Aircrew, Aviation, Pulmonary Complications, Pulmonology, Respiratory Exposures, Screening
Within the last year, the United States Air Force and United States Navy have grounded an entire fleet of aircraft due to physiologic events attributed in part to respiratory complaints. It is therefore important that there is an evidenced based consensus regarding the criterion for performance of baseline pulmonary screening/assessment of aircrew and establishment of allowable standards for our aviators given the physical demands of flight, particularly high performance flight. Given these unique physical respiratory demands placed on aviators, consideration should also be given to alternative, potentially unique modalities for evaluation of pulmonary function such as impulse oscillometry.
Multiple pulmonary complications such as spontaneous pneumothorax and venous thromboembolism (VTE) are conditions associated with the environment of flight such as expansion of gases at altitude increasing risk of pneumothorax as well as stasis and dehydration which can be experienced in long flying missions, with these conditions increasing risk of VTE. The best treatment options for these complications also need to be examined from a Flight Surgeon’s risk assessment perspective. For example, is the use of the novel anticoagulants, particularly those that do not have a reversal agent, safe for use in our aviators with VTE? How long should aviators not fly after treatment of pneumothorax? After definitive surgery for pneumothorax? Ultimately by optimizing treatment this would expedite return to flying time.
Another important factor in our aviators overall respiratory health is our current deployed environment in Southwest Asia which is also rife with environmental respiratory exposures such as dust, and burn pits. The full impact of these respiratory exposures on our aviators has yet to be determined. This is particularly important in our rotary wing aircrew, since the rotary wing stirs up environmental particles which may then be inhaled. It is important to establish what the most common exposures are and a methodology of assessment of our aviators pre and post exposure and determine if there are ways to mitigate any potential effects of these exposures and again preserve the pulmonary function of our aviators.