Postgrad Med J 84:571-578 doi:10.1136/pgmj.2008.068320
  • Review

Bubble trouble: a review of diving physiology and disease

  1. D Z H Levett1,
  2. I L Millar2
  1. 1
    Centre for Altitude, Space and Extreme Environment Medicine, UCL, London, UK
  2. 2
    Hyperbaric Service, The Alfred Hospital, Melbourne, Australia
  1. Dr D Levett, Centre for Altitude, Space and Extreme Environment Medicine, UCL, 1st Floor Charterhouse Building, Archway Campus, Highgate Hill, London N19 5LW, UK; denny.levett{at}
  • Received 14 May 2008
  • Accepted 18 August 2008


Exposure to the underwater environment for recreational or occupational purposes is increasing. Approximately 7 million divers are active worldwide and 500 000 more are training every year. Diving related illnesses are consequently an increasingly common clinical problem with over 1000 cases of decompression illness reported annually in the USA alone. Divers are exposed to a number of physiological risks as a result of the hyperbaric underwater environment including: the toxic effects of hyperbaric gases, the respiratory effects of increased gas density, drowning, hypothermia and bubble related pathophysiology. Understanding the nature of this pathophysiology provides insight into physiological systems under stress and as such may inform translational research relevant to clinical medicine. We will review current diving practice, the physics and physiology of the hyperbaric environment, and the pathophysiology and treatment of diving related diseases. We will discuss current developments in diving research and some potential translational research areas.


  • Competing interests: None declared.