Respiratory guidance material GM

1. Applicants with significant impairment of pulmonary function shall be assessed as unfit. However, they may be assessed as fit once pulmonary function has recovered and is satisfactory.
2. Applicants for a class 1 medical certificate shall undertake pulmonary morphological and functional tests at the initial examination and when clinically indicated.
3. Applicants for a class 2 medical certificate shall undertake pulmonary morphological and functional tests when clinically indicated.
4. Applicants with a medical history or diagnosis of any of the following medical conditions shall undertake respiratory evaluation with a satisfactory result before they may be assessed as fit:
   1. asthma requiring medication;
   2. active inflammatory disease of the respiratory system;
   3. active sarcoidosis;
   4. pneumothorax;
   5. sleep apnoea syndrome;
   6. major thoracic surgery;
   7. pneumonectomy;
   8. chronic obstructive pulmonary disease.
      
      Before further consideration is given to their application, applicants with an established diagnosis of any of the medical conditions specified in points (3) and (5) shall undergo satisfactory cardiological evaluation.
5. Aero-medical assessment
   1. Applicants for a class 1 medical certificate with any of the medical conditions specified in point (d) shall be referred to the medical assessor of the licensing authority.
   2. Applicants for a class 2 medical certificate with any of the medical conditions specified in point (d) shall be assessed in consultation with the medical assessor of the licensing authority.
6. Applicants for a class 1 medical certificate who have undergone a pneumonectomy shall be assessed as unfit.

CLASS 1 - AMC1 MED.B.015

(a) Examination

(1) Spirometry

A spirometric examination is required for initial examination and on clinical indication. Applicants with an FEV1/FVC ratio of less than 70% should be evaluated by a specialist in respiratory disease.

(2) Chest radiography

Posterior/anterior chest radiography may be required at initial, revalidation or renewal examinations if clinically or epidemiologically indicated.

CLASS 2 - AMC2 MED.B.015

(a) Examination

(1) A spirometric examination should be performed on clinical indication. Applicants with a forced expiratory volume in the first one second (FEV1)/forced vital capacity(FVC)ratio of less than 70 % should be evaluated by a specialist in respiratory disease.

(2) Posterior/anterior chest radiography may be required if clinically or epidemiologically indicated.

CLASS 1 - AMC1 MED.B.015

(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. Applicants requiring systemic steroids should be assessed as unfit.

CLASS 2 - AMC2 MED.B.015

(c) Asthma

Applicants with asthma may be assessed as fit if the asthma is considered stable with satisfactory pulmonary function tests and medication is compatible with flight safety. Applicants requiring systemic steroids should be assessed as unfit.

CLASS 1 - AMC1 MED.B.015

(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 - AMC2 MED.B.015

(d) Inflammatory disease

Applicants with active inflammatory disease of the respiratory system should be assessed as unfit pending resolution of the condition.

CLASS 1- AMC1 MED.B.015

(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.

CLASS 2 - AMC2 MED.B.015

(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.

CLASS 1 - AMC1 MED.B.015

(f) Pneumothorax

(1) Applicants with a spontaneous pneumothorax should be assessed as unfit. A fit assessment may be considered if respiratory evaluation is satisfactory:

(i) 1 year following full recovery from a single spontaneous pneumothorax;

(ii) at revalidation, six weeks following full recovery from a single spontaneous pneumothorax, with a multi-pilot limitation;

(iii) 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.

CLASS 2 - AMC2 MED.B.015

(f) Pneumothorax

(1) Applicants with spontaneous pneumothorax should be assessed as unfit. A fit assessment may be considered if respiratory evaluation is satisfactory:

(i) six weeks following full recovery from a single spontaneous pneumothorax;

(ii) following surgical intervention in the case of a recurrent pneumothorax, provided there is satisfactory recovery.

(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.

CLASS 1 - AMC1 MED.B.015

(h) Sleep apnoea syndrome

Applicants with unsatisfactorily treated sleep apnoea syndrome should be assessed as unfit.

CLASS 2 - AMC2 MED.B.015

(h) Sleep apnoea syndrome

Applicants with unsatisfactorily treated sleep apnoea syndrome should be assessed as unfit.

CLASS 1 - AMC1 MED.B.015

(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 - AMC2 MED.B.015

(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).

CLASS 1 - AMC1 MED.B.015

(b) Chronic obstructive pulmonary disease

Applicants with chronic obstructive pulmonary disease should be assessed as unfit. Applicants with only minor impairment of pulmonary function may be assessed as fit.

CLASS 2 - AMC2 MED.B.015

(b) Chronic obstructive pulmonary disease
Applicants with only minor impairment of pulmonary function may be assessed as fit.

 

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

Asthma

Initial Class 1 applicants or Class 1 holders with a new diagnosis of asthma require review by an aviation respiratory medicine specialist.

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.

Guidance material currently under review

Medical reports - Respiratory 

See Asthma clinical guidelines

Asthma Medication

Oral steroids are disqualifying for certification. Inhaled beta 2 agonists, anticholinergic medication, corticosteroids and cromoglycate are acceptable for certification. Leukotriene receptor antagonists, such as montelukast, will be considered on a case by case basis.

UK CAA Sarcoidosis flow chart

Medical reports - Respiratory 

There is a flow chart and guidance for the management of allergies available.

Pneumothorax

Acceptable surgical treatment includes thoracotomy, oversewing of apical blebs, parietal pleurectomy and Video Assisted Thoracic Surgery (VATS) pleurectomy but not chemical pleurodesis.

Recertification can be undertaken six weeks after a VATS pleurectomy. For other procedures, recertification may require a longer grounding period.

Unrestricted initial Class 1 and 2 medical certification can be considered 6 weeks after full recovery from surgical treatment with a normal post-operative chest radiograph.

If surgical treatment is not undertaken, for a primary spontaneous pneumothorax, certification is possible 6 weeks from full recovery with an OML for Class 1 for at least one year following recovery due to the possible risk of recurrence.

An applicant with a recurrent spontaneous pneumothorax that has not been surgically treated will be assessed as unfit.

Medical reports - Respiratory 

UK CAA Sleep Apnoea Flow Chart