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All About Salbutamol

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What will the verdict in Froome's salbutamol case?

He will be cleared
43
34%
3 month ban
4
3%
6 month ban
15
12%
9 month ban
24
19%
1 year ban
16
13%
2 year ban
21
17%
4 year ban
3
2%
 
Total votes : 126

Re:

24 Dec 2017 22:12

hazaran wrote:What's the weight loss effect of Salbutamol supposed to be anyway? From what I read it makes you slightly tachycardic, so maybe extra base load from the elevated HR? That doesn't sound terribly effective at all.

The weight loss effects have been talked about several times in this thread.
Tachycardia can be minimized through long term use enabling higher doses. Also talked about
User avatar veganrob
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Re: Re:

25 Dec 2017 00:07

veganrob wrote:
hazaran wrote:What's the weight loss effect of Salbutamol supposed to be anyway? From what I read it makes you slightly tachycardic, so maybe extra base load from the elevated HR? That doesn't sound terribly effective at all.

The weight loss effects have been talked about several times in this thread.
Tachycardia can be minimized through long term use enabling higher doses. Also talked about


Yes, I've seen lots of talk on weight loss. The point is I haven't seen what the purported mechanism is supposed to be *by which* salbumatol causes weight loss. Because last I checked it's not actually a magic diet pill.
hazaran
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Re: Re:

25 Dec 2017 00:18

hazaran wrote:Yes, I've seen lots of talk on weight loss. The point is I haven't seen what the purported mechanism is supposed to be *by which* salbumatol causes weight loss. Because last I checked it's not actually a magic diet pill.


There have been a number of studies reporting increased metabolic rate and lipolysis (fat loss), e.g.:

https://www.ncbi.nlm.nih.gov/pubmed/26239482

Note this passage from the Introduction:

A possible substitute for ephedrine is albuterol, a common and accessible bronchodilator used to treat asthma and a selective β2 adrenergic agonist. It was previously shown to increase metabolic rate (oxygen consumption) and lipolysis when given by inhalation at four times the therapeutic dose of 200 μg (8, 9). Unfortunately, albuterol given at this dose in the aerosolized form invariably causes tachycardia. However, the swallowed fraction does not cause this side effect, and thus an orally given pill form of albuterol seems to be a safer form of administration (10).


This was also discussed at the bodybuilder's site linked by that South Bay blog that was discussed upthread.

Keep in mind that salbutamol acts at the same receptors clenbuterol does, though it's shorter acting and I believe has a lower affinity for these receptors. Could be described as a poor man's clenbuterol. It may not be much better than caffeine, but I don't think it has to be very effective to be attractive to riders, given that they can use it with impunity if they stay below the threshold.

But as you yourself have pointed out, he wouldn't be taking it for weight loss during a GT. I think it would have to be for recovery. There are studies suggesting it can promote muscle growth in animals, which is consistent with aiding recovery, though as I said before, I don't think this has been directly addressed:

https://www.ncbi.nlm.nih.gov/pubmed/7916118

In fact, I've seen several papers reporting new methods for assaying salbutamol in meat, specifically because it can be used to increase lean muscle in livestock, but is forbidden because of effects on consumers:

https://www.ncbi.nlm.nih.gov/pubmed/28278125
https://www.ncbi.nlm.nih.gov/pubmed/28911579
Last edited by Merckx index on 25 Dec 2017 01:05, edited 1 time in total.
Merckx index
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25 Dec 2017 01:02

Well, the rats certainly ended up *gaining weight* with the salbutamol treatment (hence why theres so much research on its effects on livestock) :) Sure, it was muscle mass, but then lipolysis & metabolic rate increase might not be so much effects in their own right but simply side effects of the muscle hypertrophy it induces, to grow muscles after all requires these things.

