Asthma in Military Pilots

Abstract

Introduction: Asthma is a common diagnosis in the general population and, among military aviators, has the potential for significant aeromedical complications. The objectives of this study, undertaken by the North Atlantic Treaty Organization (NATO) Aviation Pulmonology Working Group (RTG299), were to determine: 1) the prevalence of asthma among trained NATO pilots; 2) agency screening procedures and policies for candidates with a history of asthma; and 3) aeromedical disposition of trained pilots diagnosed with asthma, including allowable medications.

Methods: A questionnaire was distributed to each participating NATO agency to retrieve information related to each of the above questions.

Results: Data were received from 7 agencies spanning over half a million pilot years (520,369). The prevalence of asthma among serving NATO pilots was surprisingly low at 0.04%, an order of magnitude lower than the general U.S. military (1-2%) and U.S. population in general (approx. 8%). The reported prevalence in U.S. Air Force pilots was inexplicably low at 0.007%. All agencies, apart from the U.S. Air Force, include pulmonary function screening for pilot candidates. Most agencies accept candidates with a history of childhood asthma if full and sustained remission is confirmed with enhanced screening. In trained pilots, most agencies permit the use of medications to control asthma, including inhaled corticosteroids and long-acting beta agonists.

Discussion: The incidence of asthma in NATO pilots was very low. Most NATO pilots diagnosed with asthma were retained on flying status, with some agencies imposing restrictions (generally from high-performance aircraft). Gray G, Bushby A, Frijters E, Guettler N, Lindgaard K, Naylor J, Regn D. Asthma in military pilots. Aerosp Med Hum Perform. 2025; 96(6):520-524.

Keywords: aircrew; asthma; pilots.