Pulmonary Disorders

Asthma

For the LEO diagnosed with asthma, other than a history of resolved childhood asthma, initial evaluation should be performed to classify them as “well-controlled,” “not-well-controlled” or “poorly controlled” (see Appendix B for evaluation recommendations).

In the majority of cases, asthma can be controlled as to not adversely affect an individual’s ability to safely and effectively perform essential LEO job functions. However, effective management of asthma is highly dependent on compliance with optimal medical recommendations. In some cases, despite this compliance, asthma may impair the LEO’s ability to safely and effectively perform essential job functions.

Well-controlled Asthma
LEOs with well-controlled asthma (see Appendix B on assessing degree of control) should be evaluated using job simulation tasks (without any immediate pre- or during-test use of a short-acting beta agonist [SABA]) consistent with their agency’s essential job functions.

• LEOs with well-controlled asthma who satisfactorily perform the specified job simulation tasks should have no restriction from full duty for asthma.
• LEOs with well-controlled asthma who are unable to satisfactorily perform the specified job simulation tasks should be restricted from full duty and referred to their treating physician for re-evaluation and possible modification of current treatment regimen (see Appendix B on re-assessment). If the LEO is approved by the treating physician to undergo repeat job simulation tasks, the decision should be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should repeat the same job simulation tasks previously performed.
• LEOs who satisfactorily perform the repeat job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the repeat job simulation tasks, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B).

If re-approved by the treating physician to be evaluated using job simulation tasks, the decision should again be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should repeat the same job simulation tasks previously performed.

• LEOs who satisfactorily perform the repeat job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the second repeat job simulation tasks, should remain restricted from full duty.

This process may be repeated, as per agency policy; however, in order to be cleared for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

LEOs with well-controlled asthma who have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on, at minimum, an annual basis, per LEO Task Group consensus.

Not Well-controlled Asthma
LEOs determined to have not-well-controlled asthma (see Appendix B on assessment of degree of control) with no history of job performance difficulties potentially due to asthma should be:

1. Evaluated using job simulation tasks(without any immediate pre- or during-test use of a SABA consistent with their agency’s essential job functions (see Appendix C for discussion of job simulation tasks) unless they have other contraindications to physical exertion, in which case, they should be evaluated by the criteria in the relevant section of these guides;
   AND
2. Referred to their treating physician for re-evaluation and possible modification of current treatment regimen.

LEOs with not-well-controlled asthma who satisfactorily perform the specified job simulation tasks should have no restriction from full duty for asthma pending re-assessment by their treating physician (see Appendix B regarding re-assessment).

LEOs with not-well-controlled asthma who are unable to satisfactorily perform the specified job simulation tasks should be restricted from full duty pending re-assessment by their treating physician (see Appendix B regarding re-assessment).

If approved by the treating physician to undergo repeat job simulation tasks, the decision should be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should repeat the same job simulation tasks previously performed.

• LEOs who satisfactorily perform the repeat job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the repeat job simulation tasks, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B).

If re-approved by their treating physician to be evaluated using job simulation tasks, the decision should again be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should repeat the same job simulation tasks previously performed.

• LEOs who satisfactorily perform the repeat job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the second repeat job simulation tasks, should remain restricted from full duty.

This process may be repeated, as per agency policy; however, in order to be cleared for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

LEO initially assessed to have not-well-controlled asthma who have been re-evaluated, have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on, at minimum, an annual basis, per LEO Task Group consensus.

Poorly Controlled Asthma
The LEO with poorly controlled asthma (see Appendix B for information on assessment of degree of control) should be restricted from full duty and referred to her/his treating physician for re-assessment and modification of treatment.

If approved by the treating physician to be evaluated using job simulation tasks, the decision should be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should be evaluated using job simulation tasks (without any immediate pre- or during-test use of a SABA consistent with their agency’s essential job functions – see Appendix C for discussion of job simulation tasks evaluation) unless they have other contraindications to physical exertion, in which case, they should be evaluated by the criteria in the relevant section of these guides.

• LEOs who satisfactorily perform the job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the job simulation tasks, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B on reassessment). If re-approved by their treating physician to be evaluated using job simulation tasks, the decision should again be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should repeat the same job simulation tasks previously performed.
• LEOs who satisfactorily perform the repeat job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the second repeat job simulation tasks, should remain restricted from full duty.

This process may be repeated, as per agency policy; however, in order to be cleared for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

LEOs initially evaluated initially as having poorly controlled asthma who have been re-evaluated, have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on, at minimum, an annual basis, per LEO Task Group consensus.

LEOs with On-the-job Performance Issues Potentially Related to Asthma
LEOs with on-the-job performance issues potentially related to asthma should be restricted from full duty and referred to their treating physician for re-assessment and modification of treatment.

If approved by the treating physician to be evaluated using job simulation tasks, the decision should be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should be evaluated using job simulation tasks (without any immediate pre- or during-test use of a SABA consistent with their agency’s essential job functions (see Appendix C for discussion of job simulation tasks) unless they have other contraindications to physical exertion, in which case, they should be evaluated by the criteria in the relevant section of these guides.

• LEOs who satisfactorily perform the job simulation tasks should have no restriction from full duty for asthma, but may need further evaluation for other potential medical factors related to the job performance issue cited.
• LEOs who are unable to satisfactorily perform the job simulation tasks, should remain restricted from full duty and be referred back to their treating physician for further assessment regarding the diagnosis as well as the treatment plan (see Appendix B regarding reassessment).

