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DISPOSAL ASTHMA CASES




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Reference : AIC 4 / 07  dated 01 Aug 2007

  • Diagnosis:

    • History and Physical Examination –

      • The classic triad of symptoms associated with asthma consists of cough, shortness of breath, and wheezing occurring  simultaneously.

      •  Widespread, high-pitched, musical wheezes are characteristic of asthma although they are not specific.

    • Pulmonary Function Testing –

      • Pulmonary function tests are key to the diagnosis of asthma.

      • Spirometry and peak expiratory flow rate and are the two pulmonary function tests most often diagnostic of asthma.

        • Peak Expiratory Flow Rate – The peak expiratory flow rate (PEFR) is measured during a maximal exhalation that has immediately followed a maximal inhalation.

        • Spirometry – Spirometry, which includes measurement of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), is a readily available and useful pulmonary function test.

          • FEV1 is the most important spirometric variable for assessment of airflow obstruction.

          • The FEV1 reflects the average flow rate during the first second of the forced vital capacity (FVC) maneuver.

          • It declines in direct and linear proportion with clinical worsening of airways obstruction, and it increases with successful treatment of airways obstruction.

        • Bronchoprovocation Testing – Another strategy for diagnosing asthma in patients with normal lung function is to attempt to provoke airflow obstruction using a stimulus known to elicit airway narrowing.

          •  The provocative stimulus should be in the form of exercise.

          •  Baseline spirometry and after exercise for a fixed duration are done.

          • A change in more than 15% FEV1 constitutes a positive broncho-provocative test.

  • Impairment Rating

    • Mild

      • No history of any severe exacerbation in preceding 01 yrs .

      • FEV1 > 80 % predicted.

      • Occasional inhaled bronchodilator/ chromoglycate / steroids for symptom control.

      •

    • Moderate

      • No history of any severe exacerbation in preceding 06 months.

      • FEV1 > 70 % predicted .

      • Regular inhaled chromoglycate / low dose steroids for symptom control with occasional inhaled bronchodilators.

    • Severe

      • FEV1 < 70% of predicted

      • Individual requiring hospitalization or oral bronchodilators / parentral medication / nebuliser for control of bronchospasm

       

  • DISPOSAL (The disposals are applicable only for trained aircrew and not for initial medical for flying duties)

    • An aircrew that has suffered from an acute attack and is detected for the first time to have bronchial asthma will be made unfit for flying for an initial spell of 03 months.

    • After 03 months if he remains symptom free and all investigations are normal or in ‘mild impairment range’ will be awarded P1 status to fly with a qualified P2. If on periodic review he remains symptom free for more than 2 years he can be awarded full flying status. A certificate from the individual about the medication being taken and a certificate from the treating Physician with regards to the medication prescribed must be attached.

    • If his impairment range falls in the moderate range , he will be made fit to fly as P2 for 6 months. Disposal thereafter will depend on status; if individual improves to mild status , the disposal will be as above and if continues as moderate severity as , then he will continue in P2 status only. A certificate from the individual about the medication being taken and a certificate from the treating Physician with regards to the medication prescribed must be attached.

    • If he falls in the severe range he will be declared UNFIT for flying. A certificate from the individual about the medication being taken and a certificate from the treating Physician with regards to the medication prescribed must be attached.

    •

           

Fitness Certificate to be Brought From the Concern Specialist counter signed by the Company Doctor

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