atpwannabe

Is their anyone out there or does anyone know of anyone having a SI medical for COPD? Specifically chronic bronchitis. If so, what type of flying are they engaged in? Part 121? 91? 135?. In addition, if they are medically certified and not engaged in the aforementtioned, is their flying limited to that of pleasure...ie 3rd Class medical; PPL, Instrument, CPL, ME rating...nothing further.

Thanks for responses.


Marcus
(atpwannabe)

JohnBurke

The simple answer is that it's not that simple; each individual is evaluated on his or her own merits.

If you visit the aviation medical examiner guide for a breakdown on what constitutes the various classes of COPD (and what's required for certification, you will find the following table (https://www.faa.gov/ame_guide/media/...po_table.pdf):


Click on the link above to go to the second half of the table (it doesn't copy here).

The short answer is that if you have COPD, it may be disqualifying. An exam will yield information to be sent to the FAA for a special issuance (SI). The aviation medical examiner (AME) must defer, for an FAA decision and subsequent SI. An aviation medical examiner may issue a medical certificate for someone who holds a SI for COPD, under specific circumstances. This means that if there are no changes, the SI is within it's valid period, and there have been no recurrences and the COPD has not progressed (worsened), the applicant can get an evaluation and status report within thirty days of the AME exam, and the AME do an AME Assisted Special Issuance (AASI), and provide your medical certificate at his/her office.

A number of medications can also be approved in conjunction with the SI, for both Asthma and COPD. Again, such approvals are on an individual basis.

I emphasize the nature of an individual evaluation because while one airman may have COPD and be able to obtain a SI and fly, another may not.

If you have COPD, you may be best considering investing in the help of an advisory service that will assist you with paperwork and obtaining your special issuance.

atpwannabe

JohnBurke:


As a matter of fact, I do....chronic bronchitis. Hasn't worsen since being diagnosed Oct '19. Will go over your aforementioned with a fine tooth comb. Definitely will talk to and correspond with lots of people who are in the know and can have an effectual change in my being medically certified. Also, before I start spending a whole of money to start the initial process. My hope, obviously is that it's not a permanent disqualifer. Given this, it's gonna be an arduous task in getting cerftified. Last attempt, it was determined that I have an anti-personality disorder. However, spoke to OKC last year and was told that I am eligible to reapply. I challenged the Chief Psychiatrist findings and the Hearing Board ruled in my favor.

Thanks John. I'll keep you posted.


atp

atpwannabe

JohnBurke:


As a matter of fact, I do....chronic bronchitis. Hasn't worsen since being diagnosed Oct '19. Will go over your aforementioned with a fine tooth comb. Definitely will talk to and correspond with lots of people who are in the know and can have an effectual change in my being medically certified. My hope, obviously is that it's not a permanent disqualifer. Given this, it's gonna be an arduous task in getting cerftified. Last attempt, it was determined that I have an anti-personality disorder. However, spoke to OKC last year and was told that I am eligible to reapply. I challenged the Chief Psychiatrist findings and the Hearing Board ruled in my favor.

Thanks John. I'll keep you posted.


atp


**If I'm not medically certified, I'll have one helluva setup of either MSFS or X-Plane.

JohnBurke

Personality disorders (there are many) manifest in a number of ways, including criminal acts, etc, but are typically all represented by a common trait of either disregard, distrust, or antagonism with respect to rules, regulations, and authority. They are frequently manifest as a judgement problem in social settings, which could be anything from "not reading the room" to an inability to get along...but you indicated that you've made headway with the FAA there. From your prior postings and the current thread, it appears that you have some legal entanglements with drugs as a past issue, chronic bronchitis (from drug or cigarette useage?), and the issue of the personality disorder. Each, of course, is an obstacle on its own merits, but must be considered in turn, and in combination with the others. So far as the personality disorder, the FAA looks closely at whether it has disrupted employment, schooling, or led to thoughts of suicide ("suicidal ideations"). As always, the most important issue is your health; it's far more important to seek and receive the necessary treatment, regardless of the condition, than anything else.

https://www.faa.gov/ame_guide/app_process/exam_tech/item47/amd/table/pd

COPD, Asthma, and Bronchitis are disqualifying conditions, but are allowable via special issuance, and in some cases with bronchitis and asthma, a CACI (conditions an AME can issue) allows the medical examiner to issue, so long as the condition is mild with no lung function impairment. The specific language used is "exacerbations or degree of external dyspnea." Exacerbations are asthmatic or breathing attacks (restricted breathing) that can cause lung damage. External dyspnea and exacerbations include shortness of breath or wheezing that's worse than normal, persistent cough, shallow or rapid breathing, etc. These don't mean you can't be issued a medical, but would be deferred for the FAA aeromedical to render a decision and special issuance (the criteria are spelled out in the chart previously linked in my last reply https://www.faa.gov/ame_guide/media/COPD_dispo_table.pdf).

https://www.faa.gov/ame_guide/app_process/exam_tech/item35/amd/copd

I would note that aviaton and piloting in particular are a live-and-die-by-the-rules affair, where adherence to every crossed-t and dotted-I in the regulation is crucial, as is compliance with all aircraft limitations, etc. If the personality disorder does lead to rebelling against authority or rules, policies and regulations, it may present your biggest challenge, regardless of whether the FAA finds it medically acceptable. Keep that in mind, moving forward, because once any medical hurdles are passed, the most important one that we all face is our own ethic, professionalism and behavior, regardless of whether we fly for fun or for a living. Everything comes down to personal discipline.

