dence suggests those with asthma discovered after enlistment are more likely to drop out during basic training. A reasonable question is whether or not having asthma should make an individual ineligible for military service. Currently, asthma at any level of severity precludes participation in the military. It is likely that individuals without symptoms for a prolonged period of time or even those with mild and infrequent symptoms could carry out their service requirements, especially if they received optimal medical therapy and self-management education. However, there are costs associated with ensuring timely access of personnel to needed medical therapies and making self-management education available. Furthermore, existing data are not informative regarding whether the conduct of certain military operations is more conducive to problems for those with asthma than others, for example, whether environmental conditions or specific tasks may trigger exacerbations. Nonetheless, in general, available data do not suggest a negative service trajectory after initial training for individuals with asthma compared with those without. Using asthma as an exclusionary factor for military service is likely to work against minorities and women, as these groups exhibit the highest prevalence of asthma.

It may be that the goal-oriented climate of military recruitment discourages disclosure by some individuals who have asthma. Data suggest that those who have the condition but do not initially disclose it may drop out more frequently from basic training, while those who disclose a history of the illness at the time of enlistment and receive a waiver have lower attrition rates. Encouraging disclosure in a benign environment is a desired goal.

CONCLUSION

In light of current data, the existing standard and waiver process regarding asthma is appropriate. Research on the cost-benefit consequences of enlisting individuals with more severe asthma would be needed prior to recommending any change in enlistment policy regarding asthma.



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