ds34542
10th Oct 2015, 13:55
Hi all,
I'm looking for advice from those have succeeded in passing a Class 2 medical with moderate asthma.
I've been flying RAAus, which has 'driving standard' medical requirements, for around 6 years. I've since started a family, and I'd like to one day have the option to take all four of us up, rather than be limited to the one passenger of RAAus.
I'm just over 40 years old now, and consider myself reasonably fit - I've run two marathons, a few halves, and most recently a tough mudder (13 mile obstacle course) last year, although these days typically just do a 3-4 mile run at a 9min mile on average. I do intensive interval training circuits most mornings, and my heart recovery rates are in the "very good" range.
Despite feeling confident with all that, I sat in a cramped doctor's office a few months ago and learnt I'd failed my flight medical with the DAME on a poor FEV1/FVC ratio. For a clear pass, CASA require an FEV1/FVC of >70%, with a normal being 80% (ie. 80% of your lung capacity exhaled in one second). I scored 66%.
So - I went to a doctor for an asthma management plan, and came away with a $5 a day habit in 'Seretide' - basically inhaled steroids and reliever. Four weeks of that, and I went for another spirometry test. 66% again.
So - I took them for another month, then went back to another doctor. I was feeling positive, as I felt breathing was no longer a limiting factor at my gym sessions. It came out at 62% in the first second - actually slightly worse than before. The improvement due to a reliever was negligible, so at least it's stable, which is also a factor; a 12% improvement implies your asthma isn't properly managed and is a serious issue.
So - it does seem that my asthma isn't going to disappear, and I'm going to have to work with what I have. The question is, does this mean I'm never going to be able to pass my Class 2?
The regulations seem a little confusing as to what is acceptable, and what is not:
The Avmed guidelines on the CASA website (http://services.casa.gov.au/avmed/guidelines/asthma.asp) give the 70% FEV1/FVC (FER in their guide) as the acceptable threshold, which I'm below
The DAME Manual (https://www.casa.gov.au/sites/g/files/net351/f/_assets/main/lib100096/foi_f13_5348.pdf) covers asthma in section 2.3.5, and states:
In the case of applicants with moderate well controlled asthma, periodic assessment by a respiratory physician may be required. CASA will notify specific requirements on a case-by-case basis.
I fall into the 'moderate' category as:
Their FEV1 or peak flow will be in the range 60-80% predicted, and peak flow variability may be greater than 15%. Treatment requirements will likely include low to moderate doses of inhaled corticosteroid, (e.g. beclomethasone 400-1000 micrograms per day or equivalent).
(I'm on 2000ug of seretide, but since it seems to have no impact on my FER compared to untreated, I can likely bring that down)
The actual CASR 67.155 (https://www.comlaw.gov.au/Details/F2015C00762/Html/Volume_2#_Toc429575752) Table 2.12 states for Class 2 medical:
Is not suffering from a safety-relevant condition of the respiratory system.
And that's all the actual regs have to say on it
So - it all sounds like a 'maybe'. I looked up the regs in the UK and US, and they seem similar - the UK requires a dedicated Brochial Reactionary test, which involves running for 6 minutes and testing FER before and after; a decline of less than 16% FER after exercise is acceptable for an unrestricted Class 2.
The FAA is similar - below 80% of predicted (my result was 78% of predicted) requires dedicated testing.
So - faced with all that - can anyone suggest what would my options be with CASA? It seems I fall into the 'moderate asthma' category by definition, but I can't find anything in writing with regards to any equivalent to the CAA Bronchial Reactivity tests that would specifically determine my suitability in the 'grey area'. CASA allude to such a test for 'moderate asthmatics', but I can't find information on what would perform that, and what their criteria would be.
It's a frustrating situation, particularly to see pilots twenty years older passing their medicals, while I'm running around a gym with twenty-year olds every morning, to be told I'm not physiologically safe to go up in the air. From what I can determine, the primary risk caused by asthma in my circumstance is hypoxia, as from memory a pilot may operate at 10,000ft indefinitely or 14,000ft for half an hour, and so must be medically fit to do so. In my entire 140 hours, I think I flew to 10,000ft once to see what was up there, and most aircraft I fly can't get to 14,000ft.
I'd be very interested in anyone else's experiences in a similar situation? Did you get referred, and get passed by a specialist? Did you get any restrictions on your licence - such as a maximum operating altitude? Did CASA flat-out deny the class 2? Or are there any tips and tricks to passing the medical (eg. Deep breathing exercises, or even practicing spirometry tests)?
