Asthma

Guidance for medical examiners when assessing a patient for either a general topic or condition – Asthma.

Aeromedical implications (partial / total incapacitating features / hypoxia / hypobaria)

Effect of aviation on condition

  • Hypoxia
  • Cold triggers
  • Chemicals
  • Use of breathing apparatus

Effect of condition on aviation

  • Overt incapacitation with acute attack
  • Subtle with uncontrolled poorly controlled
  • Distraction due to treatment and symptoms

Approach to medical certification

Based on the condition

  • Respiratory function [FER>70%; Reversibility post bronchodilator FVC and FEV1 less than 12%; PaO2 on air >95%]

Based on treatment

  • Not oral steroids / theophylline

Demonstrated stability

  • Absence of symptoms
  • No hospital admissions - 12M
  • No requirement for prednisone or other oral/IV steroids in 12M

Risk assessment protocol - information required

New cases

  • Confirmed diagnosis
  • Clinical status
    • progress
    • reliever use
    • preventative therapy
    • exacerbations (precipitating factors / frequency / severity / steroid use / hospitalisation)
  • Investigations conducted
  • Spirometry pre and post bronchodilator (mandatory within past 3M)
  • Challenge test (if undertaken)
  • Other tests and interventions previously undertaken
  • Management
    • treatment
    • side-effects
    • monitoring /peak flow diary
  • Follow-up plan
  • Previous specialist reports if available.

Renewal

  • Clinical status
    • progress
    • reliever use
    • preventative therapy
    • exacerbations (precipitating factors / frequency / severity / steroid use / hospitalisation)
  • Investigations conducted
  • Spirometry pre and post bronchodilator (mandatory within past 3M)
  • Management
    • treatment
    • side-effects
    • monitoring /peak flow diary
  • Follow-up plan.

Indicative outcomes

Asthma which is well-controlled (including using inhaled preventer therapy) may be eligible for any class of medical certificate. Unstable asthma and relevant triggers will need individual consideration.

Favourable

  • Stable asthma
  • Inhaled preventers
  • Inhaled bronchodilators

Unfavourable

  • Exacerbation in dry air
  • Unstable
  • Steroid requirement (oral)

Pilot and controller information

  • Any flare-up must be reported to the DAME
  • Doses of prednisolone over 10mg (or equivalent) are safety relevant and not acceptable
  • A reliever inhaler (eg Salbutamol) must be kept readily available for use when flying

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Disclaimer

The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/asthma
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