Tummy troubles and people pointing lasers into cockpits are the main reasons why Australian pilots become incapacitated during flights.

The Australian Transport Safety Bureau on Thursday released its Pilot Incapacitation Occurrences 2010-2014 report.

There were 23 pilot incapacitation occurrences per year on average, with the main cause being gastrointestinal illness, followed by laser strikes.

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In most cases the pilot had to be removed from duty for the remainder of the flight, which had minimal effect on multi-pilot crews.

On flights with more than 38 seats, half of pilot incapacitations were from food poisoning or gastroenteritis, while 13 per cent had impaired vision from laser strikes.

One Airbus A380 second officer reported getting sick after eating a dodgy chicken roll crew snack in Dubai, while a first officer flying out of a West Australian mine site became unconscious after suffering gastroenteritis and dehydration.

The report recommends all pilots on the same flight eat different meals prior to and during the flight to prevent all pilots becoming incapacitated.

Pilots on smaller aircraft were also most likely to be incapacitated from a gastro illness, but there was also one pilot who tested positive for an illicit drug after he fell asleep during a flight from Bundaberg to Brisbane.

In another incident, a sole pilot with a large gallstone passed out during descent on a charter flight from Cairns to Papua New Guinea and had to be woken by a passenger.

A chartered helicopter pilot trying to land on a ship off the Western Australian coast on a hot day was temporarily blinded when sunscreen and sweat ran into his eyes.

Incapacitation for general aviation pilots, including recreational pilots, is more likely to have serious consequences because they’re often single-pilot operations.

The report outlined two fatal accidents, one where the pilot had a heart attack while trying to land at Bruny Island in Tasmania and another where a helicopter pilot crashed into scrubland in the Pilbara region of Western Australia.

Yet most general aviation pilots were incapacitated by laser strikes.

There were four instances over the five-year period, including one helicopter pilot working near Brisbane who reported being struck twice by a green laser.

-AAP