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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: All About Salbutamol

23 Dec 2017 03:29

Djoop wrote:
bigcog wrote:
Angliru wrote:
Djoop wrote:Obviously, a high dose of Salbutamol indicates severe breathing problems. We can all see the footage, and the end result compared to a peloton of athletes in their prime. Used to enhance his performance, and probably miscalculated the max -possibly because of a blood transfusion. I'm eager to find out, but it doesn't matter all that much. He had an unfair advantage, that's what counts.

I don't know when Sky left the mpcc exactly, but it's only the fourth scandal since. You had the rider who came forward about painkiller abuse within the team, the mysterious medical package delivery,TUEs during TDF wins, and now this. Add UCI's reluctance to do their job properly when it involves 35 million, and basicly nothings changed since the US Postal scam.


Were they ever part of the MPCC?


No.

My bad,they rejected to join because ofits medical rules.



Brailsford once said that Sky’s internal rules were more stringent than MPCC hence their reason for not joining :lol:
User avatar thehog
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Re:

23 Dec 2017 04:40



Very interesting, thanks for the link. Since 1600 ug/24 hr is permitted, the rider would have to be allowed to have some salbutamol in his urine at the start of the test. If Rabin is serious about duplicating the conditions as they actually occurred, though, Froome would have to document taking some of the substance beginning after testing the previous day's stage, and it would be essentially impossible for him to make the case that he didn't urinate between then and 24 hr later. So this does seem to raise the bar even higher.

Some other interesting points made in the interview:

Has there been an overdose? It happens, even fairly frequently.


I note he's vague about the possibility of another substance affecting the excretion rate of salbutamol. If WADA knew about some substance, surely they would be studying it, but AFAIK, they aren't.

Note also that at the end, in response to a question about oral vs. inhaled, he says, "We have no element of certainty." As I thought, there is no approved test for this, because the tests that may exist aren't good enough (i.e., too many false positives and/or false negatives).

Not sure how fair that is. I guess you can do one test for WADA and if that doesn't get you off, still have another one for CAS.


I believe he can do it however he wants for CAS, though of course the closer it follows what actually happened on the road, the more convincing it will be.

Here’s a more recent study (2015) in which 1600 ug were inhaled all at once. It was mentioned by a scientist interviewed by VN, as a possible indication that super-threshold levels could occur while staying within the WADA rules. There were 13 subjects, and three protocols were run: rest, exercise and exercise/dehydration (water intake restricted). Urine samples were taken at 1.5, 4 and 6 hr. So a total of 117 samples were taken. Of these, 33 or 28% exhibited uncorrected levels > 1000 ng/ml; when urine was corrected for specific gravity, there were still 23 or 20% of the samples above the threshold.

However, keep in mind, again, that 1600 ug is not permitted in a short period of time. Also, even under these extreme conditions, only 5/117 samples exceeded 2000 ng/ml.

What someone really should test is 800 ug, followed by another 800 ug 12 hr later, then urine tests. That would set the ceiling on what is theoretically possible while following WADA rules. There has been a study, discussed above, in which 800 ug was taken at once, followed by urine tests. Only 1/64 samples exceeded 1000 ng/ml and was still below the 1200 ng/ml decision limit. However, from the two studies by the Elers group, I see that 12 hr after an 800 ug dose, there could be as much as 200-250 ug/nl if the subject doesn't pee. Most of this would be added to the amount excreted by the new 800 ug dose, if urine were collected soon after.

The other study I would like to see is of variability of one individual. Test the individual multiple times, not varying conditions, to see how much the urine levels vary. That would provide a baseline of variability, which would be increased if conditions such as exercise and dehydration varied.

http://sci-hub.la/10.1002/dta.1828

So this would be Froome's strategy:

a) He's already claimed he had three puffs after finishing the stage. If he could demonstrate he had five other puffs late in the stage, so the entire 800 ug dose was taken within two hours of testing, that would maximize his urine level.

b) If he's like one of the outlier subjects in published studies, he might conceivably have a level of 1000 ng/ml at that point

c) Most of the kinetic studies have first analyzed urine after four hours, but other studies show that the concentrations peak sooner, within an hour or so. They probably don't fall off too much, but somewhat. So that 1000 ng/ml level could possibly be pushed up to 1200-13000 ng/ml if the urine were assayed sooner.

d) If he took 800 ug in the previous 12 hr period, this would add some salbutamol to the total, if he were an outlier, maybe as much as 400-500 ng/ml. Now he's not far from 2000 ng/ml. and we still haven't considered dehydration.

e) At this point, though, the question would be raised, why wasn't such a high level ever realized before? Froome would have to establish that he never took more than 2-3 puffs total in any 12 hr period prior to this stage.

