asthma inhalers not performance enhancing?

[Blaaswix]

Re:

Disadvantages of salbutamol :

- Raises body temperature. This is a significant disadvantage if the weather is hot. A lot of the work done by the heart is for thermo-regulation.

Interesting. So conversely, there would be an advantage for cold weather activities, e.g. XC skiing?

 

[Blaaswix]

Re: Re:

Even more interesting - very informative post.

Seems to ring several bells with the doping in XC skiing thread.

 

[sniper]

A reminder: http://www.cyclingnews.com/news/rusvelo-face-four-week-suspension-after-three-positives-for-asthma-drug/

 

[thehog]

Hey guys,

i have found a weird cyclingweekly article (http://www.cyclingweekly.co.uk/news/latest-news/are-asthma-medicines-unofficial-peds-205512) which states that asthma medicines are not performance enhancing.
why is salbutamol then on the drug list and half of the peloton is using that?

I really wish they delineate between steroid based treatments like Salbutamol which are used daily and not during competition and non-steroid based treatments like Albuterol which is a remedy during exercise.

Salbutamol is beta adrenergic blocker, while Albuterol is sympathomimetic. Albuterol relaxes muscles within bronchi and thus induces relieving from the breathing problems. Both medications are used for dealing with breathing issues/obstructions. During asthma attacks, strong constriction of bronchi happens, and that is exactly what these two meds are trying to prevent.

 

[deviant]

Actually, it's not only inaccurate, but the opposite of the truth - it is not a "beta-adrenergic blocker", it is a beta-adrenergic agonist.

Also, it is not a steroid molecule, so there is no differentiation to be made on that point.


.....at last, someone with a basic understanding of chemistry.

In fact just being able to use Google proficiently would help for half of this forum....the only 'steroid' based inhalers are the corticosteroid based ones like Clenil, Seretide and the now discontinued (in the UK anyway) Becotide.....which contained Fluticasone and Beclometasone respectively.

Salbutamol (or Ventolin) are not steroids, as said above they are beta-agonists that mimic a fight or flight/adrenal response in the body....performance enhancing?....the jury's still out or it would be banned outright, like adrenaline the half life/effect is short lived and it could theoretically be used for weight loss or stimulatory properties but at the cost of raising body temp and heart rate, possibly impairing performance in some athletes.

Also i wish some people on here wouldnt lump steroids all into the same group of drugs and think they're all muscle/strength builders because they're not....some are extremely catabolic and will tear down muscle tissue, could be useful for a cyclist dropping weight but its fat you want to lose not all your muscle and completely the opposoite of what a strength athlete or sprinter goes looking for.....the steroids in the inhalers above are steroidal anti inflammatory meds and they work in asthma by reducing inflammation of the bronchi/airways (but have a bunch of nasty side effects, particularly with long term use), the complete opposite of safer non steroidal anti inflammatory meds (like ibuprofen or diclofenac).....but dont let the truth get in the way of a good athlete trashing session eh?!

 

[movingtarget]

Re:

Actually, it's not only inaccurate, but the opposite of the truth - it is not a "beta-adrenergic blocker", it is a beta-adrenergic agonist.

Also, it is not a steroid molecule, so there is no differentiation to be made on that point.


.....at last, someone with a basic understanding of chemistry.

In fact just being able to use Google proficiently would help for half of this forum....the only 'steroid' based inhalers are the corticosteroid based ones like Clenil, Seretide and the now discontinued (in the UK anyway) Becotide.....which contained Fluticasone and Beclometasone respectively.

Salbutamol (or Ventolin) are not steroids, as said above they are beta-agonists that mimic a fight or flight/adrenal response in the body....performance enhancing?....the jury's still out or it would be banned outright, like adrenaline the half life/effect is short lived and it could theoretically be used for weight loss or stimulatory properties but at the cost of raising body temp and heart rate, possibly impairing performance in some athletes.

Also i wish some people on here wouldnt lump steroids all into the same group of drugs and think they're all muscle/strength builders because they're not....some are extremely catabolic and will tear down muscle tissue, could be useful for a cyclist dropping weight but its fat you want to lose not all your muscle and completely the opposoite of what a strength athlete or sprinter goes looking for.....the steroids in the inhalers above are steroidal anti inflammatory meds and they work in asthma by reducing inflammation of the bronchi/airways (but have a bunch of nasty side effects, particularly with long term use), the complete opposite of safer non steroidal anti inflammatory meds (like ibuprofen or diclofenac).....but dont let the truth get in the way of a good athlete trashing session eh?!

