ORIGINAL ARTICLE

Use of ß₂ agonists in sport: are the present criteria right?

J Naranjo Orellana¹, R A Centeno Prada¹, M D Carranza Márquez¹

¹ Centro Andaluz de Medicina del Deporte, Seville, Spain

Correspondence to:
Correspondence to:
Dr Naranjo Orellana
Centro Andaluz de Medicina del Deporte, Sevilla, Spain; jose.naranjo{at}juntadeandalucia.es

Background: The regulations for doping control prohibit the use of ß₂ agonist bronchodilators (salbutamol, salmeterol, formoterol, and terbutaline) unless the subject follows the procedure known as abbreviated therapeutic use exemption (ATUE).

Objective: To highlight how the interest in discovering possible cheats may result in damage to athletes who really need bronchodilator treatment.

Methods: Thirty one high level athletes (18 men and 13 women) with a previous diagnosis of asthma were examined in our laboratory in order to obtain an ATUE for ß₂ agonists. All the subjects underwent spirometry at rest. If the results were normal, the subjects underwent an effort test and, if negative, a methacholine test inhaling progressive doses of methacholine until a fall of 20% in forced expiratory volume in one second (FEV₁) was achieved. The international anti-doping regulations require that the fall in FEV₁ occurs with a concentration of methacholine (PC20) lower than 2 mg/ml (4 mg/ml for Torino 2006). In clinical practice, a test is positive if the response occurs with a PC20 lower than 8 mg/ml.

Results: Only one subject met the criterion for the bronchodilation test at rest. The remaining 30 athletes underwent an effort test, which was positive in nine of them. In 21 cases (13 men and 8 women) the effort test was negative so a methacholine test was carried out. Seven (33%) were negative for ATUE with a PC20 higher than 8 mg/ml, seven (33%) were positive for ATUE with a PC20 less than 2 mg/ml, in four (19%) the PC20 was 2–4 mg/ml, and in three (14%) it was 4–8 mg/ml.

Conclusions: Strict vigilance of fair play should be pursued, but excessive control can lead to situations of inequality for asthmatic athletes such that a third of athletes cannot be treated with ß₂ agonists. Therefore under current regulations, asthmatic athletes are often denied the most effective therapeutic option.

Abbreviations: ATUE, abbreviated therapeutic use exemption; FEV₁, forced expiratory volume in one second; FEV₁%, FEV₁ as a percentage of forced vital capacity; PC20, concentration of methacholine that produces a fall of 20% in FEV₁; PD20, accumulated dose of methacholine that produces a fall of 20% in FEV₁

Keywords: asthma; ß2 agonists; bronchial hyper-responsiveness; doping

---

 

Commentary

J Ribas²

² Department of Medical Physiology and Biophysics Faculty of Medicine, University of Seville, Seville, Spain; jribas{at}us.es

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Marcovitch, H. (2006). What's new this month in BMJ Journals.. BMJ 332: 1145-1145 [Full Text]