The doses they are using (8-16mg oral) also mean you would be "glowing", so really only suitable for the WADA protected night time - and then you better pee in the morning before they come. Doesn't make it impossible, but it's another stake into the heart of the transfusion thing.
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Re:

25 Dec 2017 07:54

hazaran wrote:Well, the rats certainly ended up *gaining weight* with the salbutamol treatment (hence why theres so much research on its effects on livestock) :) Sure, it was muscle mass, but then lipolysis & metabolic rate increase might not be so much effects in their own right but simply side effects of the muscle hypertrophy it induces, to grow muscles after all requires these things.

The doses they are using (8-16mg oral) also mean you would be "glowing", so really only suitable for the WADA protected night time - and then you better pee in the morning before they come. Doesn't make it impossible, but it's another stake into the heart of the transfusion thing.

Riding 5-7h a day will counterbalance the hyperthropic effect for sure.

Would not be too surprised if the purported use is recovery, as MI has said. Maybe the anabolic effect under a GT type endurance environment is speeded fixing of micro lesions in muscles etc instead of hypertrophy per se.
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Re: All About Salbutamol

26 Dec 2017 13:41

A little good news and a little bad news, perhaps, for Froome. The good news:

In the past, Wada has not adjusted the salbutamol threshold in test results to account for "high urine density", which can increase when you are dehydrated.

But that is changing from 1 March 2018, and a Wada spokesperson told BBC Sport that for any case currently being adjudicated, "the most beneficial rule to the athlete would apply".


http://www.bbc.com/sport/cycling/42417297

As I pointed out upthread, he would still have to be severely dehydrated (commonly defined as urine SG > 1.030) for the correction to lower his salbutamol level below the threshold, and my understanding is that if his urine were that concentrated, the sample would not have been approved for assay. In fact, his USG would have to be 1.040 to lower his level to the threshold of 1000 ng/ml, or 1.033 to reach the decision level of 1200 ng/ml. So I wanted to get an idea of how often riders are dehydrated to that extent.

The first two studies are by the same group (led by one L.E. Armstrong, no less), and involved an analysis of men and women riders in a 164 km ride, not race, under intense heat, 35 – 39o C (it's called the Hotter N' Hell Hundred). In the first study, they pooled data from three years. There were 88 men, with a mean USG of 1.019 +/.007 before the ride, and 1.024 +/- .007 after the ride. Based on these values, there would be about 16% with values > 1.030, and about 2% > 1.040.

http://sci-hub.la/10.1123/ijsnem.2015-0188

This is roughly consistent with another study by the same group of 42 men from that ride, reporting that 11 had USG > 1.030, and none > 1.040.

http://sci-hub.la/10.1519/JSC.0b013e318240f677

In another study by a different group, 11 males performed 90 minutes at 50% V02 max, followed by a self-paced 20 km TT at 35o C. Various hydrated or dehydrated states were tested. The USG values were all relatively low, generally about 1.010 at start and 1.015-1.020 at end, with SDs ranging from .002 - .008.

http://sci-hub.la/10.1111/sms.12343

Still another study analyzed 37 male mountain bikers over a 120 km Swiss Masters race. USG pre-race was 1.010 +/- .007, post-race was 1.014 +/- 0.007. They found that intake of 700 ml of fluid per hour was enough to prevent dehydration. However, temperatures were relatively cool, ranging from 5 – 11o C, the lowest temperature at altitude, > 2000 m.

http://sci-hub.la/10.1097/JSM.0b013e3181b47c93

Another study examined 18 mountain bikers in a 3 stage race. The highest mean value of USG was after stage 3, 1.025 +/ .001. Temperatures ranged from 9 – 22o C.

http://sci-hub.la/10.1136/bjsm.2008.049551

So overall, at moderate temperatures, dehydration does not seem to be a problem, while at very high temperatures it could be. I'm not sure how hot it was for Stage 18 in the Vuelta? In any case, the studies at high heat on the road were of amateur riders, who may not have been as careful about hydration as pro racers would be, though the men did take in an average of 5-6 l. of water over the entire ride, about 9 hours.