A very unlikely scenario, but I think that's what it would take. However, if he were willing to confess accidentally taking more than 800 ug, then it becomes a little more plausible. Not as much as oral dosing, but maybe enough to convince CAS.
Merckx index
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23 Dec 2017 07:15

Mercx - the alternate hypothesis is, of course far more likely. This does raise an interesting point - the conditional test potentially could be gamed to maximize the salbutamol concentration, to a far higher level than would occur in real world conditions. One would hope that the test requirements be set per the circumstances of the race stage and be monitored by a CAS staff member.

Too much potential for Sky to pull a Volkswagen otherwise.

Indeed they are probably running experiments now on how to maximize test scores for when froome actually has to be tested.
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Re:

23 Dec 2017 07:56

Random Direction wrote:...indeed they are certainly running experiments now on how to maximize test scores for when froome actually has to be tested.


Fixed it for you. No charge ;)
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Re: Re:

23 Dec 2017 08:03

Merckx index wrote:...
e) At this point, though, the question would be raised, why wasn't such a high level ever realized before? Froome would have to establish that he never took more than 2-3 puffs total in any 12 hr period prior to this stage...


MI, a doctor working at a testing lab in one of the previous links said he had tested something like 50,000 samples for salbutamol. And there have been what, 21 positives over the past 20 years? And Dawg at 2000 is the World Champion? I think Dawgs fancy lawyer has an uphill battle convincing CAS that Dawg is alien enough to discount such a volume of anecdotal evidence....including Dawgs own prior hundreds of tests and specifically stage 17 and stage 19
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Re: All About Salbutamol

23 Dec 2017 10:29

thehog wrote:
Djoop wrote:
bigcog wrote:
Angliru wrote:
Djoop wrote:Obviously, a high dose of Salbutamol indicates severe breathing problems. We can all see the footage, and the end result compared to a peloton of athletes in their prime. Used to enhance his performance, and probably miscalculated the max -possibly because of a blood transfusion. I'm eager to find out, but it doesn't matter all that much. He had an unfair advantage, that's what counts.

I don't know when Sky left the mpcc exactly, but it's only the fourth scandal since. You had the rider who came forward about painkiller abuse within the team, the mysterious medical package delivery,TUEs during TDF wins, and now this. Add UCI's reluctance to do their job properly when it involves 35 million, and basicly nothings changed since the US Postal scam.


Were they ever part of the MPCC?


No.

My bad,they rejected to join because ofits medical rules.



Brailsford once said that Sky’s internal rules were more stringent than MPCC hence their reason for not joining :lol:


Brailsford said they would only join MPCC when they don't allow riders and staff banned for doping to be members.
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23 Dec 2017 11:54

Hillarious! :lol:

You mean guys like Mick Rogers, Leinders, Zabriskie, De Jongh, Barry and others..? :lol:

Or maybe it had something to do with corticosteroids and other "marginal gains"
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Re:

23 Dec 2017 12:37

Blanco wrote:Hillarious! :lol:

You mean guys like Mick Rogers, Leinders, Zabriskie, De Jongh, Barry and others..? :lol:

Or maybe it had something to do with corticosteroids and other "marginal gains"


That Brailsfraud is economical with the truth is the craziest conspiracy theory of the lot...
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Re: Re:

23 Dec 2017 15:38

sittingbison wrote:
Merckx index wrote:...
e) At this point, though, the question would be raised, why wasn't such a high level ever realized before? Froome would have to establish that he never took more than 2-3 puffs total in any 12 hr period prior to this stage...


MI, a doctor working at a testing lab in one of the previous links said he had tested something like 50,000 samples for salbutamol. And there have been what, 21 positives over the past 20 years? And Dawg at 2000 is the World Champion? I think Dawgs fancy lawyer has an uphill battle convincing CAS that Dawg is alien enough to discount such a volume of anecdotal evidence....including Dawgs own prior hundreds of tests and specifically stage 17 and stage 19


The Alien defense. Froome is not human so his tolerance is higher. Born in an African laboratory. Hence the unusual riding style.
movingtarget
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23 Dec 2017 16:01

Can we tell the difference between a general intake, which is strictly prohibited, and an inhaled intake?