There also steroids in Sinus medications which do the same thing and reduce inflammation. I remember years ago Ventolin over use in children some researchers believed stunted growth and I think the original Ventolin was different to the one that is used commonly now. I think diclofenac is now not used as much as an anti inflammatory as some of the newer drugs are supposed to be just as good and with less side effects. I was told that long term use could cause stomach issues. Drugs like Fenac and prednisone are supposed to be for short term use but for people in constant pain or have chronic conditions I guess it's not that easy.

 

[Discgear]

Re: Re:

Disadvantages of salbutamol :

- Raises body temperature. This is a significant disadvantage if the weather is hot. A lot of the work done by the heart is for thermo-regulation.

Interesting. So conversely, there would be an advantage for cold weather activities, e.g. XC skiing?

Well, there is not going to be much sports performance benefit in "running the engine hotter" than is necessary. It means the circulatory system has to work harder than necessary, to keep the core body temperature cool enough.

Possibly, in a cold-weather sport, a thermogenic drug could be useful by making a layer of clothing unnecessary, something like that. In long-distance skiing, could save a little weight on the clothing, and be more comfortable without the insulation.

In cold or cool weather, the beta-agonist drugs are going to be more tolerable, because sustainable power decreases with increasing body temperature. So yeah, that would be a better trade-off for in-competition doping. Or long-term training during cold weather only.

The way cyclists would really use them is, same as body-builders do: out-of-competition training, in which they want to get a 'cut' and "well-defined" appearance. Meaning better body composition, with less fat and more muscle. It's a strategy, to intentionally throw off more heat in low-level activity, and to burn the fat.

Body-builders choose Clen to enhance the results of their anabolic steroid doping. There are reasons for that, because it works, and if they have already chosen to dope, why not dope properly by going all the way?
The drugs intended for asthma could be used by other types of athletes as a less-extreme but much more legal and accessible version of clenbuterol.

There are also some drugs such as bupropion (Wellbutrin) which are legal and can be used in combination with a beta-agonist. The way that works during the competitive activity is: the bupropion is like an "over-ride" in the central nervous system, which tricks the brain, by over-riding the "danger signal" that core body temperature is way too hot.

That allows them to "run the engine hotter", without the brain telling the body to "shut down" at the upper temperature limit. Of course, at the risk of hyperthermia. That's why it's considered a "danger", because the athlete could die from doing that.

In the context of cycling, the asthma inhalers can be seen as "accommodating a disability", for athletes who really have that disadvantage, to let them perform to their true ability, if they didn't have the breathing condition. Should this be accommodated in elite sports? That's a philosophical question, but apparently the consensus is "yes" because there are these "therapeutic use" exceptions to the rules.

In the peloton I would guess there is some resentment when cyclists get bogus TUE exemptions, for drugs they don't need. Because they know that person is getting a slight competitive edge. But there isn't a big outrage about it

ClassicomanoLuigi, it would be nice to hear your take on world's best male XC-skier, Martin Johnsrud Sundby and the two month ban he got after WADA asked for a CAS verdict, after he was cleared by FIS.

What we know is that MJS twice tested positive above the allowed dose of Salbutamol in Urin. After som other explanations Norwegian Ski Federation and MJS finally said he was prescripted high doses of Ventoline to treat an acute worsening of his asthma in 2014. He never met the doctor, but got the prescription over the phone. The allowed dose according to WADA is 1600 mikrogram over 24 hours. MJS took 15000 mikrogram in a time span of 5 hours leading up to the race. But morever, he took that extreme dose daily a whole month before the second positive test. NSF and MJS tried to explain the uses of a dosage almost 10 times the allowed with the inefficiency of Nebulizers distributing the dose. However, according to several studies I've seen the efficiency is not worse in inhalers. Hence, no valid excuse. Being an asthmatic myself, when having severe asthma I'm prescripted with a maximum dose of 2x100 mikrogram 4 times a day (a total of 800 mikrogram).

If there is more downsides with Salbutamol than upsides, surely the Norwegian Ski Team doctor would have known. Since the days of Dählie in 1992, 69% of the Norwegian medal winners in XC-Olympics have been using asthma medication. And that is a low count by the newspaper, since only the ones admitting usage in newspaper interviews have been counted. http://www.aftenposten.no/100Sport/...renn-er-tatt-av-lopere-med-astma-788032_1.snd

 

[glassmoon]

asthmatics... asthmatics everywhere!