Thanks!
Damian
I'm looking for advice from those have succeeded in passing a Class 2 medical with moderate asthma.
I've been flying RAAus, which has 'driving standard' medical requirements, for around 6 years. I've since started a family, and I'd like to one day have the option to take all four of us up, rather than be limited to the one passenger of RAAus.
I'm just over 40 years old now, and consider myself reasonably fit - I've run two marathons, a few halves, and most recently a tough mudder (13 mile obstacle course) last year, although these days typically just do a 3-4 mile run at a 9min mile on average. I do intensive interval training circuits most mornings, and my heart recovery rates are in the "very good" range.
Despite feeling confident with all that, I sat in a cramped doctor's office a few months ago and learnt I'd failed my flight medical with the DAME on a poor FEV1/FVC ratio. For a clear pass, CASA require an FEV1/FVC of >70%, with a normal being 80% (ie. 80% of your lung capacity exhaled in one second). I scored 66%.
So - I went to a doctor for an asthma management plan, and came away with a $5 a day habit in 'Seretide' - basically inhaled steroids and reliever. Four weeks of that, and I went for another spirometry test. 66% again.
So - I took them for another month, then went back to another doctor. I was feeling positive, as I felt breathing was no longer a limiting factor at my gym sessions. It came out at 62% in the first second - actually slightly worse than before. The improvement due to a reliever was negligible, so at least it's stable, which is also a factor; a 12% improvement implies your asthma isn't properly managed and is a serious issue.
So - it does seem that my asthma isn't going to disappear, and I'm going to have to work with what I have. The question is, does this mean I'm never going to be able to pass my Class 2?
The regulations seem a little confusing as to what is acceptable, and what is not:
The Avmed guidelines on the CASA website (http://services.casa.gov.au/avmed/guidelines/asthma.asp) give the 70% FEV1/FVC (FER in their guide) as the acceptable threshold, which I'm below
The DAME Manual (https://www.casa.gov.au/sites/g/files/net351/f/_assets/main/lib100096/foi_f13_5348.pdf) covers asthma in section 2.3.5, and states:
In the case of applicants with moderate well controlled asthma, periodic assessment by a respiratory physician may be required. CASA will notify specific requirements on a case-by-case basis.
I fall into the 'moderate' category as:
Their FEV1 or peak flow will be in the range 60-80% predicted, and peak flow variability may be greater than 15%. Treatment requirements will likely include low to moderate doses of inhaled corticosteroid, (e.g. beclomethasone 400-1000 micrograms per day or equivalent).
(I'm on 2000ug of seretide, but since it seems to have no impact on my FER compared to untreated, I can likely bring that down)
The actual CASR 67.155 (https://www.comlaw.gov.au/Details/F2015C00762/Html/Volume_2#_Toc429575752) Table 2.12 states for Class 2 medical:
Is not suffering from a safety-relevant condition of the respiratory system.
And that's all the actual regs have to say on it
So - it all sounds like a 'maybe'. I looked up the regs in the UK and US, and they seem similar - the UK requires a dedicated Brochial Reactionary test, which involves running for 6 minutes and testing FER before and after; a decline of less than 16% FER after exercise is acceptable for an unrestricted Class 2.
The FAA is similar - below 80% of predicted (my result was 78% of predicted) requires dedicated testing.
So - faced with all that - can anyone suggest what would my options be with CASA? It seems I fall into the 'moderate asthma' category by definition, but I can't find anything in writing with regards to any equivalent to the CAA Bronchial Reactivity tests that would specifically determine my suitability in the 'grey area'. CASA allude to such a test for 'moderate asthmatics', but I can't find information on what would perform that, and what their criteria would be.
It's a frustrating situation, particularly to see pilots twenty years older passing their medicals, while I'm running around a gym with twenty-year olds every morning, to be told I'm not physiologically safe to go up in the air. From what I can determine, the primary risk caused by asthma in my circumstance is hypoxia, as from memory a pilot may operate at 10,000ft indefinitely or 14,000ft for half an hour, and so must be medically fit to do so. In my entire 140 hours, I think I flew to 10,000ft once to see what was up there, and most aircraft I fly can't get to 14,000ft.
I'd be very interested in anyone else's experiences in a similar situation? Did you get referred, and get passed by a specialist? Did you get any restrictions on your licence - such as a maximum operating altitude? Did CASA flat-out deny the class 2? Or are there any tips and tricks to passing the medical (eg. Deep breathing exercises, or even practicing spirometry tests)?
Thanks!
Damian