The natural history of asthma: aeromedical implications

Asthma is often incompatible with flying and it is important that the natural history of the disorder is understood in relation to both pretraining enrollment and inservice fitness checks. Studies of childhood asthma with prolonged follow-up have shown that as many as 70% experience some asthmatic symptoms in later life. Of asymptomatic adults with a history of childhood asthma, 60% have evidence of bronchial lability and therefore an ongoing asthmatic tendency. Asthma developing in adulthood may be intermittent or continuous, with a poorer prognosis. A history of childhood asthma should be disqualifying for entry into pilot training. If asthma develops after training, persistent asthma, intermittent asthma with frequent or severe attacks, and asthma requiring regular beta-agonist, theophylline or corticosteroid inhaler treatment should all preclude aircrew from further flying.