Salbutamol Study

The study involved 48 well-trained male cyclists (VO2max > 60 ml/kg/min); before the study started, they were all screened for exercise-induced asthma, and 14 of them tested positive (all but one had been previously diagnosed). They all did two 10-km cycling time trials, which take about 15 minutes -- a combination of intensity and duration that's thought to offer the toughest challenge to an athlete's respiratory system. An hour before each time trial, they inhaled either salbumatol or a placebo; neither they nor the researchers knew which one they'd been given on which occasion.

The results? Lung function did improve in both the asthma and non-asthma group -- but that didn't translate into any improvement in time-trial performance. The surprise here is that the increase in lung function didn't translate to better performance even for the group with exercise-induced asthma. That doesn't mean salbutamol doesn't work -- it's highly effective as relieving the acute symptoms of an asthma attack.


More details here

original work on pubmed
 
A very interesting little piece of work, especially given the concern about over prescribing asthma meds in athletes.

Needs broader study of course, especially in longer events than a 10K TT/
 

EnacheV

BANNED
Jul 7, 2013
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I hope USA medical system is not based on this type of "research".

Inhaled salbutamol does not affect athletic performance in asthmatic and non-asthmatic cyclists. - this is a false statement.

What they managed to find out is that for a custom group of 49 persons there were no big performance improvements over a simulated 10km TT.

They should have done it over 10,20,30,40,50km

In various temperature/humidity conditions. After previous made effort (to simulate fatigue) or rested.

With a much bigger sample pool of subjects.

That would resemble science. This is a waste of taxpayers money if it's gov. funded.
 
Jul 10, 2013
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EnacheV said:
I hope USA medical system is not based on this type of "research".
What they managed to find out is that for a custom group of 49 persons there were no big performance improvements over a simulated 10km TT.

They should have done it over 10,20,30,40,50km

In various temperature/humidity conditions. After previous made effort (to simulate fatigue) or rested.

With a much bigger sample pool of subjects.

That would resemble science. This is a waste of taxpayers money if it's gov. funded.
How does one do that?

Also, if it improves performance you see it on 10k and 50k.
 
EnacheV said:
I hope USA medical system is not based on this type of "research".

Inhaled salbutamol does not affect athletic performance in asthmatic and non-asthmatic cyclists. - this is a false statement.

What they managed to find out is that for a custom group of 49 persons there were no big performance improvements over a simulated 10km TT.

They should have done it over 10,20,30,40,50km

In various temperature/humidity conditions. After previous made effort (to simulate fatigue) or rested.

With a much bigger sample pool of subjects.

That would resemble science. This is a waste of taxpayers money if it's gov. funded.
Always good to have all the answers.

What if this was phase 1? Of a potential multi-phase study?

Don't researchers like to milk their subjects?

Good research would never waste money or effort on extensive research where there was no evidence for it.

Sounds like there is no evidence for a broader study.

Fascinating result here, perhaps. But I wouldn't want them wasting any more of my tax dollars when they have done a good job demonstrating that this is a dry well.

Dave.
 
Jul 28, 2009
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EnacheV said:
I hope USA medical system is not based on this type of "research".
Most medicine is based on peer reviewed research although I am pretty sure the "USA medical system" is not generally based on sports medicine studies.

Inhaled salbutamol does not affect athletic performance in asthmatic and non-asthmatic cyclists. - this is a false statement.
Its the article title. No one in science considers that to be a conclusion. Read the abstract.

What they managed to find out is that for a custom group of 49 persons there were no big performance improvements over a simulated 10km TT.
Yeah that's what they say too.

They should have done it over 10,20,30,40,50km
What's your scientific justification for those distances and quintupling the size of the study?


In various temperature/humidity conditions. After previous made effort (to simulate fatigue) or rested.
Why? What's the physiological rationale behind those variations in the context of the known pharmacological effects of salbutamol?

With a much bigger sample pool of subjects.:)
Please provide a power analysis that demonstrates the number of subjects is inadequate.

That would resemble science. This is a waste of taxpayers money if it's gov. funded.
No doubt a lot of sports science is crap but your critique is significantly (p<0.05) less scientific than the article.
 
Sep 13, 2010
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This study makes total sense. It's oxygen utilization (heart function/RBC/mitochondria) not air intake (lungs) that's a limiter in cycling performance. Having diseased lungs being the exception.
 
Sep 29, 2012
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kielbasa said:
This study makes total sense. It's oxygen utilization (heart function/RBC/mitochondria) not air intake (lungs) that's a limiter in cycling performance. Having diseased lungs being the exception.
So you suffer no ill effects from exercising at altitude then?

Interesting.
 
Sep 30, 2009
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Dear Wiggo said:
So you suffer no ill effects from exercising at altitude then?

Interesting.
Actually you kind of help make Kilebasa's point in a way. You train at altitude to induce physiologic changes that make better use of the available oxygen. Once your hemoglobin is satting at close 99% or higher, which it is in most healthy people, lung size, air intake (your available oxygen reservoir) won't help you much unless you're holding your breath.
 