If re-approved by their treating physician to be evaluated using job simulation tasks, the decision should again be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should repeat the same job simulation tasks previously performed.

• LEOs who satisfactorily perform the repeat job simulation tasks should have no restriction from full duty.
• LEOs who are unable to satisfactorily perform the second repeat job simulation tasks, should remain restricted from full duty.

This process may be repeated, as per agency policy; however, in order to be cleared for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

LEOs who had on-the-job performance issues potentially related to asthma who have been re-evaluated, have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on, at minimum, an annual basis, per LEO Task Group consensus.

Exercise-Induced Asthma
LEOs with symptoms potentially related to asthma during exercise should be evaluated as not-well controlled or poorly controlled asthma per the sections on “Not-Well-Controlled Asthma” and “Poorly Controlled Asthma.”

LEOs with diagnosed exercise-induced asthma (see Appendix A for definition) with no history of job performance difficulties potentially due to asthma should be evaluated using job simulation tasks consistent with their agency’s essential job functions (see Appendix C) without any immediate pre- or during-test use of a SABA unless they have other contraindications to physical exertion, in which case, they should be evaluated by the criteria in the relevant section of these guides If they have not had any job performance difficulties potentially due to asthma, they may not need restrictions pending job simulation tasks. The police physician should make individualized decisions based on the history.

LEOs with a history of job performance difficulties potentially due to exercise-induced asthma should be evaluated and managed as outlined in section on LEOs with on-the-job performance issues potentially related to asthma.

• LEOs with exercise-induced asthma who satisfactorily perform the specified job simulation tasks without any immediate pre- or during-test use of short-acting beta agonist (SABA) rescue medication should have no restriction from full duty for asthma.
• LEOs with exercise-induced asthma who are unable to satisfactorily perform the specified job simulation tasks should be restricted from full duty and referred to their treating physician for re-evaluation and possible modification of current treatment regimen (see Appendix B regarding re-assessment).

If approved by the treating physician to be evaluated using job simulation tasks, the decision should be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should undergo repeat job simulation tasks as outlined above in this section.

In order to be cleared to for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C). Once cleared to full duty, LEO should still undergo continued monitoring. It is the consensus of the Task Group that monitoring should be done annually or more frequently if indicated.

This process may be repeated, as per agency policy; however, in order to be cleared for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

LEOs with exercise-induced asthma who have been re-evaluated, have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on a regular basis for control. It is the consensus of the LEO Task Group that monitoring should be done annually or more frequently if indicated.

Allergic Asthma
LEOs with a history of asthmatic reactions on exposure to specific substances may need further evaluation and treatment modification if it is determined that there is a high likelihood of on-the-job exposure to substances that might provoke bronchospasm.

LEOs who have manifested on-the-job performance issues related to asthma on exposure to substances in their work environment should undergo further evaluation and should be restricted from full duty until:

• the allergen has been identified AND
• desensitization has been achieved, OR
• if a specific allergen could not be identified or desensitization could not be achieved, it should be demonstrated that the symptoms can be controlled when placed in the situation in which the original symptoms occurred without use of a SABA.

Since LEOs with allergic asthma may also have underlying bronchial irritability and bronchospasm, they should also undergo job simulation testing without any immediate pre- or during-test use of a SABA consistent with their agency’s essential job functions (see Appendix C) unless they have other contraindications to physical exertion, in which case, they should be evaluated by the criteria in the relevant section of these guides.

If the LEO successfully completes the job simulation tasks, no restrictions should be placed on work activities.

• LEOs with allergic asthma who have met the conditions noted above regarding desensitization or allergen challenge and who satisfactorily perform the job simulation tasks should have no restriction from full duty.
• LEOs with allergic asthma who are unable to satisfactorily perform the specified job simulation tasks should be restricted from full duty and referred back to their treating physician for further assessment regarding the diagnosis and treatment plan (see Appendix B regarding reassessment).

If approved by the treating physician to be evaluated using job simulation tasks, the decision should be reviewed by the police physician. If the police physician is in agreement with the treating physician, the LEO should undergo repeat job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

This process may be repeated, as per agency policy; however, in order to be cleared for full duty, the LEO should successfully complete job simulation tasks consistent with their agency’s essential job functions (see Appendix C).

LEOs with allergic asthma who have been re-evaluated, have satisfactorily completed the exercise challenge testing and have no restriction from full duty should be monitored on a regular basis for control. A monitoring schedule should be established by the police physician to assess for maintenance of control. It is the consensus of the LEO Task Group that monitoring should be done annually or more frequently if indicated.

Adult-Onset Asthma
Asthma that initially manifests during mid-adult life should be assessed by the same criteria as above in the sections on “Well-controlled Asthma” through “LEOs with On-the-Job Performance Issues Potentially Related to Asthma.”

Acute Bronchospasm/Asthma Exacerbation
In the event of acute asthma exacerbation limiting their ability to work, the LEO with asthma should inform their supervisor(s) that they have a medical condition which, in their opinion, requires that they be restricted from full duty. Before returning to full duty they should be evaluated by the police physician. The police physician should re-evaluate the LEO’s asthma control status as per the section above on “LEOs with On-the-Job Performance Issues Potentially Related to Asthma.”