And a little bit of bad news, if Froome thought that he could get off without showing that 2000 ng/ml is possible under some conditions. I finally tracked down some information on Piepoli, who tested positive for salbutamol in the same Giro (I believe the same stage) that Petacchi did. His urine level was 1800 ng/ml., higher than Petacchi’s. Both riders got off initially through decisions by their national federations, but the Italian Olympic Committee (CONI) appealed Petacchi’s decision to CAS, where he lost (I discussed this CAS decision upthread). Piepoli held a license in Monaco, and his decision was not subject to appeal. He also claimed he had a medical certificate that allowed him to take doses of the drug that could result in urine levels > 1000 ng/ml. I’m not sure if that’s the same as a TUE, which at that time was needed just to be allowed to have levels up to 1000 ng/ml, but apparently it was good enough for Monaco. A Barcelona lab attempted to determine if his salbutamol was inhaled or taken systemically, but couldn’t reach a definitive conclusion.

AFAIK, Piepoli is the only rider in the past decade who tested for salbutamol > 1000 ng/ml. and wasn’t sanctioned, but it’s pretty clear from his case that he had no better argument than any of the riders who were sanctioned. If his case had gone to CAS, he almost definitely would have lost just as Petacchi did. Though the panel might have accepted that he took too much by mistake, as they did with Petacchi, as asthmatics have commented on this thread, taking doses of the required amounts by inhalation would be extremely unlikely. Also, about a year after the salbutamol positives, Piepoli tested positive for CERA. So I don’t think his case has much relevance for Froome’s. If Froome can't show that taking salbutamol within the allowed amounts can result in the high level reported, either as a result of dehydration or some other factor, there is no precedent that should allow him to avoid a suspension, and I would think of at least nine months.

http://www.cyclingnews.com/news/innocently-guilty-the-petacchi-case/
http://autobus.cyclingnews.com/news.php?id=news/2007/aug07/aug06news2
http://autobus.cyclingnews.com/news.php?id=news/2007/jun07/jun13news2
Merckx index
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Re: All About Salbutamol

26 Dec 2017 17:34

But that is changing from 1 March 2018, and a Wada spokesperson told BBC Sport that for any case currently being adjudicated, "the most beneficial rule to the athlete would apply".

Why is that changing ? Is it due to lack of certainty in the test results ( doesn't appear to be case) or thinking it has no or minimal beneficial effect in terms of performance enhancement or to avoid lengthy and costly legal cases ?
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26 Dec 2017 17:42

Well the WADA guidelines say they should only collect urine that is within a narrow range of specific gravity, but I think in practice they either don't have a good portable instrument to accurately measure SG, or sample collectors routinely ignore the guidelines (it can make their job easier). I stumbled on these lists of samples released as part of the investigation into Russian government doping and the SG shown is all over the place:

https://www.ipevidencedisclosurepackage.net/documents/EDP0650_T.pdf (samples from 1.003 to 1.035)
https://www.ipevidencedisclosurepackage.net/documents/EDP0757_T.pdf (samples from 1.003 to 1.034)

They certainly don't seem to be thrown out afterwards, either. No need to fake steroid profiles to coverup doping when you could simply declare a sample invalid.

Re: rule change, it's certainly bad timing for them if they inevitably get pulled into lengthy expert discussions on the validity of the test and test criteria. Particularly after *their* experts already argued in the Petacchi case the adjustment was unnecessary. Not a good look in a panel of judges. Quote from CAS decision, which the CAS panel readily accepted:

In response to Mr. Petacchi's argument that the concentration of Salbutamol found in
his urine should be adjusted to take into account the high specific gravity of hls uiine
that day, WADA pointed out that the practice of adjusting results to take into account
variations in specific gravity is only used by it in relation to endogenous substances.
Salbutamol is not an endogenous substance. There is no WADA technical document
or other guidance which recommends this practice in relation to it. Dr Rabin stated
that WADA does not apply a correction for specific gravity because the 1000 ng/ml
threshold is considered high enough generally to take into account all the variables
mentioned by Mr. Petacchi, including urine specific gravity.
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Re: All About Salbutamol

26 Dec 2017 19:47

Merckx index wrote:A little good news and a little bad news, perhaps, for Froome. The good news:

In the past, Wada has not adjusted the salbutamol threshold in test results to account for "high urine density", which can increase when you are dehydrated.