We have no element of certainty. By combining certain indicators with other elements of outcome information and the environment described by the athlete, this may, however, lead to a relatively high level of certainty.

Olivier Rabin, science director at WADA

http://www.lemonde.fr/cyclisme/article/2017/12/14/affaire-froome-la-charge-de-la-preuve-revient-a-l-athlete_5229768_1616656.html
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Re:

23 Dec 2017 18:28

70kmph wrote:Can we tell the difference between a general intake, which is strictly prohibited, and an inhaled intake?
We have no element of certainty. By combining certain indicators with other elements of outcome information and the environment described by the athlete, this may, however, lead to a relatively high level of certainty.
Olivier Rabin, science director at WADA

There are ways that a sophisticated lab could differentiate between oral/injected salbutamol and inhaled. But are those methods part of the ordinary lab work-up on positive samples? Can WADA request any kind of testing they want in order to prove a point in a contested doping case? It is not so much technical as procedural, so that would be a good topic for someone to look into. They can prove it, but are they allowed to use the logical approach to do that?

A-t-on des connaissances précises sur les facteurs qui font évoluer l’excrétion (action par laquelle l’organisme évacue une substance) du salbutamol ?
Je me garderais bien d’envisager tous les cas pharmacologiques, toxicologiques ou physiologiques possibles où il peut y avoir des interférences avec l’excrétion rénale d’une substance ou avec son métabolisme. Il suffit que vous ayez pris une autre substance qui passe par le même cytochrome P-450 [molécule organique impliquée dans la biodégradation de molécules exogènes, dont le salbutamol] : ça peut avoir un effet sur le délai d’excrétion. Au niveau rénal, il peut aussi y avoir une substance qui interfère avec l’excrétion. Mais on ne se base pas sur les hypothèses. On veut des faits.

M. Olivier also raises two points which have not really been addressed by this salbutamol thread - could other substances which compete for the same cytochrome prolong the metabolism of the drug? And "at the renal level" he says some other substances could interfere with excretion of the salbutamol.

Without saying which drugs those may be, and whether those are also implicated in doping practices. But he says it's hard "to imagine ... all possible cases", so there are too many possibilities, to easily sort out
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Re: Re:

23 Dec 2017 19:19

There are ways that a sophisticated lab could differentiate between oral/injected salbutamol and inhaled. But are those methods part of the ordinary lab work-up on positive samples? Can WADA request any kind of testing they want in order to prove a point in a contested doping case? It is not so much technical as procedural, so that would be a good topic for someone to look into. They can prove it, but are they allowed to use the logical approach to do that?


See the Petacchi case from 10 years ago, they sent his sample to a Barcelona lab for this specific testing

In his witness statement, Prof. Segura, the Director of the Barcelona Laboratory, stated his
opinion that, “The results of the sample coded A926245, which I have been told belongs to Mr. Petacchi, are not compatible with an “accidental” swallowing of a portion of the product in the course of a therapeutic use of Salbutamol by inhalation, i.e within the dosage indicated above. Possible explanations of the results of the test obtained through the enantiomers method indicate that such results have been caused by a direct oral administration of Salbutamol or the “accidental” swallowing of a part of the product administered by inhalation at a supra therapeutic dose, i.e. a dose, which clearly exceeds the dosage indicated above”.
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Re: Re:

23 Dec 2017 21:23

See the Petacchi case from 10 years ago, they sent his sample to a Barcelona lab for this specific testing
That, and the Le Monde interview with Olivier point to really key information, thank you. It really solidifies the case.
Il y a une différence entre un athlète qui va se retrouver avec du salbutamol alors qu’il n’a pas d’autorisation d’usage thérapeutique (AUT) et celui qui a été sous salbutamol pendant des années et se retrouve avec un dépassement de seuil, pour lequel une étude d’excrétion va montrer qu’il a un métabolisme un peu différent de la norme sur cette substance.
L’un prendra deux ans de suspension ferme parce qu’il n’aura pas eu d’AUT et se retrouve avec 3 000 ng/ml. Si un autre est juste au-dessus du seuil, prouve qu’il métabolise le salbutamol de façon différente mais a poussé un peu sur la « topette » dans des circonstances que l’on peut comprendre et dont il a parlé à son médecin, il prendra peut-être une réprimande ou trois mois de suspension.

