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asthma case-based scenario

Sigh of relief as aviation career takes off

It had been so many years since 20-year old Jesse had been hospitalised for asthma that he was surprised to learn his lungs were still compromised by his condition. Luckily, a new asthma action plan soon restored him to optimum lung health and let him launch his flight career exactly as planned.

"It just goes to show," Jesse says. "You can think you are finally over something like asthma, and never realise just how much damage it has already done to your lungs. As it happens, going for my aviation medicals not only let me see how impaired my lungs were, but put me back on the path to optimum health. I call that a real win."

With his heart set on an aviation career, Jesse had already begun a Bachelor of Aviation before attending his initial aircrew medical, confident he would be given a clean bill of health.

Although he’d suffered from asthma in his younger years – even having to be hospitalised for treatment on a number of occasions – the older he had gotten, the more his symptoms had reduced. These days, he needs to use his inhaler so rarely he thought he might have largely "grown out" of the condition.

"Sure, as the weather gets colder or if I’m playing touch football (which I do most weekends in winter) I might need to use my inhaler," Jesse says. "But I haven’t had to see my doctor about asthma in years and I have been buying ventolin inhalers direct from the local pharmacy. I didn’t even really consider myself an asthmatic, any more."

Visit to DAME

When Jesse presented to a Designated Aviation medical Examiner (DAME) for his initial aircrew medical certificate application, he found the assessment fairly straightforward, but was surprised to be asked so many questions about his asthma.

"I told the DAME I thought my asthma had largely gone away and certainly wasn’t as bad as it had been even five years ago," Jesse says. "Then he explained that asthma could cause major problems for pilots because of the reduced oxygen environment, low ambient temperatures, the potential for exposure to airborne chemicals and the need to occasionally use breathing apparatus.

"He pointed out that an asthma attack in flight could incapacitate me."


The DAME examined Jesse, listened to his chest, and then performed a lung function test called a spirometry. Jesse and the DAME were both surprised to find that the test showed Jesse’s lungs had been significantly affected by asthma and were not in the best possible condition.

The DAME referred Jesse to a respiratory physician, who performed more tests and examinations. These confirmed Jesse remained at risk of acute asthma attacks. The specialist recommended a change to Jesse’s treatment and gave him an asthma action plan which taught him how to manage his condition both when he was well and when he was ill.

Four weeks later the specialist repeated some of the tests and reported back to the DAME that Jesse had achieved optimum lung function and was at a low risk of suffering an acute attack.

"It is amazing how much better I feel now," Jesse says. "My sporting performance has even improved. It made me realise my asthma symptoms had been slowly creeping up on me for years."


Armed with the new reports, the AvMed doctor was happy to issue a certificate, provided Jesse sticks with his asthma action plan and provides a yearly report from his general practitioner or respiratory physician describing the management of his asthma.  CASA also requires Jesse to always have a reliever inhaler on hand when flying, in case of emergency.

Jesse was reminded to notify his DAME or CASA if his condition or treatment changed, especially if he was given a regimen of oral steroids or needed hospital treatment – both recognised markers of unstable asthma.