But that is changing from 1 March 2018, and a Wada spokesperson told BBC Sport that for any case currently being adjudicated, "the most beneficial rule to the athlete would apply".


http://www.bbc.com/sport/cycling/42417297

As I pointed out upthread, he would still have to be severely dehydrated (commonly defined as urine SG > 1.030) for the correction to lower his salbutamol level below the threshold, and my understanding is that if his urine were that concentrated, the sample would not have been approved for assay. In fact, his USG would have to be 1.040 to lower his level to the threshold of 1000 ng/ml, or 1.033 to reach the decision level of 1200 ng/ml. So I wanted to get an idea of how often riders are dehydrated to that extent.

The first two studies are by the same group (led by one L.E. Armstrong, no less), and involved an analysis of men and women riders in a 164 km ride, not race, under intense heat, 35 – 39o C (it's called the Hotter N' Hell Hundred). In the first study, they pooled data from three years. There were 88 men, with a mean USG of 1.019 +/.007 before the ride, and 1.024 +/- .007 after the ride. Based on these values, there would be about 16% with values > 1.030, and about 2% > 1.040.

http://sci-hub.la/10.1123/ijsnem.2015-0188

This is roughly consistent with another study by the same group of 42 men from that ride, reporting that 11 had USG > 1.030, and none > 1.040.

http://sci-hub.la/10.1519/JSC.0b013e318240f677

In another study by a different group, 11 males performed 90 minutes at 50% V02 max, followed by a self-paced 20 km TT at 35o C. Various hydrated or dehydrated states were tested. The USG values were all relatively low, generally about 1.010 at start and 1.015-1.020 at end, with SDs ranging from .002 - .008.

http://sci-hub.la/10.1111/sms.12343

Still another study analyzed 37 male mountain bikers over a 120 km Swiss Masters race. USG pre-race was 1.010 +/- .007, post-race was 1.014 +/- 0.007. They found that intake of 700 ml of fluid per hour was enough to prevent dehydration. However, temperatures were relatively cool, ranging from 5 – 11o C, the lowest temperature at altitude, > 2000 m.

http://sci-hub.la/10.1097/JSM.0b013e3181b47c93

Another study examined 18 mountain bikers in a 3 stage race. The highest mean value of USG was after stage 3, 1.025 +/ .001. Temperatures ranged from 9 – 22o C.

http://sci-hub.la/10.1136/bjsm.2008.049551

So overall, at moderate temperatures, dehydration does not seem to be a problem, while at very high temperatures it could be. I'm not sure how hot it was for Stage 18 in the Vuelta? In any case, the studies at high heat on the road were of amateur riders, who may not have been as careful about hydration as pro racers would be, though the men did take in an average of 5-6 l. of water over the entire ride, about 9 hours.

And a little bit of bad news, if Froome thought that he could get off without showing that 2000 ng/ml is possible under some conditions. I finally tracked down some information on Piepoli, who tested positive for salbutamol in the same Giro (I believe the same stage) that Petacchi did. His urine level was 1800 ng/ml., higher than Petacchi’s. Both riders got off initially through decisions by their national federations, but the Italian Olympic Committee (CONI) appealed Petacchi’s decision to CAS, where he lost (I discussed this CAS decision upthread). Piepoli held a license in Monaco, and his decision was not subject to appeal. He also claimed he had a medical certificate that allowed him to take doses of the drug that could result in urine levels > 1000 ng/ml. I’m not sure if that’s the same as a TUE, which at that time was needed just to be allowed to have levels up to 1000 ng/ml, but apparently it was good enough for Monaco. A Barcelona lab attempted to determine if his salbutamol was inhaled or taken systemically, but couldn’t reach a definitive conclusion.

