MED.B.015 Respiratory System

(a)Examination

(1)Spirometry A spirometric examination is required by points MED.B.015 (b) and (c) for applicants for a class 1 medical certificate in specific situations. 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

(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.

(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.

(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.

(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 or neurological sarcoid should be assessed as unfit.

(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, 6 weeks following full recovery from a single spontaneous pneumothorax, with an OML for at least a year after full recovery;

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

(2)Applicants with a recurrent spontaneous pneumothorax that has not been surgically should be assessed as unfit.

(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.

(g)Thoracic surgery

(1)Applicants requiring major thoracic surgery should be assessed as unfit until recovery is complete, the applicant is asymptomatic, and the risk of secondary complication is minimal.

(2)A fit assessment following lesser chest surgery may be considered after satisfactory recovery and full respiratory evaluation.

(h)Sleep apnoea syndrome/sleep disorder Applicants with unsatisfactorily treated sleep apnoea syndrome should be assessed as unfit. Obstructive sleep apnoea (OSA) screening should include an anamnestic interview and assessment of OSA risk factors such as increased BMI, and a history of cardiovascular, cerebrovascular, metabolic and ENT pathology.

(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.

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

(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.

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

(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.

(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.

(g)Thoracic surgery Applicants requiring major thoracic surgery should be assessed as unfit until recovery is complete, the applicant is asymptomatic, and the risk of secondary complication is minimal.

(h)Sleep apnoea syndrome Applicants with unsatisfactorily treated sleep apnoea syndrome should be assessed as unfit.

SCREENING OF THE OBSTRUCTIVE SLEEP APNOEA (OSA) SYNDROME

(a)AMEs may consider the following algorithm when screening their applicants regarding the OSA syndrome: Assessment of OSA risk may be considered at every medical examination of pilots through scores that combine history questions with physical findings such as the STOP-BANG score.

(b)AME guidance: Indicators to initiate OSA evaluation History interview including at least the following: Daytime sleepiness (i.e. Epworth Sleepiness Scale)? Snoring (what does spouse/partner say?) Psychosocial issues due to sleepiness, heavy snoring Observable apnoea episodes Contributing factors: BMI >30 Previous bariatric history Neck circumference: ≥ 40 cm Diagnosed arterial hypertension Heart troubles Arrhythmia Congestive heart failure

CHD Previous TIA, stroke Diabetes Type 2

ENT Nasal obstruction Orthodontic/Retrognathia Oropharyngeal examination –e.g. modified Mallampati Score or Friedman tongue position Methodology (if indicated): Nocturnal oximetry Respiratory polygraphy Polysomnography in certified sleep laboratories Eventually evaluation of vigilance: Maintenance of Wakefulness Test (MWT) Multiple Sleep Latency Test (MSLT)