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STUDY OBJECTIVES: Obstructive changes in lung function have been reported with cumulative scuba diving exposure. The aim of this study was to investigate the decline in FEV(1) in scuba divers over time. DESIGN: Prospective controlled cohort study. SETTING: German Naval Medical Institute. PATIENTS: Four hundred sixty-eight healthy, male, military scuba divers and 122 submariners (control subjects) were entered. MEASUREMENTS AND RESULTS: Pulmonary function tests were performed in all subjects on at least three occasions with a minimum interval of 1 year between first and last measurement. The decline in FEV(1) was investigated fitting a general linear model to FEV(1) across time with a factorial main-effects model for slopes and intercepts with respect to the factors group, smoking status, and baseline FEV(1). Mean baseline age of all subjects was 32 years (SD, 9.1), and mean body mass index was 24.7 kg/m(2) (SD, 2.4). Subjects were followed up for 5 years (range, 1 to 9 years) on average. Baseline FEV(1) exceeded the predicted values in both divers and nondiving control subjects. There was no significant difference in the decline of FEV(1) between divers and control subjects. Over time, FEV(1) declined more rapidly in smokers than in nonsmokers (p = 0.0064) and declined more rapidly also in subjects with a baseline FEV(1) above average compared to subjects below average (p < 0.0001). The annual decline of FEV(1) peaked in smoking divers who had a high FEV(1) at baseline. CONCLUSIONS: The data indicate that scuba diving is not associated with an accelerated decline in FEV(1). Combined exposure to diving and smoking contributes to the fall of FEV(1); therefore, smoking cessation is advised for divers. [ABSTRACT FROM AUTHOR]