AFAIK, Piepoli is the only rider in the past decade who tested for salbutamol > 1000 ng/ml. and wasn’t sanctioned, but it’s pretty clear from his case that he had no better argument than any of the riders who were sanctioned. If his case had gone to CAS, he almost definitely would have lost just as Petacchi did. Though the panel might have accepted that he took too much by mistake, as they did with Petacchi, as asthmatics have commented on this thread, taking doses of the required amounts by inhalation would be extremely unlikely. Also, about a year after the salbutamol positives, Piepoli tested positive for CERA. So I don’t think his case has much relevance for Froome’s. If Froome can't show that taking salbutamol within the allowed amounts can result in the high level reported, either as a result of dehydration or some other factor, there is no precedent that should allow him to avoid a suspension, and I would think of at least nine months.

http://www.cyclingnews.com/news/innocently-guilty-the-petacchi-case/
http://autobus.cyclingnews.com/news.php?id=news/2007/aug07/aug06news2
http://autobus.cyclingnews.com/news.php?id=news/2007/jun07/jun13news2

Temp was 20C
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Re: All About Salbutamol

26 Dec 2017 20:39

veganrob wrote:Temp was 20C


Well Petacchi recorded a urine SG of 1.033 when he won the stage to Pinerolo on 23rd of May 2007, where it's usually <20 degrees at that time of the year. I think you'll find that outside of laboratory tests designed to investigate dehydration, the primary factor in whether or not you will be dehydrated is *how much you had to drink*.

I've actually now looked at the WADA guidelines for urine collection again, and there is no upper limit. So they'll happily take urine with SG of 1.033 or even higher as long you can get the (pretty low) figure of 90 milliliters.
In retrospect they really pulled a number on this Petacchi guy, I'm sure he'll be beaming with happiness upon hearing they'll now be adjusting for SG :lol: They gave him 10 months, more than the dude Ulissi who outright admitted to exceeding the allowed dose
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26 Dec 2017 23:22

I was looking for confirmation on WADA applying urine SG correction for salbutamol (and didn't find it yet), but the list of modifications to the 2018 prohibited list published September 29th has this tidbit on salbutamol:

Image
(Source: https://www.wada-ama.org/sites/default/files/prohibited_list_2018_summary_of_modifications_en.pdf)

I'm sure some lawyer is already preparing a 10 page treatise on how the wording in the 2017 version allows Froome to take 1.6 mg in a short period of time.
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Re: All About Salbutamol

27 Dec 2017 00:06

Good find on those files associated with the Russian doping investigation, haz. I count 10/154 samples > 1.030, or 6-7%.

I had forgotten that Petacchi’s USG was 1.033. He won the stage in a sprint, and while there were a few small hills, and a breakaway group or rider that had to be reeled in, he should have been able to ride at a comfortable pace most of the way, taking enough water I would have thought. However, it was hot:

In Bra, where it was 34°C at 69.5 kilometres to go


http://www.cyclingnews.com/races/giro-ditalia-2007/stage-11/results/

Petacchi might have gotten shafted, but even correcting for USG, his level was > 800, which is still very unusual for someone inhaling within the allowed limits. In any case, his situation does nothing to suggest that a rider at cooler temperatures is likely to be dehydrated. However, as I said before, the USG of Froome’s sample ought to be known, or can be determined now if it isn’t.

With regard to the 800 ug/12 hours, that was a rule before 2018. I think the change in wording was to make it clear that a rider couldn’t take 800 ug at the end of a 12 hour period in which he had taken none previously, then take another 800 ug that would count for the next 12 hour period. I actually wondered about doing this before, but when I looked at the (pre-2018) rules, I was satisfied that this was not allowed.

