Asthma in military aviators: Safe flying is possible

Introduction: Asthma is considered relatively incompatible with aviation. Firstly, due to the risk of sudden incapacitation, and secondly, due to cold and dry air and other asthmogenic factors characteristic of the aviation environment. The medical requirements for flying fitness of asthmatic aviators are inconsistent between different air services, and many flight surgeons are unfamiliar with the recent developments in asthma management. This study aims to describe our experience with asthmatic aviators and to discuss the medical standards required for flying fitness in chronic asthma. Methods: The records of all aviators diagnosed with asthma between January 1988 and September 2005 were reviewed. Pulmonary function tests and examination by a pulmonary disease specialist and flight surgeon were performed at least annually. Results: Nineteen Israeli Air Force aviators with asthma were studied. Most were treated with inhaled long-acting β agonists and corticosteroids. Disease control was satisfactory in more then 90%, with significant worsening in only one case. We had no cases of sudden incapacitation or any other safety breach. One aviator was grounded 23 yr after diagnosis due to deterioration in the severity of the disease, and another aviator was permanently grounded 1 yr after diagnosis. Conclusions: Adequate asthma control is readily feasible, even in the aviation environment. Long-term inhaled corticosteroids are effective and have few side effects in aviators. Our management approach to aviators with asthma appears to be safe and effective.