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Re: Response to Dickinson´s and McConnell´s letter - authors reply

Dear Editor,

We appreciate the electronic letter from Dickinson and McConnell who refer to our review “Inhaled beta 2-agonists and performance in competitive athletes”. They make the point that maintaining the formal requirement to apply for a TUE (therapeutic use exemption) before the start of therapy with inhaled beta 2-agonists in asthmatic athletes in the long term leads to improved medical care and diagnostic techniques. However, this argument leads to the consideration whether such aims are worth the bureaucratic burden brought up by the application process – a view that we challenge. In addition, we do not agree that improvement of medical care and refinement of diagnostic techniques are worthwhile targets for the formulation of prohibited lists within doping control efforts. In contrast, optimal medical care and innovation of diagnostic tools represent natural issues for physicians dealing with elite athletes as well as for sports medical science.

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Re: Abbreviated TUE's have improved service delivery

Dear Editor,

We read with great interest the recent review from Kinderman and Meyer in the recent supplement in the BJSM entitled ‘Inhaled ß₂-agonists and performance in competitive athletes’. They raise the issue as to whether it is appropriate for inhaled ß₂-agonists to require an abbreviated TUE before an athlete is allowed to use them in order to attenuate their asthma/EIA. They put forward the suggestion inhaled ß₂-agonists are inappropriately on the WADA prohibited list due to the lack of evidence in the literature suggesting a performance enhancing effect of inhaled ß₂-agonists. Although the process of acquiring a TUE can cause administrative burden we would like to point out that our work in this area has demonstrated marked improvement in the quality of care elite athletes receive regarding respiratory issues. In the build up to the 2004 Athens Olympic Games we reported that 20% of British elite athletes using asthma medication where doing so inappropriately [1]. Furthermore, screening elite athletes for asthma/EIA appears warranted as reports have suggested many athletes fail to recognise the symptoms of asthma and even those athletes who do report symptoms do not necessarily have EIA and may suffer from other conditions such as inspiratory stridor [2;5,4;3]. Therefore diagnosis without specific tests for EIA may result in false positive and false negative diagnosis.

In summary we agree with Kinderman and Meyer that there is no conclusive evidence that inhaled ß₂-agonists improves athletic performance. However, the requirement of abbreviated TUE’s has resulted in improved diagnostic techniques being used on a more regular basis with elite athletes and has lead to an improvement in the quality of care athletes receive. In the future if inhaled ß₂-agonists are removed from the WADA prohibited list we hope this will not result in deterioration of the support athletes have started to receive since the TUE requirement came into effect in 2002

Yours Sincerely,

Dr. John Dickinson

English Institute of Sport

Prof. Alison McConnell

Sports Science, Brunel University

References

1. Dickinson, J., Whyte, G., McConnell, A. et al. The Impact of the IOC- MC changes in asthma criteria: A British Perspective. Thorax 2005; 60: 629 -632

2. Dickinson, J., Whyte, G., McConnell, A. et al. Screening elite winter athletes for exercise-induced asthma: a comparison of three challenge methods. British Journal of Sports Medicine 2006; 40: 179-183

3. Holzer, K. and Brukner, P. Screening of athletes for exercise-induced bronchoconstriction. Clinical Journal of Sports Medicine 2004; 14: 134-8

4. Rundell, K. Im, J. Mayers, L. et al. Self-reported symptoms and exercise-induced asthma in the elite athlete. Medicine and Science in Sports and Exercise 2001; 33: 208-213