But as you say, a sharp lawyer will no doubt try to seize on this. Still, if they take that approach, Froome will have to cop to taking a lot more puffs than what he’s been implying to now. Also, if he’s going to take advantage of the 2018 rules wrt USG, I’m not sure he can cherry-pick the 2017 rules to make an argument about doses.
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27 Dec 2017 00:40

The 800 ug/12h limit seems to have been introduced in 2017:

It is believed that WADA’s involvement in the case of the cross
country skier had a role in the change of wording from 2016[25]:
‘Inhaled salbutamol (maximum 1600 micrograms over 24 hours)’ in
2016 to ‘Inhaled salbutamol: maximum 1600 micrograms over 24
hours, not to exceed 800 micrograms every 12 hours’ in 2017.[3]


From "The enigma of inhaled salbutamol and sport: unresolved after 45 years" on the WADA status of salbutamol:

http://sci-hub.tw/10.1002/dta.2184

It makes two other recommendations:
The changes to comments about inhaled salbutamol in the 2017 Prohibited List do not fully address problems that can follow and need to be revisited.

Finally, it is overdue for WADA to introduce a correction factor down to an SG of 1.020 for urines that exceed 1.020 and contain a threshold exogenous substance, notably salbutamol.

Both of which seem to have come true now. Also has a longer discussion on Petacchi.

Re: Froomes SG, I think we will know soon enough, because if he was dehydrated (however likely that is) to the point of bringing the measurement under the decision limit, I'd expect WADA will simply drop the AAF. If they don't do that, Froome should probably start writing that CAS appeal. The timing of this is just all too suspicious for the clinic :lol:
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27 Dec 2017 01:50

Another very relevant find. The paper reports five of Petacchi’s samples in that Giro. I find it interesting that the one that exceeded the threshold was much higher (more than double) than the others, even after correction for USG. Also, the USG values were lower for all the other stages after which he was tested, in the range 1.026 – 1.028. The temperature at the outset of Stage 3 was also lower, 30o; Stage 7 was described as “warm”, while I couldn’t find any information on the other two stages. I'd guess temperatures as high as 35o are rare in Italy in May, so in general I think this supports other studies that find USG levels > 1.030 usually associated with very hot weather.

He also cites several other important papers. One I was particularly interested in reported huge intra- as well as inter-individual variation in urinary levels among elderly asthmatic patients. Unfortunately, I couldn’t access the complete article through sci hub. The data described in the abstract doesn’t make sense to me, though, with salbutamol levels up to 50,000 ng/ml. and variations of hundreds of fold. They made a distinction between total and unchanged salbutamol. WADA assays both free and gluco-conjugated, but as I understand it, not sulfated (which I don’t understand, as much of an oral dose is sulfated, so if you want to detect athletes using oral doses, why not maximize the amount detected?)

https://www.ncbi.nlm.nih.gov/pubmed/9373810

He also refers to an earlier paper that he wrote, in which he discusses three athletes with unusually high urinary levels. One is the Swiss track athlete, discussed here before. A second is a female fencer, who reportedly took 800-1000 ug 3 hr prior to giving a sample, and returned a level of 1270 ng/ml, with a USG of 1.015 (so even higher if corrected). She got off, apparently she was considered an outlier.

The third was a male rugger, who said he took a total of 800 ug beginning before a game, and up to half-time. He didn’t provide a sample until an hour and a half after the game, because his urine was too concentrated. When he did, it was 1640 ng/ml, with a USG of 1.030, but later measured as 1.025 in the lab. Two weeks earlier, he gave another sample 80 ng/ml, 1.012. Because of the huge discrepancy, he was suspended for two years, but the suspension was overturned because his enantiomeric ratio was considered compatible with inhalation. This could be very relevant to Froome’s case, in that he got off even though his value, even corrected, was far higher than a previous value. Still, Froome has maybe one hundred samples below the threshold, so it will be harder for him to argue that this is normal variation.