 

[movingtarget]

Re:

asthmatics... asthmatics everywhere!

You can hear them approaching. No ninjas !

 

[akrogirl]

Re:

asthmatics... asthmatics everywhere!

Even the British Olympic badminton player.....

 

[ToreBear]

@ClassicomanoLuigi

His nebulizer had a 10% efficiency according to the manufacturer. So to inhale 1500 mg he had to insert 15000mg.
His samples revealed about 1350ug(whatever). The max allowed was 1000ug, while the decision limits were 1200. Had he inhaled 10 times that amount, I would assume he would have had a value of 13500ug in his samples.

The team doctor thought the 1600mg/24h was related to what was inhaled not what was on the label. Hence that is why he got such a short suspension.

He had received the same treatment in 2009, but with a TUE as was then required. They thought they didn't need a TUE this time because the amount, in their understanding of the new rules was below what would require a TUE.(Apearently USADA also had that same interpretation.)

As a consequence of this ruling, it is not allowed to use a nebulizer without a TUE due to the minimum amount you can put into the machine is IIRC 5000mg.

In the 2014 Sochi Olympics mens XC one or more team members on the relay winners teams and all the gold medalists in the individual events have asthma.
https://en.wikipedia.org/wiki/Cross-country_skiing_at_the_2014_Winter_Olympics

My understanding is that the more years you have trained, the more susceptible you are to developing asthma if you don't already have it.

Likewise the more years you train XC skiing the likelier you are to win. So it's really not that strange that so many of the winners have asthma.

Here is the CAS ruling if you are interested:
http://www.tas-cas.org/en/general-information/news-detail/article/cas-2015a4233-wada-v-martin-johnsrud-sundby-fis.html

 

[Discgear]

Re: Re:

ClassicomanoLuigi, it would be nice to hear your take on world's best male XC-skier, Martin Johnsrud Sundby and the two month ban he got after WADA asked for a CAS verdict, after he was cleared by FIS.

I had not heard about the case - I am a cyclist, and I live in a region where there is no skiing. So it is not common here for fans to follow the cross-country skiing competition in Europe. Since your suggestion, I read about it now online. It seems that Sundby's penalty in itself, was not harsh. But the circumstances made it unfortunately severe him, because the timing of the violations resulted in him having his champion titles taken away.

What we know is that MJS twice tested positive above the allowed dose of Salbutamol in Urin. After som other explanations Norwegian Ski Federation and MJS finally said he was prescripted high doses of Ventoline to treat an acute worsening of his asthma in 2014. He never met the doctor, but got the prescription over the phone.

I found a scientific article which is amazingly similar to this topic -
Prevalence of asthma in young cross-country skiers in central Scandinavia: differences between Norway and Sweden
http://www.sciencedirect.com/science/article/pii/S0954611196902061

"The prevalence of self-reported asthma-related symptoms was 46% in Norway and 51% in Sweden. The prevalence of bronchial hyper-responsiveness (BHR) was significantly different between the two regions. In Norway, 14% of the skiers were hyper-responsive to methacholine compared to 43% in Sweden (P < 0·001). Moreover, the estimated prevalence of clinically diagnosed asthma was 12% in Norway and 42% in Sweden (P < 0·001)."

Very serious study, and they conclude something very interesting - that self-reported "asthma-like symptoms" were about the same between Norwegian and Swedish skiers. But, when they clinically tested these athletes in the lab, there was a huge difference, the real asthma among elite skiers was only 14 percent in Norway.

Compared to about 10 percent prevalence of asthmatic conditions in the general Norwegian population (I found that estimate in another source). Clearly more of the skiers had asthma than regular people, but the difference is not dramatic (14% versus 10%)

Besides cyclists, the cross-country skiers have the best aerobic capacity of any kind of athlete in the world. To be competitive, they must have unusually great lung function. A conclusion is: that the ski training itself is a cause of asthma, because of this intense use of breathing in cold air. Seems reasonable. Also seems plausible that the Swedish skiers got more asthma because of their training in colder, drier climate than coastal Norway.

However ... why would the Norwegian athletes over-report that they have asthma, when most of them don't have the real medical condition? That is somewhat mysterious, and shows a difference in attitude between these groups of people of two different Scandinavian nationalities.

