I just endured a pretty terrible waiver experience, but everything turned out well and I'm slated for OCS in a month -- thought I'd share for the folks out there who are worried about Spirometry/Methacholine/Asthma/Inhalers.
My situation was a little bit of a special case, but in the end I learned a lot about the process and the tests, which knowing more about going in would have been nice. The way it works, as I understand it, is below:
First, you fill out MEPS pre-screening paperwork. MEPS reviews it. If they see no problems, they arrange for you to come in and take a physical. If there is a problem, they may request medical records before they agree to give you a physical. They review again and hopefully grant you the physical. If, your records indicate a history of asthma or inhaler use at any point, they will say "NO" to giving you a physical. Your recruiter/processor then sends those records to BUMED for review. BUMED reviews the records and will either tell MEPS to give you a physical or they will say "NO", you will need to get such and such tests done first. They will most likely require a Pre-Post Bronchidilator Spirometry test (PFT - Pulmonary Function Test).
- Pre-Post Bronchidilator Spirometry: You breathe in and exhale out as fast as you can several times into a machine that measures and records your lung capacity. It is compared against a control population of normal patients, and percentage values are determined based on your race, age, height, and weight. The most important measurements are FVC (Forced Vital Capacity, i.e. the total amount of air your lungs can hold) and FEV1 (Forced Expository Volume in 1 Second, i.e. the amount of air you can exhale from your lungs in the first second after taking a huge breath). You can find your predicted amounts through several online resources, they're pretty readily available. Generally speaking, if you do lots of athletics and cardio, you'll be right around your predicted values if not higher. After your first set of breaths, they give you a couple puffs of a fast acting inhaler like albuterol. You wait a few minutes, then do the test again. If you show an increase of over 12%, then there is something causing constriction in your lungs that is correctible via medication, i.e. they will diagnose asthma.
If you pass the PFT with normal results (likely on your own dime, out of pocket will cost ~$150, depending on full-pay or self-pay discounts, etc), your recruiter/processor resubmits to BUMED. They review results and instruct MEPS to give you the physical. At MEPS, you take your physical and interview with the doctor. The doctor will "PHYSICALLY DISQUALIFY" you, so do not be alarmed. It is automatic at this point. They wait until your blood test and urine test to come back and then MEPS sends the ENTIRE physical to your service's waiver processing office. They send it to BUMED, who then will issue the waiver to your processor/recruiter.
Once you get a final select and an OCS date and you report to OCS, you will be given a full flight physical by NOMI on the 2nd or 3rd day. They have more strict guidelines than MEPS, and will likely require you to get a Methacholine Challenge Test. It is a showstopper of a test.
-Methacholine Challenge Test: The doc has you breathe in increasing doses of nebulized methacholine, designed to instigate a reaction. If you have asthma, your lungs will react and begin to constrict. You first begin by doing a regular spirometry. These numbers should closely match the numbers you did before. You then breathe in about 5-6 deep breaths of the methacholine. After 2 minutes, you do a spirometry. Again, you are primarily concerned with the FVC and FEV1 measurements. If you drop 20%, the test is positive. You have to complete about 5-6 dose levels. Usually the first 3 are pretty easy (I had about 1% change in FEV1 for the first few which is negligible, and then 8% and then 14% on the last two...in the clear). 14% decrease doesn't feel like much beyond some fatigue, but you feel tired. At that point, you've basically been blowing as hard as you can for an hour, so you're tired to begin with. There's really no way to cheat the test, it does what it is supposed to do. Hints: make sure when you blow your nose is clipped and your lips are sealed around the mouthpiece to no air escapes and cheats you out of your measurements. Apparently, caffeine is a proven agent that will open your lungs, which is why they specify that you be off it before the test along with all medicines and inhalers (although it really won't make a difference if you have a cup in the morning beyond mentally making you confident, so says the technician). If you actually have major asthma problems, you can be sure that no amount of coffee or anything will help you pass the test. Asthma or not, Technique is everything. On my final dose, I hit 14% on my first blow, and on my second and third I hit 26%. The doc had me do it again, really emphasizing technique. I adjusted myself, blew again, and hit 13% and 14% on the next two blows, which basically validated the first good number and negated the bad ones. Technique can be the difference between 14% (passing) and 26% (failing), so be cognizant of it...and remember, it needs to be repeatable in order for the measurements to be accurate.
I would HIGHLY recommend getting the Methacholine test before attending OCS because a) you'll know you're in the clear and can spend your time worrying about fitness and memorization b) if by some stupid chance they want you to do it again, you know what to expect and know you've passed it once and can pass it again c) you can control the test environment and retake, get a second opinion, etc if you don't perform as well as you'd hoped d) you're taking it on your own grounds, without the stress of actually being at OCS factoring into your performance. I have not yet been to NOMI, but I will be taking my results with me to OCS to pull out in case they request the MCT. On your own, if you are insured then insurance will cover the cost of a doctor ordered test. You may have to pay a copay depending on your plan. If you are not insured, you need to shop around because I have seen pricing vary. I have seen it cost $200, $420, $850, $1200 (most common range), and $2300. Really it just comes down to the facility. As far as estimating how you will do on it, the Pre-Post Spiro is not a statistically reliable method in predicting methacholine challenge performance. But FWIW, I blew 112% on my baseline Spiro and had a 1% increase after the inhaler puffs (negligible difference). I maxed out on the methacholine challenge at 14% decrease, a negative test (hooyah). When I am around cats, I still get itchy eyes and sneezy, and used to have a lot of chest tightness after 2-3 days of being around them (that mainly included sleeping where there is dander). This is what had me scared, knowing that I have had trouble breathing around cats (and ONLY cats), but I also work out and started doing a lot of cardio so who knows. What I'm saying is that even with these past symptoms, it IS possible, so get the test done and have confidence!
Hopefully this breakdown helps someone, I know I could have used a laid out "what to expect" analysis. Good luck to all!