Also, none of these three cases was a laboratory study. I don't see how one can rule out that the athletes either lied about how much they took, or were simply mistaken. While the rugger's enantiomeric ratio was considered compatible with inhalation, I'm not sure from what was said that that ratio confirmed it must have been inhaled.

http://sci-hub.la/10.1385/CRIAI:31:2:259

A few other comments on the Fitch paper:

1) He says only 6.1% of athletes at 2008 Summer Olympics, and 4.6% at the 2010 Winter Olympics, confirmed they were medically approved to use salbutamol. Why, then, are 70% of UK swimmers asthmatic? I understand the point about breathing in a lot of air, and not all Olympic sports involve endurance, but still, if 70% of swimmers really have EIA, why isn't it that high for marathon runners, and for most track runners (even sprinters put in a lot of miles during training)? If 70% of all athletes who do a lot of heavy breathing during training are asthmatics, the total proportion for the Olympics ought to be much higher, surely?

Edit: He does discuss this further in another article, which also details exactly what athletes must do to get a TUE for salbutamol and other substances. He says 25.7% of triathletes, 17.3% of cyclists, 16.9% of X-country skiiers and 14.9% of speed-skaters were asthmatic. Also, of relevance to Froome, he cites data that indicate a higher proportion of approved asthmatics developed the condition after age 25, as opposed to when younger.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933613/

2)
Since 2002, the author has been involved in or been consulted about many athletes who have exceeded the 1000 ng/mL urinary threshold and, to his knowledge, there has not been one instance when the athlete’s AAF has definitely been confirmed to be due to administering oral salbutamol.


Translation: There is still no test that can reliably distinguish oral from inhaled, and no athlete I’ve ever consulted with has ever confessed to being a doper.

3) He discusses another issue I had wondered about. Salbutamol is commonly administered as a racemic mixture, which means only half of the dose is actually effective. There are preparations which contain only the active R- form, though. Since both active and inactive forms are excreted, one could take twice as large a dose of the pure R- form to reach the same urine level. IOW, one could effectively double the allowed amount.
Merckx index
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27 Dec 2017 04:44

They cant determine how the drug was administered
So they call it a supratherapeutic dose (generic name)
Take into consideration extraneous factors of the rider
Then give out the sanctions with 2 years as maximal
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Re: All About Salbutamol

27 Dec 2017 06:38

I think I can see the outlines of Froome’s defense. It begins with his USG (urine specific gravity). Thanks to the modification of the rules, that now becomes a key value. If his USG is 1.033 or higher, his corrected salbutamol concentration is lowered to the decision level of 1200 ng/ml. (more or less; we don’t know the exact uncorrected concentration, I assume it’s somewhere between 1950-2050). In that case, as haz says, he can get off, and we should probably expect an announcement fairly soon.

But even that possibility is not without complications. The change supposedly goes into effect in March (unlike the annual updates to the prohibited list, which go into effect on Jan. 1). At the very least, it seems technically Froome could not get off till then; he would have to stall until the rule went into effect.

But there is a bigger issue: when was the decision to modify the rules made? And this is a problem. If it was made before Froome was notified of his positive, Sept. 20, why wasn’t the correction made, and the conclusion determined that there was no AAF? If it was made after that date, then it certainly raises the suspicion that it was made specifically to help Froome. Granted, as the Fitch article makes clear, a change like this is probably needed, and maybe it was coming, anyway, but the timing has to make one wonder.

I’m guessing the decision was made before Froome’s positive, but since it was not to go into effect until March 2018, it did not factor into the decision to call the result an AAF. Maybe UCI did not even know about the change in the rule. But if that’s the case, the announcement that “currently adjudicated cases” can use that rule (or not, and as we will see, both sides of that equation could help Froome) certainly looks fishy. The AAF was made based on the rules at the time. Now it seems that rules that go into effect later can apply. We’re used to back-dated suspensions, but now we have the prospect of back-dated rules.

So if Froome gets off on the basis of the new dehydration rule, don’t expect the controversy to die down. But suppose he doesn’t? Suppose his USG is < 1.030. Based on the studies I’ve seen of riders at relatively moderate temperatures, as seems to have existed on Stage 18, my guess is his value will be below that threshold. But any correction could still help him, if the case goes to CAS.

