My Flight Surgeon
Sr. Aviation Medical Examiner
This is one of a series of posts about medical issues potentially affecting a pilot’s ability to obtain a medical certificate. In this series, we will look at common problems seen by the AME, review the requirements the FAA has to consider allowing one to fly and discuss what you need to do to expedite consideration by the FAA to allow you to fly. We plan to go through all of the medical history items in Section 18 on the front of Form 8500-8 over the next several months.
I would suggest that if you are unsure of how to answer these questions in Item 18, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.
18f. Asthma or lung disease
The applicant should provide frequency and severity of asthma attacks, medications, and number of visits to the hospital and/or emergency room. For other lung conditions, a detailed description of symptoms/diagnosis, surgical intervention, and medications should be provided.
Asthma
If the asthma exhibits mild or seasonal asthmatic symptoms, and If the symptoms are infrequent, mild, have not required hospitalization or steroid medication, and no symptoms in flight, then the AME may issue the medical certificate. The pilot still must submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs, and side effects to the AME for review and forwarding to the FAA.
If the pilot has Frequent severe asthmatic symptoms, he/she must submit all pertinent medical information and current status report, include pulmonary function tests,(PFT’s), duration of symptoms, name and dosage of drugs and side effects to the FAA for consideration of a Special Issuance. If there has been a previous Special Issuance the AME may issue the medical certificate if the pilot has provided the following:
An Authorization granted by the FAA;
The applicant’s current medical status that addresses frequency of attacks and whether the attacks have resulted in emergency room visits or hospitalizations;
The AME should caution the applicant to cease flying with any exacerbation as warned in § 61.53;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
Results of pulmonary function testing, if deemed necessary, performed with last 90 days
However, The AME must defer to the AMCD or Regional Flight Surgeon if:
The symptoms worsen;
There has been an increase in frequency of emergency room, hospital, or outpatient visits;
The FEV1 is less than 70% predicted value;
The applicant requires 3 or more medications for stabilization; or
The applicant is using steroids in dosages equivalent to more than 20mg of Prednisone per day.
Chronic obstructive pulmonary disease (COPD or emphysema) or chronic bronchitis
For these conditions, the pilot is required to submit all pertinent medical information and current status report. Include an FVC/FEV1 (this is a part of the pulmonary function test). If this is the first time the condition has been reported, it will require a Special Issuance. Certification may be granted, by the FAA, when the condition is mild without significant impairment of pulmonary functions. If the applicant has frequent exacerbations or any degree of exertional dyspnea, certification may be denied by the FAA.
However for re-issuance AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
An Authorization granted by the FAA;
A statement regarding symptomatology of the condition;
A statement addressing any associated illnesses, such as heart failure;
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects; and
A pulmonary specialist evaluation that includes the results of a current pulmonary function test, performed within last 90 days.
The AME must defer to the AMCD or Regional Flight Surgeon if:
The FEV1 or FEV1/FVC is less than 70%;
The applicant has been placed on a steroid dose equivalent to greater than 20mg of Prednisone per day; or
The applicant has developed an associated cardiac condition.
GREAT reason to not smoke!!!!!!!!!!!!!!
Lobectomy (removal af a portion of a lung) reuires FAA approval for a medical certificate.
Pulmonary Fibrosis (scarring of the lungs) requires the submission of all pertinent medical information, current status report, PFT’s (pulmonary function tests) with diffusion capacity. For the diffusion capacity, one will have to get this done in a pulmonologist’s office or a hospital since it requires a more elaborate testing machine than the regular office spirometer. If the lung function is >75% predicted and no impairment, then the AME can issue the medical certificate. If it is worse than this, it will require an FAA decision.
Pulmonary Embolism (blood clots in the lungs) requires the applicant with a history of thromboembolic disease must submit the following if consideration for medical certification is desired:
Spontaneous pneumothorax (or spontaneous collapse of the lung) is a problem that can recur. A history of a single episode of spontaneous pneumothorax is considered disqualifying for airman medical certification until there is x-ray evidence of resolution and until it can be determined that no condition that would be likely to cause recurrence is present (i.e., residual blebs). On the other hand, an individual who has sustained a repeat pneumothorax normally is not eligible for certification until surgical interventions are carried out to correct the underlying problem. A person who has such a history is usually able to resume airmen duties 3 months after the surgery. No special limitations on flying at altitude are applied. Issuance of a medical certificate requires FAA approval.
