Respiratory Guidance Material

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on respiratory conditions

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the respiratory system.

Implementing Rules	Acceptable Means of Compliance	Guidance Material
MED.B.015 Respiratory System
(a) Applicants with significant impairment of pulmonary function shall be assessed as unfit. A fit assessment may be considered once pulmonary function has recovered and is satisfactory. (b) For a Class 1 medical certificate, applicants are required to undertake pulmonary function tests at the initial examination and on clinical indication. (c) For a Class 2 medical certificate, applicants are required to undertake pulmonary function tests on clinical indication.	Class 1 (a) Examinations (1) Spirometry Spirometric examination is required for initial examination. An FEV₁/FVC ratio less than 70% at initial examination should require evaluation by a specialist in respiratory disease. (2) Chest radiography Posterior/anterior chest radiography may be required at initial, revalidation or renewal examinations when indicated on clinical or epidemiological grounds. Class 2 (a) Chest radiography Posterior/anterior chest radiography may be required if indicated on clinical grounds. (1) Spirometry Spirometric examination is required for initial examination. An FEV/FVC ratio less than 70% at initial examination should require evaluation by a specialist in respiratory disease. (2) Chest radiography Posterior/anterior chest radiography may be required at initial, revalidation or renewal examinations when indicated on clinical or epidemiological grounds.	Exercise Spirometry testing Exercise spirometry testing is required if there is any of the following: 1. Abnormal lung function: Class 1 : FEV₁/FVC <70% Class 2:Peak flow <80% predicted 2. History of asthma: Class 1 current or within last 5yrs Class 2 current or within last 2yrs Asthma needing regular (> once per 3 months) use of any inhaler 3. Any other indication Medical reports - Respiratory
(d) Applicants with a history or established diagnosis of: (1) asthma requiring medication;	Class 1 & 2 (c) Asthma Applicants with asthma requiring medication or experiencing recurrent attacks of asthma, may be assessed as fit if the asthma is considered stable with satisfactory pulmonary function tests and medication is compatible with flight safety. Systemic steroids are disqualifying.	Asthma Initial Class 1 applicants or Class 1 holders with a new diagnosis of asthma require review by CAA consultant advisor in respiratory medicine. Class 1 holders with an established diagnosis of asthma who are stable, or initial Class 2 applicants, require local respiratory specialist review, to include exercise spirometry and details of medication required. A history of asthma attacks requiring acute medical intervention/admission within past 5 years for Class 1 and 2 years for Class 2 and/or repeated courses of oral steroids/frequent exacerbations is normally disqualifying. UK CAA Asthma guidance Medical reports - Respiratory See Asthma clinical guidelines Asthma Medication Oral steroids are disqualifying for certification. Inhaled beta 2 agonists, anticholinergic medication, corticosteroids, cromoglycate and the leukotriene receptor antagonists, such as montelukast, are acceptable for certification.

Implementing Rules	Acceptable Means of Compliance	Guidance Material
(2) active inflammatory disease of the respiratory system;	Class 1 (b) Chronic obstructive airways disease Applicants with chronic obstructive airways disease should be assessed as unfit. Applicants with only minor impairment of their pulmonary function may be assessed as fit. (d) Inflammatory disease For applicants with active inflammatory disease of the respiratory system, a fit assessment may be considered when the condition has resolved without sequelae and no medication is required.
	Class 2 (b) Chronic obstructive airways disease Applicants with only minor impairment of pulmonary function may be assessed as fit. (d) Inflammatory disease Applicants with active inflammatory disease of the respiratory system should be assessed as unfit pending resolution of the condition.
(3) active sarcoidosis;	Class 1 (e) Sarcoidosis (1) Applicants with active sarcoidosis should be assessed as unfit. Investigation should be undertaken with respect to the possibility of systemic, particularly cardiac, involvement. A fit assessment may be considered if no medication is required, and the disease is investigated and shown to be limited to hilar lymphadenopathy and inactive. (2) Applicants with cardiac sarcoid should be assessed as unfit.	UK CAA Sarcoidosis flow chart Medical reports - Respiratory
	Class 2 (e) Sarcoidosis (1) Applicants with active sarcoidosis should be assessed as unfit. Investigation should be undertaken with respect to the possibility of systemic involvement. A fit assessment may be considered once the disease is inactive. (2) Applicants with cardiac sarcoid should be assessed as unfit.	UK CAA Sarcoidosis flow chart

Implementing Rules	Acceptable Means of Compliance	Guidance Material
(4) pneumothorax;	Class 1 (f) Pneumothorax (1) Applicants with a spontaneous pneumothorax should be assessed as unfit. A fit assessment may be considered if respiratory evaluation is satisfactory: 1.1 one year following full recovery from a single spontaneous pneumothorax; 1.2 at revalidation, six weeks following full recovery from a single spontaneous pneumothorax, with a multi-pilot limitation; 1.3 following surgical intervention in the case of a recurrent pneumothorax provided there is satisfactory recovery. (2) A recurrent spontaneous pneumothorax that has not been surgically treated is disqualifying. (3) A fit assessment following full recovery from a traumatic pneumothorax as a result of an accident or injury may be acceptable once full absorption of the pneumothorax is demonstrated.	Pneumothorax Acceptable surgical treatment includes thoractomy, oversewing of apical blebs, parietal pleurectomy and Video Assisted Thoracic Surgery (VATS) pleurectomy. Recertification can be undertaken six weeks after a VATS pleurectomy. For other procedures, recertification may require a longer grounding period. If 6 weeks following successful surgical treatment with a normal post-operative chest radiograph, unrestricted initial Class 1 and 2 medical certification can be considered. If surgical treatment is not undertaken, an OML for Class 1 is required for one year following the pneumothorax due to the possible risk of recurrence. Medical reports - Respiratory
	Class 2 (f) Pneumothorax (1) Applicants with spontaneous pneumothorax should be assessed as unfit. A fit assessment may be considered if respiratory evaluation is satisfactory six weeks following full recovery from a single spontaneous pneumothorax or following recovery from surgical intervention in the case of treatment for a recurrent pneumothorax. (2) A fit assessment following full recovery from a traumatic pneumothorax as a result of an accident or injury may be acceptable once full absorption of the pneumothorax is demonstrated.
(5) sleep apnoea syndrome	Class 1&2 (h) Sleep apnoea syndrome Applicants with unsatisfactorily treated sleep apnoea syndrome should be assessed as unfit.	UK CAA Sleep Apnoea Flow Chart Medical reports - Respiratory
(6) major thoracic surgery;	Class 1 (g) Thoracic surgery (1) Applicants requiring major thoracic surgery should be assessed as unfit for a minimum of three months following operation or until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s). (2) A fit assessment following lesser chest surgery may be considered by the licensing authority after satisfactory recovery and full respiratory evaluation.
	Class 2 (g) Thoracic surgery Applicants requiring major thoracic surgery should be assessed as unfit until such time as the effects of the operation are no longer likely to interfere with the safe exercise of the privileges of the applicable licence(s).
7) pneumonectomy; shall undergo respiratory evaluation with a satisfactory result before a fit assessment can be considered. Applicants with an established diagnosis of the conditions specified in (3) and (5) shall undergo satisfactory cardiological evaluation before a fit assessment can be considered. (e) Aero-medical assessment: (1) applicants for a Class 1 medical certificate with any of the conditions detailed in (d) above shall be referred to the licensing authority; (2) applicants for a Class 2 medical certificate with any of the conditions detailed in (d) above shall be assessed in consultation with the licensing authority. (f) Applicants for a Class 1 medical certificate who have undergone a total pneumonectomy shall be assessed as unfit