Objectives: i) To review the methacholine tests performed in our Laboratory up until 2008; ii) to compare them with previously reported data in 2006 and iii) to examine if the Anti-Doping rules are meeting the needs of asthmatic athletes who really need bronchodilator treatment.
Methods: Between April 2004 and September 2008, 89 high level athletes were examined in our laboratory in order to obtain an ATUE for beta 2 agonists. Of these, 50 men (23.31 ± 7.05 years) and 23 women (20.68 ± 5.94 years) performed a methacholine inhalation test with increasing concentrations of methacholine (0,025 mg/ml, 0,25 mg/ml, 2,5 mg/ml, 5 mg/ml, 10 mg/ml and 25 mg/ml) until a fall of 20% in FEV1 was achieved.
Results: 31 candidates (42.5%) had a PC20 lower than 2 mg/mL; 12 (16.4%) were between 2 and 4 mg/mL; 8 (11%) between 4.1 and 8 mg/mL and 22 candidates (30.1%) had a PC20 higher than 8 mg/mL. Seven of the 73 candidates had an obstructive pattern in the spirometry at rest, demonstrated by a FEV1% lower than 70% but with a FEV1 higher than 70% of the reference value.
Conclusions: The anti-doping regulations with respect to beta-2 agonists need to be reviewed and measures should be adopted to include a fall of 70% in FEV1% as an obstruction criterion to indicate a bronchodilation test and to extend the criterion for a positive methacholine test to a PC20 of 8 mg/ml.