Each of the things you've noted thus far are significant challenges in their own rite, and regardless of FAA medical certification, overcoming or mastering them is an worthwhile and laudable achievement.

JohnBurke

I should have addressed the GOLD criteria, which you'll find on the FAA table previously linked. The table divides COPD, Asthma, Bronchitis, etc, into two broad classifications: GOLD 1A and 2A, and anything else other than GOLD 1A and 2A.

GOLD is a grading criterai for pulmonary problems; it stands for Global Initiative for Chronic Obstructive Lung Disease. It revolves around a spirometry test, which is the amount of air you can exhale, and the force with which you can exhale it. The spirometry comes with two tests that you're probably familiar with. The FVC, or forced vital capacity, measures how much air you can breathe out after taking as deep a breath as you can. The second is the FEC-1 (forced expiratory volume), which measures how much you can breathe out in one second. This measurement of your breathing is syrometry, and looks at lung capacity. Your blod oxygen saturation (SP2OH) looks at your lung efficiency, meaning how much oxygen you're actually getting into your bloodstream, or specifically, how saturated your blood hemoglobin is with oxygen. You can purchase SP2OH oxygen saturation monitors at your local pharmacy; they're the little clippy thing that goes on the end of your finger.

The GOLD rating looks at your spirometry, as well as the presence of other health problems, the severity of your COPD (asthma, bronchitis, or emphysema), and also the possibility of your condition worsening. Two tests are used to enquire about your condition; these are either the mMRC (modified medical research counsel, scores 1-5) or the CAT (COPD assessment test, scores 0-40). The lower the number, the more mild your condition, so something that causes you to get winded walking or with exercise might be a 0 or 1 on the mMRC, where as if you can't function at all, you might be a 40 on the CAT. This, along with your spirometry, will flesh out your GOLD score, which is either 1 (mild), 2 (moderate), 3 (severe), or 4 (very severe). Significant exacerbation is typical of 3 or 4.

Gold 1 or 2 can fit into group A or B. Group A is a FEV-1 of 80% or better, no hospitalization, no significant flareups in the last year. Group B is more symptoms than A, one significant flare-up in the last year, FEV-1 of 50-80%, and some wheezing, coughing, etc, typical of COPD. Group B also has no hospitalization in the last year.

Conditions worse than groups A or B move into groups C or D, which are GOLD 3 or 4. These include hospitalization in the last year, FEV-1 30-50% or worse, more than two flare-ups in the last year, etc. Group D is considered end-stage, or an end-of-life condition. This will include extreme difficulty in breathing, flare-ups are are life-threatening, and the lungs hardly work at all.

There is no cure for COPD. There are treatments, but no cure.

For aviation, because we fly to areas of lower atmospheric pressure (altitude) and reduced partial-pressure oxygen availability, flight operations can exacerbate pulmonary (lung) conditions, sometimes by a significant margin. It's not just that it may be hard to breathe, but hard to use the oxygen that's avaialble, and may be significantly worsened as altitude increases; small increases can make substantial differences in the ability to respirate, or transfer oxygen and waste products, in the lungs. If one is flying in a pressurized aircraft, cabin pressure altitude may seldom exceed 7,500' (like a day trip to Flagstaff, AZ), but a rapid depressurization may pose a two-fold critical issue: rapidly diminished oxygen pressure, and also may trigger or exacerbate the lung condition.

Most of this, you may or probably already know, dealing with COPD, but I include it for those who don't. Once again, it's all on an individual basis, and muts also be considered in conjunction with other conditions. I have been in altitude chambers, which are enclosed metal vessels in which the pressure is gradually lowered, to allow occupants to experience simulated high altitude, and observed a vareity of behaviors. Among them are invariably a few who feel euphoric or fine, who don't think they're suffering the effects of hypoxia (lack of oxygen), and who insist they don't need a mask or supplemental oxygen. This comes in part due to the false sense of feeling well or even better than well (euphoric), and in some cases a sense of bravado or anti-authority (I don't need no stinking oxygen mask). The result is always the same, and everyone else in the chamber can see it, except the one effected. I point this out because conditions that the FAA considers significant are often considered trivial or overblown by those seeking a medical, who may not know or appreciate the ramifications. The medical standards are there for good reason. Again, however, none of this precludes you getting a medical: it's determined on an indiviual basis, and my comments are strictly informational, only. As always, anything here is worth precisely what one has paid for it, which is to say, don't take my comments to be the first, or last say on any of this subjet material.

atpwannabe

JB: Wow! Thank you so much for the information. You are correct in your assessment that I'm very familiar with COPD protocol & treatment. I must admit that tobacco is very addictive...more so than narcotics. It took a serious episode for me to stop and stay stopped. The attending physician in the ER came to me after me having been administered magnesium sulfate, solumedrol, and coming off the BI-PAP...told very straight. He said, "Mr. B*****, if you continue to smoke, you will surely die an early death." Well, that was all that need to be said. Haven't smoked since.

This weekend, I'll revisit this post and start reading up on FAA protocol when it comes to respiratory issue. Truly a wealth of information. I'll keep you posted. Thanks again!



Marcus
(atp)

JohnBurke

Cigarettes are harder to quit than almost anything, though I know quite a few who'd argue the point. "They're the easiest thing in the world to give up," I'm often told. "I've done it a dozen times!"

The next stone down the mountain will be the impending fallout from those who vape. It's truly astounding how few see it coming.

PineappleXpres

It’s psychologically and physically addictive without altering your mental state. Different sort of high.


Vaping and energy drinks.

JohnBurke

The physical effects are as bad, or worse. It's the damage that's coming. The fallout will be worse than cigarettes.