The allowed dose according to WADA is 1600 mikrogram over 24 hours. MJS took 15000 mikrogram in a time span of 5 hours leading up to the race. But morever, he took that extreme dose daily a whole month before the second positive test.

In the news articles about this controversy, they say Martin Johnsrud Sundby claims he did not know that this is doping. And the sports authorities accepted the concept that he was less-at-fault if he was unaware of the limits, and if it was not his intention to dope. But that is a very typical defense strategy in doping cases, for example in tennis, Maria Sharapova recently claimed that she didn't know a certain dosage of a drug is banned, etc.

Also the chronic use over a period when it was not necessary - and dose way higher than recommended. Taking more of the drug beyond the clinical dose doesn't help more to prevent the asthma attacks. Because the bronchodilation in the lungs reaches a point where the bronchioles just can't expand any further.

NSF and MJS tried to explain the uses of a dosage almost 10 times the allowed with the inefficiency of Nebulizers distributing the dose. However, according to several studies I've seen the efficiency is not worse in inhalers. Hence, no valid excuse. Being an asthmatic myself, when having severe asthma I'm prescripted with a maximum dose of 2x100 mikrogram 4 times a day (a total of 800 mikrogram).

I think their contention was: that since Sundby used a nebulizer, he was less-responsible for the doping, because the device does not precisely control the dose, in the way a metered inhaler does. He could take a "puff" and not know how much the dose is, because of wider variation in the dosage without the pre-setting function of an inhaler meter. For those readers out there who haven't seen asthma inhalers - there is actually a numeric read-out on the inhaler, which tells the number of remaining "puffs".

Inaccurate device equals less-responsible? You are absolutely right, it's not a good argument in this case, where Sundby was obviously taking much more drug than is necessary, and over a sustained period of training.

If there is more downsides with Salbutamol than upsides, surely the Norwegian Ski Team doctor would have known. Since the days of Dählie in 1992, 69% of the Norwegian medal winners in XC-Olympics have been using asthma medication. And that is a low count by the newspaper, since only the ones admitting usage in newspaper interviews have been counted.

They know very well that the salbutamol is performance-enhancing, and the athletes know it, too. Through their own experience, after they "try" the drug, they will tend to want to use it more. A hard training work-out is one in which you can feel it in the lungs afterwards. The sensation of "expanded" breathing feels great, whether or not it is improving their speed.

Luigi

Thank's for a very informative post.
Interesting link to the research about differences between self-reported asthmatic problems and clinically tested problems. I think you have a valid point in the climatic differences between the cold and dry climate in especially northern Sweden compared to coastal Norway.

Concerning Johnsrud Sundby i would like to point out a few things mentioned in another thread. FIS Antidoping cleared MJS but FIS central quarters had the same view as WADA, that he should get a two year ban.

Their expert was prof. Ken Fitch from Australia. When he spoke out in media after the CAS-verdict his main critique was:

• That the national association economically compensates a doping convicted athlete (MJS was compensated by the Norwegian Ski federation, due to the lost prize-money from the verdict)
• That the national association, in conflict with WADA-code, takes away the responsibility from the athlete
• He emphasizes that the explanations from the team doctor “lacks credibility” and is like “clinging to a straw”
• He asks rethorically if the Norwegian Ski Association would have handled the case in the same way, if it was about a foreigner

It was impossible for me to defend the athlete in this case due to the two following specific things, says prof Fitch to NRK:

-a) I cannot support the advice from the team doctor, especially since it was given over the phone and without an examinaning the patient.
-b) the decision by the athlete to use the Nebulizer three times in a time-span less than five hours, on days of competition.

Finally Fitch says:

1-2 times before I’ve come across other athletes that have tested positive for Salbutamol due to use of Nebulizer. But they didn’t use it every day for one month, only once due to severe asthma.

But for me personally Johsnrud Sundby case have highlightened quite a few issues concerning the main question in this thread "asthma inhalers not performance enhancing?"

Inhaling salbutamol, which is the most appropriate way to combat asthma, will not provide the same beneficial effects to athletes as taking a much higher doses pill and thus "going systemic"

(Norris. 1996; Koch. 2013)

So, by going with extreme inhaled doses, you could be suspected trying to achieve systemic doses similar to oral salbutamol. Which is forbidden due to its performance enhancing effects.