Do airway-widening drugs enhance performance, asks George Winter

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Only 17 per cent of the cyclists who competed in the 2008 Olympics were registered as asthmatic, but these athletes won 29 per cent of the individual medals. Could there be a connection to asthma medication?

Exercise-induced asthma (EIA) is a temporary narrowing of the airways during or after exercise, causing coughing and shortness of breath.

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EIA can be relieved by using inhaled beta-2 agonists (IBA) such as salbutamol — the active ingredient in Ventolin inhalers which relaxes the smooth muscle cells surrounding airways, for easier breathing.

Even though IBAs are on the World Anti-Doping Agency’s (WADA) list of prohibited substances, asthmatic cyclists are permitted by the International Olympic Committee to take inhaled IBAs such as salbutamol up to a maximum of 1600μg/day (micrograms a day) — i.e. without requiring a therapeutic use exemption (TUE).

It has been shown that orally ingested beta-2 agonists can increase exercise performance, but what about the inhaled forms?

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A recent study investigated whether inhaling 1600μg of salbutamol would improve time trial performance in 20 trained male cyclists, with and without asthma. Since IBA doses are not calculated according to body weight, it was assumed that lighter cyclists would benefit more than heavier ones.

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The researchers found that inhaling WADA’s maximum permitted dose of salbutamol allowed the cyclists to breathe more easily, yet their performance did not improve, perhaps owing to side effects of the drug.

Further research under way aims to determine whether the same effects are found in female cyclists.

This article was modified on January 6 to clarify that no TUE is required for salbutamol below a dosage of 1,600 micrograms.

  • Nuno Frederico de Oliveira

    If you’d bother asking an GP he would have explained what salbutamol does to asthmatics. Asthma causes the bronchia in ones lungs to contract thus reducing their capacity to process oxygen. Salbutamol is a bronchodilator. And it returns the affected bronchia to their natural state. Salbutamol works only on affected bronchia. If you’re not having an asthma attack then Ventilan or Ventolin will do nothing to you. I’m 41 and have suffered from asthma since I can remember. I raced at a national level and obviously this issue came up. There are a number of drugs similar to Ventilan that have other substances that help carry the oxygen in the blood. These might accuse a positive result for AD tests. My point is that if you’re not asthmatic, an asthma medicine will make your lungs go into overboost. If you are asthmatic, the medicine will only return you to your normal state. There are loads of swimmers with asthma as well, not just Cyclists.

  • no one important

    False belief of a PED. If a persons bronchials aren’t spasming, then albuterol isn’t going to do anything for you. Some people may get the jitters but that isn’t performance enhancing – in fact it actually may cause fatigue before you even get to the starting line! For you and others who have asthma, it doesn’t give you an edge but can at least bring you to the level of other competitors who do not have asthma- ergo do not have impaired pulmonary function issues. Yep, they are amazing medications and used correctly mean folks with asthma can compete along side anything else :-). Best of luck with your competitions!

    PS to TOM – Salbuterol or albuterol are only by prescription in the USA so you do have to convince a legally prescribing provider to write you a script in order to obtain it. It’s not an over the counter med.

  • Nomad

    I’m an amateur masters competitor (50+), and use Albuterol for exercise-induced asthma (was diagnosed decades ago w/asthma & severe allergies). It’s far from a PED, but it does keep my symptoms more manageable allowing me to train & race at a competitive level. My son, who’s a top HS runner, inherited my crappy genes and also has EIA & allergies and requires an inhaler. These are nothing short of modern medical miracles for those of us that have EIA & severe allergies and want to compete in endurance sports. There does, though, seem to be a lot of pro endurance athletes using inhalers these days. An epidemic of EIA or a false belief of a PED?

  • no one important

    Please explain how Fluticasone used as an Ihaled Corticosteroid (ICS) for asthma is ‘performance enhancing’ beyond keeping inflammation down for those who have asthma. This is not an anabolic steroid and does not work by building muscle bulk. Athletes who have asthma are at a disadvantage with inflammed and overly twitchy airways which can reduce the amount of oxygen getting to the blood stream. Inhaled steroids simply reduce the swelling and reduce the risk of bronchospasm – but they do not eliminate that risk. Side effects from using ICS’s depend on dosing w/high dosing for long periods of time at greater risk for systemic absorption. Systemic absorption of corticosteroids is anything but ‘enhancing’. It’s miserable.

  • Tom

    I can see that you have now acknowledged the correction. Thank you very much for this.

  • Tom

    You still say that ‘asthmatic cyclists’ are permitted Salbutamol. As Salbutamol is no longer a banned substance at all, then you would not need to prove, or even be, asthmatic to legally take it.
    I notice you have changed the body text to acknowledge that a TUE is not necessary, and you have shifted the piece towards a discussion on sub-TUE salbutamol, and I would appreciate an acknowledgement of that – I have the article in print form (from the magazine last month) so these changes are very evident.

  • David Bradford

    Tom, you are correct that salbutamol <1,600 micrograms doesn't require a TUE, but the original article did not mention TUEs. In fact, it is directly addressing the question of whether sub-TUE levels of the substance could have a performance-enhancing effect.
    The potentially misleading sub-heading "Athlete exemptions" has now been removed. Apologies for any confusion.

  • Andrew Bairsto

    Correct.

  • Matt JS

    Please post a response to Tom or pull the article. I rely on investigative journalism to keep me informed on technical matters. Doping is such an important issue in sport, the readership require timely, accurate, impartial information in order to formulate their opinions.

  • Tom

    This article is, unfortunately, completely wrong.

    Most TUEs are for CorticoSteroids such as Fluticasone, a much more concerning prospect given its capacity for performance enhancing. Salbumatol no longer requires a TUE for competitive use, the 1600 microgram limit is without a TUE.

    Misinformation and lazy journalism like this is exactly the sort of thing that facilitates the gradual slip into the grey area of doping in sport.