Lungs & Chest : What to Expect at the Flight Physical

Item 35: FAA Policies on the Airman Medical Exam

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide pages 66-72, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

Breast examination: The breast examination is performed only at the applicant's option or if indicated by specific history or physical findings. If a breast examination is performed, the results are to be recorded in Item 60: AME Comments on History and Findings of FAA Form 8500-8. The applicant should be advised of any abnormality that is detected, then deferred for further evaluation.

Below is a table adapted from the 2014 AME Guide that lists some common respiratory and lung conditions of aeromedical significance. Also mentioned is the FAA's directed course of action (an instruction to the AME). The "disposition" is prescribed action that should be taken by the AME as defined by the protocol and disposition in the table or elsewhere. AME must not issue aviation medical certificates to any applicant with medical conditions listed below that require deferral to FAA staff. (Recall that an AME is considered an FAA Designee, not staff). Importantly, if an applicant has any other condition not listed in the table that may result in sudden or subtle incapacitation (in the judgement of the AME), then the AME still has the ethical duty to consult the FAA higher headquarters (AMCD or the RFS) prior to issuing a medical certificate. When applying for a waiver on your behalf, you should anticipate their needs and help them collect supporting documention (test results, specialist opinions) associated with the condition. AMEs will need to forward all associated records to the FAA to help your case as you pursue issuance of an airman medical certificate.

FAA Aerospace Medical Disposition Grid for
Item 35. Lungs and Chest
Allergies
DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Allergies, severe	All	Submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects	Requires FAA Decision
Hay fever controlled solely by desensitization without antihistamines or other medications^{1, 2, 3}	All	Submit all pertinent medical information and current status report, include duration of symptoms, name and dosage of drugs and side effects	If responds to treatment and without side effects - AME Authorized to Issue the Certificate Otherwise - Requires FAA Decision
¹ Applicants with seasonal allergies requiring antihistamines may be certified by the Examiner with the stipulation that they not exercise privileges of airman certification within 24 hours of experiencing symptoms requiring treatment or within 24 hours after taking an antihistamine. Also see Item 18e: Allergies section of applicant history. The Examiner should document this in Item 60: AME Comments on History and Findings. ² Individuals who have hay fever that requires only occasional seasonal therapy may be certified by the Examiner with the stipulation that they not fly during the time when symptoms occur and treatment is required. ³ Nonsedating antihistamines including loratadine, or fexofenadine may be used while flying, after adequate individual experience has determined that the medication is well tolerated without significant side effects.
Asthma
DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Mild or seasonal asthmatic symptoms	All	Review all pertinent medical information and current status report, include PFT’s, duration of symptoms, name and dosage of drugs and side effects for special issuance consideration	See Asthma Worksheet If airman meets all of those certification criteria – AME Authorized to Issue the Certificate. All others require FAA Decision. Submit all evaluation data. Initial Special Issuance - Requires FAA Decision Followup Special Issuances - See AASI Protocol
Frequent severe asthmatic symptoms	All	Submit all pertinent medical information and current status report, include PFT’s, duration of symptoms, name and dosage of drugs and side effects for special issuance consideration.	Initial Special Issuance - Requires FAA Decision Followup Special Issuances - See AASI Protocol
Chronic Obstructive Pulmonary Disease (COPD)
DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Chronic bronchitis, emphysema, or COPD ⁴	All	Submit all pertinent medical information and current status report. Include an FVC/FEV1	Initial Special Issuance - Requires FAA Decision Followup Special Issuance’s - See AASI Protocol
⁴Certification 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 should be deferred.
Disease of the Lungs, Pleura, or Mediastinum
DISEASE/CONDITION	CLASS	EVALUATION DATA	DISPOSITION
Abscesses Active Mycotic disease Active Tuberculosis	All	Submit all pertinent medical information and current status report	Requires FAA Decision
Fistula, Bronchopleural, to include Thoracostomy	All	Submit all pertinent medical information and current status report	Requires FAA Decision
Lobectomy	All	Submit all pertinent medical information and current status report	Requires FAA Decision
Pulmonary Embolism	All	See Thromboembolic Disease Protocol	See Thromboembolic Disease Protocol
Pulmonary Fibrosis	All	Submit all pertinent medical information, current status report, PFT’s with diffusion capacity	If >75% predicted and no impairment - AME Authorized to Issue the Certificate Otherwise - Requires FAA Decision

This page discussed the Lungs & Chest section of the Fight Physical Examination required of pilots.

Reminder: use FlightPhysical.com to familiarize yourself with aviation medical regulations and guidelines, but always discuss your specific situation with one or more AMEs before dedicating resources toward expensive clinical workups. Find an AME now

Lungs & Chest : What to Expect at the Flight Physical

Item 35: FAA Policies on the Airman Medical Exam

FAA Aerospace Medical Disposition Grid for Item 35. Lungs and Chest

FAA Aerospace Medical Disposition Grid for
Item 35. Lungs and Chest