We explain the main factors in Chris Froome's adverse analytical finding for salbutamol at the 2017 Vuelta a España, and what could happen in the case going forward

On Wednesday, December 13, both the Union Cycliste Internationale (UCI) and Team Sky issued statements confirming that British rider Chris Froome had returned an adverse analytical finding (AAF) for salbutamol at the 2017 Vuelta a España.

Froome won the Vuelta riding for Team Sky, but now faces the possibility of having his victory removed should he face a sanction from the UCI for having too much salbutamol in his system.

Here, we answer the main questions arising from the case so far.

What is salbutamol, and why was it in Froome’s system?

Salbutamol is drug used to treat and alleviate the symptoms of asthma and is part of a group of drugs known as Beta-2 agonists.

The drug opens the airways in the lungs to help breathing. It is usually administered via an oral inhaler.

Froome has a known history of suffering with asthma and uses salbutamol to manage his symptoms. Team Sky said in a statement that Froome suffered from ‘acute asthma symptoms’ during the final week of the Vuelta. A team doctor advised Froome to take an increased dose of salbutamol to help alleviate his symptoms.

Froome’s use of an inhaler received attention in June 2014, when he was filmed using it during the Critérium du Dauphiné.

According to World Anti-Doping Agency (WADA) rules, 1,600 micrograms of salbutamol can be taken by an athlete via inhaler in a 24-hour period without the need for a therapeutic use exemption (TUE) certificate. A TUE is issued when an athlete requires a drug listed as prohibited by WADA for a legitimate medical need.

>>> The truth about cycling and asthma

What is an ‘adverse analytical finding’?

An adverse analytical finding is when an anti-doping authority identifies a potential breach in anti-doping rules, in this case a specified substance detected at a higher-than-allowed level by the Cycling Anti-Doping Foundation (CADF). CADF are responsible for doping control for the UCI.

WADA rules state that salbutamol is permitted to be present up to a threshold of 1,000 nanograms per millilitre (ng/ml). Froome’s urine sample collected on September 7, 2017, after stage 18 of the Vuelta is reported to have had 2,000ng/ml.

WADA rules state: “The presence in urine of salbutamol in excess of 1000ng/ml or formoterol in excess of 40ng/ml is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding (AAF) unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic dose (by inhalation) up to the maximum dose indicated above.”

>>> UCI Anti-Doping Rules (external PDF)

What about any other samples taken during the Vuelta?

Team Sky said in a statement that 20 other samples were collected from Froome during the Vuelta, and none required “any further explanation”. In other words, none returned an adverse analytical finding.

Is Froome suspended?

Froome is not currently suspended from competition as a result of the finding.

The UCI said in a statement relating to Froome’s AAF: “Pursuant to Article 7.9.1 of the UCI Anti-Doping Rules, the presence of a Specified Substance such as Salbutamol in a sample does not result in the imposition of such mandatory provisional suspension against the rider.”

>>> ‘It can already be said for certain that Froome’s abnormal test could hardly have come at a worse time for Team Sky’

What happens now?

According to the UCI, Froome’s B sample has already been tested and “has confirmed the results of the rider’s A sample”. Following the UCI’s anti-doping guidelines, the case will now be referred to Legal Anti-Doping Services (LADS). LADS is a unit separate from the UCI that is “essentially composed of legal experts, this body intervenes when a case of an apparent breach of the anti-doping rules is reported to it”.

Team Sky and Froome have been issued with a request to explain the elevated level of salbutamol. According to the Guardian, Team Sky have lawyers and scientists working to challenge the result.

What is Team Sky and Froome’s explanation?

Team Sky has said in its initial statement that “There is considerable evidence to show that there are significant and unpredictable variations in the way salbutamol is metabolised and excreted.

“As a result, the use of permissible dosages of salbutamol can sometimes result in elevated urinary concentrations, which require explanation. A wide range of factors can affect the concentrations, including the interaction of salbutamol with food or other medications, dehydration and the timing of salbutamol usage before the test.”

Froome said in the statement: “It is well known that I have asthma and I know exactly what the rules are. I use an inhaler to manage my symptoms (always within the permissible limits) and I know for sure that I will be tested every day I wear the race leader’s jersey.

“My asthma got worse at the Vuelta so I followed the team doctor’s advice to increase my salbutamol dosage. As always, I took the greatest care to ensure that I did not use more than the permissible dose.”

Since the news of Froome’s adverse test emerged in mid-December, various reports have emerged about possible defences that Froome and Team Sky could use in the case.

In mid-January, French newspaper L’Equipe reported that Froome’s lawyers would argue that a “kidney malfunction” was behind the AAF.

The scientists are reportedly aiming to show that rather than excreting the metabolites of salbutamol after it had been processed by his liver, Froome’s kidneys malfunctioned and accumulated them. When his kidneys began to function properly again, they excreted it in the high levels that resulted in the extremely elevated test reading on 7 September.

In May, The Times reported that Froome’s legal team was also considering pointing to a recently published research paper, entitled Futility of current urine salbutamol doping control which casts doubt on WADA’s test for salbutamol.

According to the paper, there is a large volatility in test results even from legal salbutamol use with as many as 15.4 per cent of tests returning a false positive, meaning that the test is “fundamentally flawed”.

Will Froome lose his Vuelta a España title?

This hinges on the evidence provided during the investigation into the AAF as to why Froome had an elevated level of salbutamol.

There are two scenarios once this have been presented and considered, according to UCI anti-doping guidelines. LADS and an external and independent legal counsel could conclude that there is no grounds for the case to be pursued. Or LADS and the external legal counsel both consider that there is cause to open disciplinary proceedings.

In the latter case, the rider would be informed of the applicable sanction – which could include a suspension from competition back-dated to the time of the test, in which instance Froome would have his Vuelta result annulled.

The case could then be referred to the UCI Anti-Doping Tribunal if the rider rejects the proposed sanction.

>>> Chris Froome could face ban after abnormal drugs test result during Vuelta a España

Another possibility is that Froome could negotiate for an “acceptance of consequences”, as was reported by Italian newspaper Il Corriere.

This would mean that Froome would acknowledge negligence in his use of an inhaler to treat asthma, and in return would only receive a six-month, back-dated ban that would see him lose his Vuelta title but leave him free to compete in the 2018 Giro d’Italia and Tour de France.

However Froome has denied the suggestion that he could pursue this course of action, dismissing these reports as “completely untrue”, suggesting that he will continue to attempt to clear his name.

Have any previous riders been banned for salbutamol?

Riders have been banned in the past for returning an AAF for salbutamol. The most recent is Italian rider Diego Ulissi, who returned an AAF for 1900ng/ml of salbutamol during the 2014 Giro d’Italia. He was suspended from competition for nine months.

Among other cases, Alessandro Petacchi was suspended for a year and had five stage wins removed after returning an AAF for salbutamol at the 2007 Giro d’Italia.

Other riders have had their cases acquitted due to medical reasons, and were not served a sanction.

Will Froome continue to race?

While some have argued it would be better for everyone if Froome was to avoid racing while case is ongoing, he and Team Sky have continued with their season as normal, with Froome racing the Ruta del Sol, Tirreno-Adriatico, and the Tour of the Alps in preparation for the Giro d’Italia.

After the Giro d’Italia, Froome is still set to compete in the Tour de France, which starts on July 7.