INTRODUCTION: Military pilots are subjected to unique pulmonary demands, particularly in high performance jets. The hypobaric environment necessitates use of on-board oxygen, breathing masks, and regulators to increase oxygen pressure, affecting ventilation and breathing responses. Safety features like pilot flight equipment and strapping into an ejection seat further impact pilot pulmonary function. Acceptable pulmonary function required for high performance aircraft is not well understood. There is no consensus among North Atlantic Treaty Organization (NATO) partners on how to perform pulmonary screening and which conditions and medications are acceptable.

METHODS: This study was conducted with a questionnaire, gathering retrospective data. In 2019, questionnaires were sent out to national aeromedical representatives from 29 NATO countries and 3 allied nations. Questions were current aeromedical regulations used, pulmonary data collected from each individual pilot, acceptable pulmonary conditions, and acceptable medical treatments. Data were collected before the COVID-19 pandemic; a follow-up questionnaire was sent out after to ask if screening policies had changed.

RESULTS: A total of 16 questionnaires were returned from 13 NATO and 3 allied nations. This equates to an overall response rate of 50%. Pulmonary function testing is conducted on pilot applicants in 15/16 countries and 9/16 perform pulmonary function testing at every follow-up aeromedical examination as well. Conventional chest X-rays as a part of the first initial aeromedical examination are being used in 8/16 countries.

DISCUSSION: This study describes the divergent medical standards for pulmonary function in NATO aircrew and confirms that no standards for best practice exist.

Frijters E, Lindgaard K, Regn D, Gray G, Naylor J, Bushby A, Guettler N, Leino T. Policies on pulmonary screening and management of respiratory conditions in military pilots. Aerosp Med Hum Perform. 2024; 95(12):908–912.