FAA Asthma Guidance: What Pilots Need to Know About Medical Certification

Asthma is one of the most common chronic respiratory conditions in the general population, affecting an estimated 25 million Americans. For pilots, the question is not whether you have asthma — it is whether your asthma is well-controlled enough to safely exercise the privileges of your airman medical certificate. The good news is that the FAA has a well-defined pathway for pilots with asthma, and many cases can even be certified directly in the AME's office through the CACI (Conditions AMEs Can Issue) process.

This article breaks down the FAA's current guidance on asthma certification under Item 35 — Lungs and Chest, including the CACI worksheet, the AME Assisted Special Issuance (AASI) process, and what to expect if your case requires an FAA decision.

How the FAA Classifies Asthma

The FAA divides asthma into two broad categories when evaluating pilots for medical certification:

Category	Class	Required Documentation	Disposition
Mild or seasonal symptoms	All (1, 2, 3)	Pertinent medical info, current status, PFTs, symptom duration, medication names/dosages/side effects	CACI eligible — AME may issue if criteria met. Otherwise requires FAA decision.
Frequent or severe symptoms	All (1, 2, 3)	All pertinent medical info, current status, PFTs, symptom duration, medication names/dosages/side effects	Requires FAA decision for initial SI. Follow-up via AASI protocol.

This distinction is critical because it determines your certification pathway. Mild or seasonal asthma can often be handled entirely in your AME's office, while more severe cases require FAA involvement — at least initially.

The CACI Pathway: Certification in the AME's Office

For pilots with mild or seasonal asthma, the FAA allows Aviation Medical Examiners (AMEs) to issue a medical certificate directly using the CACI Asthma Worksheet (PDF). This is the fastest and least burdensome pathway.

To qualify for CACI issuance, pilots generally need to demonstrate:

Symptoms are mild, intermittent, or seasonal
No history of hospitalization for asthma
No use of systemic steroid medications
No symptoms experienced during flight
Stable medication regimen with no significant side effects
Pulmonary function testing (PFTs) within normal limits — only if taking medications beyond as-needed albuterol

Important: PFTs Are Not Always Required

If as-needed albuterol (rescue inhaler) is your only asthma medication, PFTs are not required for CACI clearance. PFTs are only needed when the pilot uses any additional controller or maintenance medication beyond a rescue inhaler. This is a common misunderstanding that causes pilots to delay their appointments unnecessarily.

If you meet all the criteria on the CACI worksheet, your AME can issue your certificate on the spot — no need to wait for Oklahoma City. If you do not meet all the criteria, the AME must defer to the FAA for a decision.

Pro Tip:

If you take any asthma medications beyond a rescue inhaler, bring your PFT results and a current status letter from your treating physician to your AME appointment. Having all documentation ready at the time of your exam can mean the difference between walking out with a certificate and waiting weeks for a deferral decision.

The Special Issuance Pathway

If your asthma does not meet the CACI criteria — for example, if you have frequent or severe symptoms, a history of hospitalization, or require multiple medications — you will need a Special Issuance (SI) authorization from the FAA.

Initial Special Issuance

For a first-time SI application, even if you have all the requisite medical documentation, the AME must defer your case to the Aerospace Medical Certification Division (AMCD) or your Regional Flight Surgeon (RFS). The FAA physician will review your records and, if appropriate, grant an Authorization for Special Issuance under 14 CFR 67.401.

Follow-Up Special Issuances (AASI)

Once you have received your initial SI authorization, subsequent renewals can often be handled through the AME Assisted Special Issuance (AASI) process — meaning your AME can re-issue your certificate without sending your case back to the FAA each time.

For an AASI renewal, you will need to provide your AME with:

Your original Authorization letter from the FAA
A current medical status report addressing frequency of attacks and whether any have resulted in ER visits or hospitalizations
The name, dosage, and side effects of all medications used for treatment or prevention
Pulmonary function testing (PFTs) within the last 90 days, if deemed necessary

When Your AME Must Defer

Even with an existing AASI authorization, your AME is required to defer your case back to the AMCD or Regional Flight Surgeon if any of the following apply:

Symptoms have worsened
There has been an increase in ER, hospital, or outpatient visits
Your FEV1 is less than 70% of predicted value
You require 3 or more medications for stabilization
You are taking steroid doses equivalent to more than 20mg of prednisone per day (use the steroid conversion calculator to check)

These red flags indicate that your asthma may pose an unacceptable risk for in-flight incapacitation, and the FAA wants a physician at AMCD to make the call.

The 14 CFR 61.53 Reminder

Regardless of your certification pathway, it is important to remember 14 CFR 61.53 — the regulation that prohibits pilots from exercising certificate privileges when they know or have reason to know of any medical condition that would make them unable to meet the requirements for their medical certificate. In practical terms: if you are having an asthma exacerbation, do not fly. This is not just good practice — it is the law.

Commonly Allowed Asthma Medications

The FAA allows many commonly prescribed asthma medications. In general, inhaled corticosteroids and short-acting bronchodilators (rescue inhalers like albuterol) are acceptable. However, pilots should always disclose all medications to their AME and verify acceptability. Use the FAA Medication Lookup tool on our site to check specific medications.

Medications that may cause concern include:

Oral/systemic corticosteroids — high doses (>20mg prednisone equivalent/day) trigger deferral
Biologics (omalizumab, dupilumab, etc.) — typically require individual FAA review
Combination inhalers with long-acting beta-agonists — generally acceptable but should be documented

What to Bring to Your AME Appointment

Whether you are pursuing CACI certification or a Special Issuance, come prepared with the following documentation:

Current status letter from your treating physician (pulmonologist or allergist)
Pulmonary function test results (spirometry with FEV1, FVC, and FEV1/FVC ratio) — ideally within the last 90 days. Note: PFTs are only required if you take medications beyond as-needed albuterol.
Complete medication list with dosages and any side effects noted
Hospitalization or ER records if applicable
FAA Authorization letter if you have an existing Special Issuance

The Bottom Line

Asthma is one of the more straightforward conditions to certify if your symptoms are well-controlled. Many pilots with mild asthma are certified the same day through the CACI process. Even pilots with more severe asthma can maintain their certificates through the Special Issuance pathway with proper documentation and regular follow-up. The key is preparation, compliance, and working with an experienced AME who understands the process.

How Go Flight Medicine Can Help

At Go Flight Medicine, we handle asthma certifications regularly — from straightforward CACI issuances to complex Special Issuance cases. If you have questions about your specific situation, our team can help you understand which pathway applies, prepare the right documentation, and guide you through the process efficiently.