There are other less common diseases of the lungs and chest that we will not take time to discuss now. As with many other disease processes, if all of the documentation is available to the AME, he/she can call the duty officer in OKC to discuss a disposition over the phone.
*Italicized text is from FAA documents
I would suggest that if you are unsure of how to answer these questions in Item 18, you discuss them with your AME before you complete the form. Some things may not be significant while others will require explanation.
18f. Asthma or lung disease
The applicant should provide frequency and severity of asthma attacks, medications, and number of visits to the hospital and/or emergency room. For other lung conditions, a detailed description of symptoms/diagnosis, surgical intervention, and medications should be provided.
Asthma
If the asthma exhibits mild or seasonal asthmatic symptoms, and If the symptoms are infrequent, mild, have not required hospitalization or steroid medication, and no symptoms in flight, then the AME may issue the medical certificate. The pilot still must submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs, and side effects to the AME for review and forwarding to the FAA.
If the pilot has Frequent severe asthmatic symptoms, he/she must submit all pertinent medical information and current status report, include pulmonary function tests,(PFT’s), duration of symptoms, name and dosage of drugs and side effects to the FAA for consideration of a Special Issuance. If there has been a previous Special Issuance the AME may issue the medical certificate if the pilot has provided the following:
However, The AME must defer to the AMCD or Regional Flight Surgeon if:
Chronic obstructive pulmonary disease (COPD or emphysema) or chronic bronchitis
For these conditions, the pilot is required to submit all pertinent medical information and current status report. Include an FVC/FEV1 (this is a part of the pulmonary function test). If this is the first time the condition has been reported, it will require a Special Issuance. Certification may be granted, by the FAA, when the condition is mild without significant impairment of pulmonary functions. If the applicant has frequent exacerbations or any degree of exertional dyspnea, certification may be denied by the FAA.
However for re-issuance AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
The AME must defer to the AMCD or Regional Flight Surgeon if:
GREAT reason to not smoke!!!!!!!!!!!!!!
Lobectomy (removal af a portion of a lung) reuires FAA approval for a medical certificate.
Pulmonary Fibrosis (scarring of the lungs) requires the submission of all pertinent medical information, current status report, PFT’s (pulmonary function tests) with diffusion capacity. For the diffusion capacity, one will have to get this done in a pulmonologist’s office or a hospital since it requires a more elaborate testing machine than the regular office spirometer. If the lung function is >75% predicted and no impairment, then the AME can issue the medical certificate. If it is worse than this, it will require an FAA decision.
Pulmonary Embolism (blood clots in the lungs) requires the applicant with a history of thromboembolic disease must submit the following if consideration for medical certification is desired:
- Hospital admission and discharge summary
- Current status report including:
- Detailed family history of thromboembolic disease
- Neoplastic workup, if clinically indicated
- PT/PTT
- Protein S & C
- Leiden Factor V
- If still anticoagulated, submit all (no less than monthly) INR from time of hospital discharge to present
Spontaneous pneumothorax (or spontaneous collapse of the lung) is a problem that can recur. A history of a single episode of spontaneous pneumothorax is considered disqualifying for airman medical certification until there is x-ray evidence of resolution and until it can be determined that no condition that would be likely to cause recurrence is present (i.e., residual blebs). On the other hand, an individual who has sustained a repeat pneumothorax normally is not eligible for certification until surgical interventions are carried out to correct the underlying problem. A person who has such a history is usually able to resume airmen duties 3 months after the surgery. No special limitations on flying at altitude are applied. Issuance of a medical certificate requires FAA approval.
There are other less common diseases of the lungs and chest that we will not take time to discuss now. As with many other disease processes, if all of the documentation is available to the AME, he/she can call the duty officer in OKC to discuss a disposition over the phone.
*Italicized text is from FAA documents
