The Asthma Disclosure
A 19-year-old applicant for an aircrew role is filling in the medical questionnaire. He had childhood asthma, diagnosed at age 6, and used a reliever inhaler until about age 12. He has not used an inhaler for seven years and has not wheezed since. However, he plays competitive basketball and occasionally gets 'tight chested' after very hard training, which he puts down to being unfit. He also had one course of oral steroids at age 9 during a bad chest infection. He is worried that ticking 'yes' to asthma will end his application, so he considers ticking 'no' and explaining that he 'grew out of it'. A friend told him that as long as he can pass the fitness test, the history doesn't matter. He asks the recruiting staff for advice.
1. What should the recruiting staff advise about how to answer the asthma question, and why?
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Staff should advise him to answer truthfully and completely - 'yes' to the childhood asthma history - and describe the details: diagnosis at 6, inhaler until about 12, no inhaler for seven years, one steroid course at 9, and the recent exercise-related tight chest. Ticking 'no' would be a false declaration. That matters for three reasons: it is dishonest, it can be detected through medical records or the examination, and it can invalidate his application or lead to discharge later. The friend's advice is wrong: passing a fitness test does not erase a medical history, and the medical assessment exists precisely to weigh history against the demands of the role. The recent 'tight chest' during hard training is the detail most worth raising, because it may indicate exercise-induced symptoms that need assessment rather than being dismissed as unfitness. The staff should reassure him that disclosure is not automatic rejection - the medical officer assesses the whole picture - but that concealment is far more damaging than an honest history.
2. How should the medical officer weigh the childhood history and the recent exercise symptoms when deciding fitness?
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The medical officer should treat the two elements separately and then together.
- Childhood history: asthma diagnosed at 6, reliever use ceasing around 12, and no symptoms for seven years is a favourable pattern. Many people with childhood asthma become asymptomatic, and a long symptom-free interval with no medication is relevant positive evidence.
- Recent symptoms: 'tight chested' after very hard basketball training is a red flag that needs explanation. It could be simple deconditioning, but it could be exercise-induced bronchoconstriction. It should not be waved away.
- What is needed: a current clinical assessment, ideally with lung function testing (spirometry) and, if indicated, a supervised exercise challenge, plus a review of his medical records to confirm the history.
- Decision logic: if testing is normal and symptoms are explained by fitness, the history alone is unlikely to bar him. If testing shows reversible airflow obstruction or exercise-induced bronchoconstriction, that is a significant finding for an aircrew role and must be assessed against the applicable standard, possibly leading to unfitness or deferral.
The judgement must rest on current objective evidence, not on the label 'grew out of it'.