Dr. Robert Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a Senior AME since 1993 and is appointed as AME Consultant to the FAA Federal Air Surgeon.

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Robert Sancetta

While sickness can happen at any time of the year, as we enter the winter cold and flu season, there is typically an uptick in respiratory complaints.&nbsp;
Interactions this time of year often begin in a typical fashion. As an aviation medical examiner, I am frequently asked by pilots if they can fly while taking a certain antibiotic by itself or perhaps with the addition of an oral steroid (prescription anti-inflammatory medication) and/or a pulmonary inhaler (which can be used to dilate bronchial passages, sometimes with the addition of a steroid component).
The question often sounds like this, “Hey doc, can I fly on xyz medication?” Often no additional information is given to me in the initial contact message.
My response must begin with the question of why the pilot is taking the medication(s). As I have discussed before, medications can be prescribed for either the disease that the medication was engineered and FDA approved for, but also for many off-label uses—conditions not initially researched, but in common use the medication has been found useful for.
The banter then goes back and forth.
Before I discuss the ramifications of the individual prescriptions, I ask the pilot—in a general, vague, and open-ended manner—simply how they are doing. Then I wait for what comes next.
If a pilot tells me that they had suffered from a typical winter illness, viral or bacterial, but are now “getting better,” the conversation continues yet further before there are formal discussions about the medications themselves.
I typically have asked the inquiring pilots over the years simple questions such as whether the pilot is still too sick to fly. And by “too sick” I have already assumed that if the pilot was still bed-ridden and barely able to get out of bed that they wouldn’t have contacted me. But once they are improving, even if they are still taking medications, they pose very appropriate and reasonable questions about their aeromedical status.
The considerations here include whether the pilot is still ill, and while perhaps on an improving trend, symptomatic enough to be distracted and not be an effective crewmember. Another consideration is that, regardless of how the pilot feels, are they still coughing frequently?
Even if otherwise feeling well enough to fly, does that pilot want to risk getting other crew members ill? It is challenging to determine if a pilot is still contagious.
<h2>No One Wants Your Coughing in the Cockpit</h2>
Who has not been stuck in a cockpit for days with a fellow pilot who is clearly ill and perhaps coughing throughout the flight? It unnerves the other crewmembers and potentially places them at some risk. Therefore, this may make them less effective crewmembers due to their concern and distraction about their fellow pilot’s illness.
If a pilot chooses to fly yet, to their surprise, is coughing more than they expected, that pilot should use a disinfectant wipe to clean all surfaces that have either been touched during the flight or were otherwise exposed due to the coughing. The FARs do not prohibit a pilot from wearing a protective mask, so long as that pilot can communicate normally with ATC and fellow crewmembers.
Speaking of FARs, please remember that FAR 61.53 applies on all flights—it is the pilot’s responsibility to self-assess their personal airworthiness. When it comes to routine illnesses, while much of the time the pilot should be able to comply with FAR 61.53 without asking for advice, it is sometimes a very good idea for a pilot to seek counsel from their aeromedical examiner or their corporate or airline’s aeromedical consultants.
If a pilot either is not feeling well or cannot make contact with a consultant for advice, the best suggestion I can give is for that pilot to stand down until symptoms improve and perhaps they have then spoken with an aeromedical advisor.
I appreciate that calling off from a flight either on the road or in a small corporate operation is not something that comes easily to a pilot—after all, pilots do want to get the job done—but sometimes the best decisions are not always the simplest or most popular.
FAR 61.53 is intentionally written in a very generic manner and is designed to be able to, in essence, cover a pilot’s decision-making on almost any aeromedical topic. That includes routine illnesses, medication usage, a new medical condition of concern, or exacerbation of a previously known condition.
The FAA considers FAR 61.53 important enough to reference it on each medical certificate. This reference is in the “Conditions of Issue” section of the certificate.
Where on earth is that? Oh yeah, it is on that printed “other side” of the medical certificate that nobody looks at but that the pilot will get spanked for if they cut if off from the main part of the certificate (remember, fold those parts, do not cut).
In a recent set of updates on medications—prescription and over-the-counter—and responsibilities under FAR 61.53, the FAA poses questions to pilots similar to those that I have been asking since I first became an AME. These include:
• Am I having trouble clearing my ears?
• Do I feel bad enough that I keep thinking about how I feel?
• Are others asking me how I feel?
There are other sage recommendations from the FAA on this subject, but you get the gist of the idea: “Seriously, am I too sick to fly today?”
FAR 61.53 is somewhat akin medically to the operational responsibility stated in FAR 91.3. Both FARs are short and sweet but pack a lot of punch.
<h2>Clogged Ears and Sinuses</h2>
While I will cover specific illnesses and medications in my next blog, a quick word about ears and sinuses being clogged. I believe the FAA put that at the top of its list of questions for very good reasons.
A pilot should not fly if they are feeling significant sinus pressure or clogged ears. While the FAA refers to the cautionary self-assessment as occurring on the ground (before flight), this also applies to how the pilot felt on their last descent.&nbsp;
Significant barotrauma (injury caused by air pressure) can occur in the ears, sinuses, lungs, and other body cavities as a result of illness or anatomical anomalies in the upper respiratory tract, among other factors. An injury can occur to a pilot, scuba diver, or alpinist.
Such injuries can range from quite minor (which will usually resolve without too much fanfare), to a severity that may cause an extended period of grounding or even be career-ending for a pilot (or avocation-ending in the case of scuba diving), to life-threatening in extreme cases.
I will discuss this theme further in a future blog, but for now please simply refrain from flying if there is any concern for sinus and/or ear clogging.
Please note that item 17a on the FAA MedXpress application form asks for medications being taken. On face value that seems to be simple enough but read further.
It states that the pilot is asked to report both “prescription and non-prescription” medications. This quagmire of a topic is fraught with challenges and frustrations for pilots and is something I will explain in greater detail in my next blog.
As you can see, I have covered a lot of ground and have not yet answered the “simple” question that the pilot posed to me that started this wandering discussion. Typical illnesses, symptoms, FAR 61.53, medications (prescription and non-prescription), vaccines, and other non-medicinal remedies is a large topic.
Regardless of all of the discussion that might ensue from a seemingly simple question, it is always a pilot’s responsibility to self-assess their airworthiness on a day-to-day basis and to avoid placing other crew members at risk for illness or distraction from their own flight duties.
The opinions expressed in this column are those of the author and not necessarily endorsed by AIN Media Group.

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