Olivier contrasts two hypothetical athletes with adverse findings for salbutamol. One of them does not have a TUE, is caught with 3000ng/ml salbutamol, and gets a two-year ban. The other has a TUE, goes a little above 1000ng/ml, and has an "understandable" explanation as to how it happened - gets 3 months suspension.

So Froome resembles the former case (the hypothetical cyclist who gets a 2-year ban) and has also already given muddled and implausible explanations. Which will not be consistent with the detailed findings of the laboratory testing.

I see no way out for Froome, there is no way the system could be corrupted to the point he escapes this. And Froome might get suspended for more than 9 months... that's the sub-text of this hypothetical "dichotomy" proposed by Olivier
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24 Dec 2017 05:17

ClassicomanoLuigi wrote:
There are ways that a sophisticated lab could differentiate between oral/injected salbutamol and inhaled. But are those methods part of the ordinary lab work-up on positive samples? Can WADA request any kind of testing they want in order to prove a point in a contested doping case? It is not so much technical as procedural, so that would be a good topic for someone to look into. They can prove it, but are they allowed to use the logical approach to do that?


To repeat, there is apparently no approved test. If there were, WADA would use it and not have to be concerned with threshold levels. An unapproved test can certainly be submitted as evidence at CAS, but as noted in the Petacchi case, they didn't attempt to discriminate between an oral dose and an inhaled dose that was partially swallowed. The furthest they were willing to go, at least at that time, was to say that if he had inhaled no more than the allowed amount, the amount he could have swallowed would not have been enough to account for the results.

In any case, I don't know how you can stop a rider from claiming he swallowed some of the dose. In fact, according to ScienceisCool, typically only about 40 ug—at best--of a 100 ug dose is inhaled,and I would think it would be worse during the heat of a race. I assume the rest is swallowed. If it doesn't get into the system at all, then we have a real problem in overestimating how much a rider is taking. As SiC goes on to point out, studies using inhalers probably take care to make sure that all the dose is inhaled, because if it weren’t, it would be difficult to draw any conclusions in comparisons to oral doses. Yet checking some of the studies that have been linked in this thread, I find no mention of this in most cases. One article mentions the use of a spacer, which I understand helps ensure that more of the drug gets into your lungs. Is that sufficient to get all of it in? * You would think if it were a serious problem--and SiC linked an article indicating it is--that some mention of it would be made in the Methods section.

M. Olivier also raises two points which have not really been addressed by this salbutamol thread - could other substances which compete for the same cytochrome prolong the metabolism of the drug? And "at the renal level" he says some other substances could interfere with excretion of the salbutamol.

Without saying which drugs those may be, and whether those are also implicated in doping practices. But he says it's hard "to imagine ... all possible cases", so there are too many possibilities, to easily sort out


As I noted before, there doesn't seem to be any evidence of inhibitors that affect detoxification of salbutamol, nor of substances that affect renal clearance. When Olivier says "all possible cases", I think he's just referring to the fact that there could be such substances, but unless Froome's team can point to specific research, that doesn't help him. Petacchi’s team brought this issue up, but couldn’t back it up with any evidence. And of course, even if Froome did come up with some relevant evidence, he'd have to explain why this was only a problem on this one stage. This would also be the case if he had some more general disorder. E.g., if he had some problem with his liver or kidneys, that might affect clearance of the drug, but then one would expect to see the problem on preceding and/or succeeding stages.

One class of drugs that might be a problem would be b-blockers, or antagonists, but I assume Froome would not be taking any of those. I assume they're probably banned, in any case. They would not necessarily affect clearance of salbutamol, but by interfering with its interaction with its receptors, so more of the drug would be required to get a given effect. But even if he were taking a b-blocker, it certainly wouldn't be by inhalation, and I'm not sure how much of it would get into the lungs in that case.

By the way, just for the record, Froome has worn the leader's jersey in the TDF 59 times, per Wiki, and 20 times in the Vuelta. I haven't bothered to check, but he probably won a few stages in those Tours when he wasn't the leader, and would be tested then, too. When you add random OOC tests, he probably has been tested for salbutamol close to one hundred times.