Suppose, e.g., that his USG is 1.028, which is a fairly typical value. His corrected urine value would be about 1400 ng/ml, which is still above the decision level. But this is where the “whatever maximally benefits you” twist could come into play. We know that all his previous samples, numbering it seems close to a hundred, were < 1000 ng/ml, and probably not even close. Let’s say they ranged from 300-800 ng/ml. But suppose some of those samples had USG values < 1.020. Correcting them would increase the values, closer to 1000 ng/ml, and perhaps in a few cases maybe even to >1000 ng/ml. Not all of them would be higher; only those with relatively dilute urine. Correcting some of them would decrease the values, just as correcting his 2000 ng/ml value would, but because he can correct or not, whatever works best, he can ignore those that don’t help his case.

Now the lawyers can have a field day. They will argue that Froome was taking less than the maximum allowed amount of salbutamol, and he knew from his reported values he would stay comfortably below 1000 ng/ml. Based on those values, he had reason to believe he could take a few extra puffs, and still remain below the threshold. What he didn’t realize is that if those values had been corrected, some might have flirted with the threshold, maybe crossed it. So when on stage 18, when he took a few more puffs than he ever had in the past, he went well over the threshold. Because of his concentrated urine, he went even higher. But this was not really his fault, because a) he didn’t take more than the allowed amount; and b) he had reason to believe, based on his earlier values, that he wouldn’t exceed the threshold.

This is still a long shot, IMO; it assumes Froome is an outlier, with unusually high urine values. But it’s not as hopeless as his case would be if he couldn’t correct the values. The main point is that if he can bring the 2000 ng/ml values down somewhat, while raising the values of selected other samples that were well below the threshold, there is much less of a gap, which thus becomes easier to explain through a few extra puffs as well as just chance.

I'll bet Fitch is already on Froome's team. If I were Froome, I would definitely want him as an expert witness. Not only is very experienced in this field, but he seems sympathetic to these poor, honestly-not-doping asthmatics.
Merckx index
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27 Dec 2017 06:51

Dawg arguing a technicality...and being let off...will do more harm for the sport than if he pleaded guilty any got 9 months.

As to the USG, it was 20C, 4 hours, and Dawg kicked **** rather than suffering badly (dehydrated). His USG would be totally normal. If there was ANYTHING that could have been argued in the THREE MONTHS BETWEEN being notified and the leak, it would have been to make it go away. It's only because he doesn't have an excuse that it is now public, and he is lawyered up.

Remember, Lance got a TUE for saddle sore cream ;)
User avatar sittingbison
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Re:

27 Dec 2017 13:38

Merckx index wrote:

Edit: He does discuss this further in another article, which also details exactly what athletes must do to get a TUE for salbutamol and other substances. He says 25.7% of triathletes, 17.3% of cyclists, 16.9% of X-country skiiers and 14.9% of speed-skaters were asthmatic. Also, of relevance to Froome, he cites data that indicate a higher proportion of approved asthmatics developed the condition after age 25, as opposed to when younger.




Interesting that 3 of those sports are endurance sports ...
TheSpud
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27 Dec 2017 13:54

I don't think the time of the WADA decision is very material to the outcome. Ultimately, if he has the urine SG to get off, WADA can do it now or delay till the CAS where Froome argues correction is necessary. And then obviously they can't claim the opposite.
hazaran
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Re:

27 Dec 2017 22:42

sittingbison wrote:Dawg arguing a technicality...and being let off...will do more harm for the sport than if he pleaded guilty any got 9 months.

As to the USG, it was 20C, 4 hours, and Dawg kicked **** rather than suffering badly (dehydrated). His USG would be totally normal. If there was ANYTHING that could have been argued in the THREE MONTHS BETWEEN being notified and the leak, it would have been to make it go away. It's only because he doesn't have an excuse that it is now public, and he is lawyered up.

Remember, Lance got a TUE for saddle sore cream ;)



When I saw the proposed rule change in made me wonder if Dawg was silently waiting for the change to get himself off. I also wonder if a Reedie lead WADA has facilitated the change just for Froome.

After seeing the Impey outcome, nothing would surprise me.
User avatar thehog
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