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Asthma is an inflammatory condition of the airways, producing variable bronchoconstriction. First line therapy is directed at controlling the inflammatory process with agents such as inhaled steroids, nedocromil, and the newer leukotriene inhibitor drugs. In severe cases, systemic steroids or other immunosuppressive therapies may be required for suppression of inflammation., Presented at RTO Human Factors and Medicine Panel (HFM). p21-26 This article is from ADA395446 Medication for Military Aircrew: Current Use, Issues, and Strategies for Expanded Options (les medicaments pour les equipaes militaires: Consommation actuelle, questions et strategies pour des options elargies)

Introduction: In 1997, DCIEM conducted an Operational Vision Survey of current Canadian Forces (CF) pilots. This third report deals with those aspects related to vision protective and enhancement equipment, specifically sunglasses, visors, laser protective devices, and night vision goggles.

In 1997, DCIEM conducted an Operational Vision Survey of current Canadian Forces pilots. This second report deals specifically with the clinical and administrative support offered at the Base/Wing level and the use of spectacles and contact lenses. 1551 questionnaires were sent out 813 questionnaires were completed and 200 returned "undelivered" for a response rate of 61% of those actually received. On the administrative and clinical support questions, the majority of pilots favoured the selection of candidates with uncorrected visual acuity of 20/20 or better and judged color vision as an important selection criteria. 46% of the pilots indicated interest in improving their visual acuity throughout the use of spectacles and 28% indicated they would consider eye surgery including photorefractive keractectomy (PRK!. When pilots were asked to consider potential adverse effects of surgery on visual acuity, contrast and glare sensitivity, the number contemplating surgical correction dropped significantly. 86% were receptive to yearly complete visual examination. Staff officers and operational pilots wearing spectacles were more likely than uncorrected individuals to accept yearly visual testing. On average the clinical support offered at the base level was judged as "acceptable" but the understanding of the specific visual requirements for pilots by the medical professionals was considered as "borderline". Pilots were more likely to discuss openly visual matters with civilian than military professionals and their reluctance level increased when previous grounding had occurred. 29% of the surveyed pilot population were wearing either spectacles and/or contact lenses. 6% of the group requiring visual correction were wearing multifocals but these were seldom correctly prescribed for their current cockpit environment Tactical and fighter pilots considered that their multifocals did not have large enough unrestricted and uninterrupted field of view.

DCIEM conducted an operational vision survey of current Canadian Forces pilots. The overall survey was designed to acquire information on operational vision requirements, visual aids, and clinical and administrative support. In Section 1, Operational Visual Requirements, pilots in 9 different operational flying roles were asked to rank order from 11 to 65 different flying tasks for which they had operational experience. Information was also acquired about the importance of contrast sensitivity and the problems of glare in operational flying. Results: 1551 questionnaires were sent out. 813 questionnaires were completed and 200 returned "undelivered" for a response rate of 61% from those actually received. The average age was 37 years, range 24-54. The greatest number of tasks rated as "difficult" (D) or "very difficult" (VD) were in rotary wing flying. Tac Hel (TH) so identified 12 tasks in 6 of 10 groups. SAR RW had 12 tasks in 7 of 10 groups. Maritime patrol RW had 14 D or VD tasks in 8 task groups. In fixed wing operations, maritime patrol rated as the most challenging with 11 tasks in three groups rated as D or VD. Fighter operations were not generally rated as visually demanding with only 2 tasks in 11 task groups rated as D or VD. Tasks rated as D or VD were almost all related to operational flying such as NVGs, target or smoke detection, and not to general flying requirements. Contrast Sensitivity was identified by the pilot population as being important in all military flying operations, particularly in conditions of low visual contrast such as flying over snow or water, or at dawn or dusk. Glare is a continuing problem in CF flying operations. In particular, reflected glare was identified as a problem interfering with CRT visualization in the Griffon and Aurora.

A patent foramen ovale (PFO) is a small opening between the right and left cardiac atria, a persisting remnant of a physiologic communication present in the fetal heart. This normally closes after birth, but remains patent through to adulthood in up to a third of normal adults. A patent PFO is a potential conduit for blood clot (resulting in a stroke), or venous gas bubbles during decompression, (resulting in type II neurologic decompression sickness). There has been considerable controversy about the significance of a PFO as a possible mechanism for type II decompression sickness. Despite the high prevalence of PFO in the general population and the relatively common occurrence of venous gas bubbles in diving and altitude exposures, the incidence of type II DCS in diving or with altitude exposure is low. This paper reviews the literature with respect to the potential for right-to-left embolization through a PFO, relation of PFO to DCS, screening techniques for PFO, and treatment options. The literature supports a relationship between the presence and size of PFO and cryptogenic stroke (stroke, generally in younger individuals with no other identifiable risk factors). The weight of evidence also favours an increased relative risk of type II DCS with a PFO, although the absolute increase in risk accrued is small. The gold standard for PFO screening is a trans-esophageal echocardiographic (TEE) and colour flow study, but trans-cranial Doppler (TCD) with contrast is a promising technique with good accuracy compared with TEE.