*Here’s a recent study comparing a measured dose inhaler (MDI), which is generally what is used in the pharmacokinetic studies, with other means of inhaling salbutamol:

http://sci-hub.la/10.1016/j.pupt.2017.06.004

Subjects inhaled 800 ug of salbutamol, then provided a urine sample 30 min later. Using the MDI, 35% of the 800 ug dose was found in the urine. The study also used a filter which was placed over the subject’s throat; apparently previous studies showed that it would trap all of the substance that would otherwise go to the lungs. Analysis of the filter revealed that 65% of the inhaled dose was trapped on it. So a lot of the dose, but certainly not all of it.

The first result doesn’t make sense to me, it's way too much. However, other articles by the same group reported far lower values.

But another study noted that: "Even when MDIs are used correctly, approximately 10% of the drug is deposited in the lungs, whereas nearly 80% is deposited in the oropharynx." This study found no effect of using a spacer, as determined by an FEV1 test for effect on asthma. A study cited in the Discussion reported a slight increase in deposition in the lungs with the use of a spacer, and a major reduction in deposition in the throat. When I looked at that study, I found that the main effect of the spacer was to reduce by more than 50% the amount of drug getting into the body at all. The spacer was effective in reducing the amount of drug swallowed, but only because most of the drug never got into the body.

At this point I have no idea how studies of inhaled salbutamol can be carried out with any confidence that the amount nominally present in the puff gets in the lungs, or maybe even in the body.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132011000600008&lng=en&nrm=iso&tlng=en

Here’s a study of the effect of a polymorphism (mutation) in a gene for a salbutamol-metabolizing enzyme. No differences between polymorphic and wild-type (normal) subjects were found. This is an example of research into the issue, though:

https://www.ncbi.nlm.nih.gov/pubmed/24692077
Merckx index
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24 Dec 2017 10:52

So motive for Salbutamol in larger doses, beyond relief of asthma symptoms, is weight loss while maintaining body mass: clearly desirable for a GT cyclist.

But would such somatological change not be a long term objective, attained by long term medication, rather than by sudden large doses? This goal seems compatible with all year round oral dosages, probably scaled back during competition. Even if Froome's response to a (relatively) poor day on stage 17 had been to eat incredibly unhealthily, no amount of Salbutamol will restore the desired weight/power ratio within 24 hours.

If we have accepted that dilution issues mean that blood bags are only a small contributor to the Salbutamol excretion levels recorded, what would be the motivation for such a huge Salbutamol intake on that particular day? The daily variances of asthma accounts for 3 extra puffs: what gain does Salbutamol give that quickly that comes even close to running the risk?

Is this a purely irrational panic response (in the pattern of running up Ventoux) of throwing anything and everything at a perceived problem? Or am I missing something about speed of weight loss, and some belief in the team that he was overweight on the morning of 7th Sept, and expected lots of Salbutamol to resolve the issue by mid afternoon?
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24 Dec 2017 13:30

Didn't Froome claim he had actually gained weight during a TdF. Was it this year?
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24 Dec 2017 14:08

Froome claimed he weighed more at the Vuelta then at the TDF.
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24 Dec 2017 17:55

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.
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Re:

24 Dec 2017 18:26

Armchair cyclist wrote:So motive for Salbutamol in larger doses, beyond relief of asthma symptoms, is weight loss while maintaining body mass: clearly desirable for a GT cyclist.

But would such somatological change not be a long term objective, attained by long term medication, rather than by sudden large doses? This goal seems compatible with all year round oral dosages, probably scaled back during competition. Even if Froome's response to a (relatively) poor day on stage 17 had been to eat incredibly unhealthily, no amount of Salbutamol will restore the desired weight/power ratio within 24 hours.

If we have accepted that dilution issues mean that blood bags are only a small contributor to the Salbutamol excretion levels recorded, what would be the motivation for such a huge Salbutamol intake on that particular day? The daily variances of asthma accounts for 3 extra puffs: what gain does Salbutamol give that quickly that comes even close to running the risk?

Is this a purely irrational panic response (in the pattern of running up Ventoux) of throwing anything and everything at a perceived problem? Or am I missing something about speed of weight loss, and some belief in the team that he was overweight on the morning of 7th Sept, and expected lots of Salbutamol to resolve the issue by mid afternoon?


