In the article "Smoking and scuba diving”Dr. David Buch draws our attention to the fact that too many active divers are also passionate smokers. In fact, during the 15 years I spend in recreational scuba diving, I have seen a decrease in the number of smokers among swimmers. Many diving boats restrict smoking on board, but there is also a significant number of divers who "smoke" before, after, or between two dives. I am also familiar with several instructors who are also passionate smokers.
When working as a forensic expert on a daily basis, the harmful effects of tobacco smoking on human health are regularly monitored. The smoker's lungs differ not only visually, but also have a different consistency. Sometimes you even have to wonder how they can exchange the gases needed for life at all. There is also an effect of tobacco consumption on the development of atherosclerosis in peripheral and coronary arteries. Despite recent activity in the medical and popular press, where the effects of obesity on premature deaths have been reported, smoking is the leading cause of death in the world. A 2004 journal from the American Medical Society found that of all deaths in the United States in 2000, 18.1% were related to tobacco use. Other causes of death - malnutrition, car accidents and diseases - are lower.
Why not smoke? CO, or carbon monoxide, also known as Twan gas.
From a medical point of view, it is absolutely unclear why people engaged in scuba diving, where quality gas exchange and oxygen supply are essential, start or continue to smoke. Smoking can and is known to affect gas exchange in the body. Combustion of tobacco produces many toxic compounds, the best known of which is carbon monoxide. It results from incomplete combustion of any organic compounds and greatly affects the ability of red blood cells to carry oxygen to the body's tissues. In scuba diving, on the other hand, everything is directly linked to efficient gas exchange and all the factors that affect it pose an unnecessary risk. If carbon monoxide attaches to red blood cells, they are no longer able to carry oxygen. If the level of carbon monoxide in the blood in a non-smoker (the measured parameter is carboxyhemoglobin) is 2%, then in smokers this parameter is five times higher (worse).
Note: Look at the interest with distrust, because it is suspected that the original text mentions percentages, which translated into Russian as a percentage. Carbon monoxide binds to hemoglobin and does not release so easily, but its partial pressure in a normal atmosphere is so low that there are doubts about the level of 2% in non-smokers.
Lung irritation
Tobacco smoke toxins irritate the airway surface. One of the most important types of airway cells in the mucosa is the fringes, which are used to remove mucus and foreign bodies from the respiratory organs. Smoke damages these cells, causing the body to lose its ability to remove foreign bodies from the airways. This defect significantly increases the risk of developing chronic bronchitis, is the cause of the cough of a "smoker" as well as the cause of the phenomenon that passionate and prolonged smokers have to cough up significant amounts of secretions after sleep. Respiratory tract irritation can also cause unpredictable and acute bronchospasm attacks, which puts the diver at risk of severe barotrauma and gas embolism.
Emphysema
If we exclude a small group of people with congenital genetic disorders, emphysema does not occur in a non-smoker. In the lungs, gas is exchanged in small sacs called alveoli. The surface of the alveolus is covered with special cells that help transfer gases to nearby capillaries. In a non-smoker, the structure of the alveoli remains constant throughout life. In smokers, toxins in tobacco smoke break down the layer of connective tissue that makes up the alveolar structure. Emphysema breaks down the surface of the alveoli in such a way that gas exchange becomes impossible and as a result the alveoli are unable to fill and empty as needed.
In fact, the breakdown of the walls creates large air "holes" in the lungs, which are covered by thin walls. They are so thin that they can detach from the surface of the lungs. These formations, called bulls in medical terminology, can cause lung barotrauma and arterial gas embolism in a diver. Examination of the alveoli of the smoker's lungs under a microscope shows their fragmentation, which indicates unfavorable changes in the cystological (tissue) structure of the lungs.
Emphysema is an incurable chronic disease, although medications such as asthma inhalers and steroid hormones can sometimes relieve symptoms. In other cases, oxygen therapy is already needed, but in admitted cases and in the final stages of the disease, rescue is possible only by lung transplantation.
Nicotine
Nicotine is a drug that enters the body through smoke or other forms of tobacco consumption, such as sniffing or chewing. Nicotine causes temporary narrowing of blood vessels, raises blood pressure and promotes atherosclerosis with prolonged use. Atherosclerosis, in turn, causes problems with insufficient blood supply and consequent lack of oxygen to the tissues over time. If the blood vessels that supply the brain or spinal cord are involved in this process, then the end result is a diagnosis - a stroke. If the blood vessels that supply the heart are damaged, the smoker may have a heart attack. Sudden pain in the heart area indicates an ischemic disease. A stroke or heart attack during a dive is usually fatal, because even if you manage to swim and return to the ship, the necessary medical care is almost inaccessible or it is too long.
Lung cancer
One of the most dangerous consequences of prolonged and passionate smoking is lung cancer. The most common forms of lung cancer in non-smokers are rare. Smokers, on the other hand, are well aware of the link between this dangerous harm and tobacco consumption. The dangers of smoking were articulated as early as 1984 by the chief physician of the U.S. health care system and accepted by Congress for publication on all tobacco product packaging and promotional materials. Tobacco use is associated not only with the development of lung, throat or oral cancer, but also with other types of cancer. Cancer is essentially the effect of tobacco toxins on cells that lose their normal growth and self-regulatory mechanisms. Therefore, there is a definition that tobacco smoke contains carcinogenic (cancer-promoting) substances. As already mentioned, tobacco smoke irritates the airway fringes, causing the cells to change to more toxin-resistant forms, which may lack the mechanisms of normal cell growth, interaction and self-regulation.
Youth is a stage in life when many feel almost or forever. Unfortunately, medical practice often faces the consequences of such a lifestyle, where high-risk behavior is the norm for many young people. The consequences of self-destructive behavior seem so far in the future that they may not think about it now. Most young smokers have enough cardiorespiratory reserve to cope with the harmful effects of smoking. A long-term smoker, on the other hand, no longer has such a reserve and even abandoning tobacco will not be able to reverse the pathology - return to the originally normal gas exchange and circulation.
Dr. A study by David Bush mentions a DAN study that points to a possible link between smoking and the development of severe symptoms in decompression sickness. Hopefully, the information provided in both of these articles will make you think, and people will prefer safe diving instead of tobacco.
Original translation from the magazine "Octopus" Aug.-Sept. 2008 in Russian.
Text author Dr.med. Jim Carousel
Translated into Russian by Anton Cherkasov
