centres hyperbares [Map of hyperbaric centres]. Web page, undated. Read on 8 November 2026; for 16 centres, a hospital page or an article confirms that diving accidents are treated (the others are flagged)
  66. IGN (French national mapping agency), via the france-geojson project (G. David). Admin Express COG 2018: simplified outlines of metropolitan France. Etalab open licence. Base map of the section “Where are the chambers?”
  67. Arnal-Laugier V. Le caisson hyperbare de Vaucluse est désormais au Centre Hospitalier d'Avignon [The Vaucluse hyperbaric chamber is now at Avignon General Hospital]. L'Écho du mardi, 26 February 2026. Full text read on 8 November 2026
  68. Faatau JT. Nouvelle-Calédonie : le seul caisson hyperbare à l'arrêt faute de personnel disponible depuis les émeutes [New Caledonia: the only hyperbaric chamber out of service for lack of available staff since the riots]. Outremers 360, 16 September 2024. Full text read on 8 November 2026
  69. FFESSM, CMPN. Questionnaire de santé pour les jeunes. 2 August 2021. Full text read on 7 November 2026
  70. UCPA. Certificat médical de non-contre-indication à la plongée en scaphandre, séjours mineurs. 2026. Full text read on 7 November 2026
  71. Diver Medical Screen Committee (UHMS, DAN, DAN Europe, UC San Diego). Diver Medical Participant Questionnaire (questionnaire médical du plongeur, utilisé par PADI et SSI). Version of 1 January 2026, in English and French. Full text read on 7 November 2026
  72. Song P, Adeloye D, Salim H et al. Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study. J Glob Health 2022;12:04052. doi: 10.7189/jogh.12.04052 · PMID 35765786. Full text read on 7 November 2026
  73. UK Diving Medical Committee (UKDMC). Asthma & Diving Exercise test. Revised on 18 August 2024. Full text read on 8 November 2026
  74. UK Diving Medical Committee (UKDMC). Risk Assessment for Exercise Testing. Revised on 18 August 2024. Full text read on 8 November 2026
  75. Muller A. Asthme et plongée sous-marine : création et évaluation d’un site internet destiné aux médecins, aux asthmatiques et aux moniteurs de plongée. Medical thesis, University of Lille, defended on 2 April 2019. Full text read on 7 November 2026
  76. Rochoy M, Muller A, Pelayo S, Bailleux B, Hedouin V, Girard J. Asthme et plongée sous-marine : création et évaluation d’un site internet (à destination des médecins, plongeurs asthmatiques et moniteurs de plongée). Rev Mal Respir 2021;38(1):22-33. doi: 10.1016/j.rmr.2020.11.008 · PMID 33455823. Full text read on 7 November 2026 (revised manuscript; published abstract identical)
Glossary of abbreviations
BTS
British Thoracic Society
CACI
Certificat d’absence de contre-indication (certificate of no contraindication to diving)
CMPN
Commission médicale et de prévention nationale (national medical and prevention commission) of the FFESSM
CROSS
Centres régionaux opérationnels de surveillance et de sauvetage: France’s maritime rescue coordination centres (phone 196)
FVC
Forced vital capacity (CVF in French)
FEF25-75
Forced expiratory flow between 25 and 75% of vital capacity (DEM 25-75 in French)
PEF
Peak expiratory flow, “peak flow” (DEP in French)
DMSC
Diver Medical Screen Committee (international medical questionnaire)
Médecin fédéral
FFESSM-accredited diving doctor (“federation doctor”)
PFTs
Pulmonary function tests (EFR, explorations fonctionnelles respiratoires, in French)
FFESSM
Fédération française d’études et de sports sous-marins (French Underwater Studies and Sports Federation)
GINA
Global Initiative for Asthma
MEDSUBHYP
Société de physiologie et de médecine subaquatiques et hyperbares de langue française (French-language society of underwater and hyperbaric physiology and medicine)
PADI, SSI
International diver-training organisations
SCMM
Samu de coordination médicale maritime: France’s maritime medical emergency coordination service
SFMES
Société française de médecine de l’exercice et du sport (French Society of Exercise and Sports Medicine)
SPLF
Société de pneumologie de langue française (French-language respiratory medicine society)
SPUMS
South Pacific Underwater Medicine Society (Australia, New Zealand)
UHMS
Undersea and Hyperbaric Medical Society (United States)
UKDMC
UK Diving Medical Committee (United Kingdom)
FEV1
Forced expiratory volume in one second (VEMS in French)
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