Doesn't salbutamol have a similar effect to cortisone when injected into the blood stream?..anti inflammatory..presumably if used in a much higher dose it would boost performance significantly then there may be a way of flushing it out of the body before the dope control? Maybe having a bad day previously caused his levels to go out of wack unexpectedly..?
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Re: Re:

24 Dec 2017 19:22

Merckx index wrote:


Very interesting, thanks for the link. Since 1600 ug/24 hr is permitted, the rider would have to be allowed to have some salbutamol in his urine at the start of the test. If Rabin is serious about duplicating the conditions as they actually occurred, though, Froome would have to document taking some of the substance beginning after testing the previous day's stage, and it would be essentially impossible for him to make the case that he didn't urinate between then and 24 hr later. So this does seem to raise the bar even higher.

Some other interesting points made in the interview:

Has there been an overdose? It happens, even fairly frequently.


I note he's vague about the possibility of another substance affecting the excretion rate of salbutamol. If WADA knew about some substance, surely they would be studying it, but AFAIK, they aren't.

Note also that at the end, in response to a question about oral vs. inhaled, he says, "We have no element of certainty." As I thought, there is no approved test for this, because the tests that may exist aren't good enough (i.e., too many false positives and/or false negatives).

Not sure how fair that is. I guess you can do one test for WADA and if that doesn't get you off, still have another one for CAS.


I believe he can do it however he wants for CAS, though of course the closer it follows what actually happened on the road, the more convincing it will be.

Here’s a more recent study (2015) in which 1600 ug were inhaled all at once. It was mentioned by a scientist interviewed by VN, as a possible indication that super-threshold levels could occur while staying within the WADA rules. There were 13 subjects, and three protocols were run: rest, exercise and exercise/dehydration (water intake restricted). Urine samples were taken at 1.5, 4 and 6 hr. So a total of 117 samples were taken. Of these, 33 or 28% exhibited uncorrected levels > 1000 ng/ml; when urine was corrected for specific gravity, there were still 23 or 20% of the samples above the threshold.

However, keep in mind, again, that 1600 ug is not permitted in a short period of time. Also, even under these extreme conditions, only 5/117 samples exceeded 2000 ng/ml.

What someone really should test is 800 ug, followed by another 800 ug 12 hr later, then urine tests. That would set the ceiling on what is theoretically possible while following WADA rules. There has been a study, discussed above, in which 800 ug was taken at once, followed by urine tests. Only 1/64 samples exceeded 1000 ng/ml and was still below the 1200 ng/ml decision limit. However, from the two studies by the Elers group, I see that 12 hr after an 800 ug dose, there could be as much as 200-250 ug/nl if the subject doesn't pee. Most of this would be added to the amount excreted by the new 800 ug dose, if urine were collected soon after.

The other study I would like to see is of variability of one individual. Test the individual multiple times, not varying conditions, to see how much the urine levels vary. That would provide a baseline of variability, which would be increased if conditions such as exercise and dehydration varied.

http://sci-hub.la/10.1002/dta.1828

So this would be Froome's strategy:

a) He's already claimed he had three puffs after finishing the stage. If he could demonstrate he had five other puffs late in the stage, so the entire 800 ug dose was taken within two hours of testing, that would maximize his urine level.

b) If he's like one of the outlier subjects in published studies, he might conceivably have a level of 1000 ng/ml at that point

c) Most of the kinetic studies have first analyzed urine after four hours, but other studies show that the concentrations peak sooner, within an hour or so. They probably don't fall off too much, but somewhat. So that 1000 ng/ml level could possibly be pushed up to 1200-13000 ng/ml if the urine were assayed sooner.

d) If he took 800 ug in the previous 12 hr period, this would add some salbutamol to the total, if he were an outlier, maybe as much as 400-500 ng/ml. Now he's not far from 2000 ng/ml. and we still haven't considered dehydration.

e) At this point, though, the question would be raised, why wasn't such a high level ever realized before? Froome would have to establish that he never took more than 2-3 puffs total in any 12 hr period prior to this stage.

A very unlikely scenario, but I think that's what it would take. However, if he were willing to confess accidentally taking more than 800 ug, then it becomes a little more plausible. Not as much as oral dosing, but maybe enough to convince CAS.

So they don't distinguish between oral vs inhaled. If there's any way to sneak in those pills in a capsule beforehand, it's easy.

So Froome's goals is gonna be to test as high as possible under 'legal' conditions. Is there anyway to verify all the things they're saying they did or do they no burden of proof for that?

Also, does he need to prove he gets over 1200, or does he need to prove he gets near 2000?
Veni, Vidi, Kirby

I came, I saw, I was dead wrong as per usual
User avatar Red Rick
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