Sep 29, 2012
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twothirds said:
Actually you kind of help make Kilebasa's point in a way. You train at altitude to induce physiologic changes that make better use of the available oxygen. Once your hemoglobin is satting at close 99% or higher, which it is in most healthy people, lung size, air intake (your available oxygen reservoir) won't help you much unless you're holding your breath.
And before adaptation occurs... ?
 
Sep 29, 2012
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Try this for an experiment: breathe through your nose, no matter how hard you are riding. I can almost guarantee, depending on nose structure, of course, that once you are riding hard, the restricted oxygen intake capacity of your nasal passages will involuntarily lead you to breathe through your mouth.

Now imagine your oesophagus has been reduced in size due to asthma.

Same deal.

It matters.
 
Sep 30, 2009
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Dear Wiggo said:
Try this for an experiment: breathe through your nose, no matter how hard you are riding. I can almost guarantee, depending on nose structure, of course, that once you are riding hard, the restricted oxygen intake capacity of your nasal passages will involuntarily lead you to breathe through your mouth.

Now imagine your oesophagus has been reduced in size due to asthma.

Same deal.

It matters.
That is true. A reduction in available oxygen will result in these physiologic changes I was talking about. The study looks at what would happen with an increase in available oxygen. Flipside of the coin. It's the transport system that matters when your oxygen availablility increases. If your heamoglobin is maxed out, then the extra oxygen doesn't do anything for you. If you throw in oxygen vectoring drugs, epo, etc., then you have a different situation because you've improved the ablility to transport more oxygen.
 
Strange.
I have an allergy (pollen likely) that triggers ex. end. asthma.
If I get my trigger, I cannot do without Salbutamol. Jogging is just impossible, even when I am in ~18min 5k shape. Breathing frequency drops like a brick, and intake per stroke halves or worse. I may get a lot of oxygen from a little bit of air, but it ain't fun.
Just last Thursday I jogged to the track and found it was one of those days. Just couldn't keep a jog going. Struggled home, inhaled 400ug, and 200ug more at the track (I rode my bike). Joined the group, and performed normally in the repeats. sub 4 minute km's, and I'm over 200lb/90kg. So salbutamol fixed me. If I use it before exercize 200ug tends to suffice.

I have found I am a backmarker at best in MTB racing when my allergy hits me, even when I am in top-20 (100+ field) shape.
On a 5km run, I must imagine the difference is several minute. Without the oxygen, you just can't perform as well.
For me, the power output would need to be below that of an easy endurance ride (50-60bpm under threshold) to dream of not having performance loss.
And I don't consider myself a highly dependent or heavy case. Most winters I can do without, and I even won a MTB series in a winter after a summer that basically had me doing nothing due to the athma and not wanting to use doping.
This astma got me to quit MTB racing.
Can't imagine how diagnosed athletes would not suffer performance loss without it. Perhaps they were really light cases?
Last Thursday I felt my chest tighening up, and pinching pains in the heart region once my lungs started chocking up. How can one NOT slow down with that? Stick a patato in a cars sole air intake, see how it does.
 
Jul 28, 2009
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Cloxxki,
Depends on the level of bronco construction. I have exercise induced asthma too and I can manage without salbutamol once I get over the first few hard efforts adrenalin is enough.

I like the study because it contradicts what you would expect and its intriguing to try and work out why. Could be it is only in the particular context of the study, could be broader.
 
Jul 8, 2010
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They could be looking in the wrong area. Bodybuilders use Salbutamol for fat burning in that it enables the body to preferentially use fat as a fuel. I read that they take 4-8mg 3x day, a bit more than the inhaler which I think is 200mcg.

Being diagnosed asthmatic could be a good mask.
 
parkaboy said:
They could be looking in the wrong area. Bodybuilders use Salbutamol for fat burning in that it enables the body to preferentially use fat as a fuel. I read that they take 4-8mg 3x day, a bit more than the inhaler which I think is 200mcg.

Being diagnosed asthmatic could be a good mask.
That 'side use' is why on a TUE for asthmatics, there is a maximum dose permitted, which falls well under the body builder sort of intake.

Specifically
"The presence in urine of salbutamol in excess of 1000 ng/mL … is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic inhaled dose up to the maximum indicated above.”"

There was a British Amateur boxer who got a AAF. It was recognized this reasonably certain to be from excessive inhaler use, as his GP had suggested he up his dose, during a period of a chest infection.

2-3 puffs oer day isn't going to trigger the threshold.
10+ for per day likely will.
 
Jul 8, 2010
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I guessed there would be maximum. I was wondering how much of an effect on fat burning there would be at permitted levels and maybe that's where to look.

Also, I had some breathing issues last year on the bike and my doctor said that the only real way of finding if I had asthma was to take the medication. She said generally if you improve you have asthma, if you don't then it's something else. :)
 
I think the point people are missing is that if somebody does have asthma, they can't even compete/ride a bike at all with the inhalent.

Thus, this drug allows you to get on the bike and pedal. Whether there is a positive performance effect with people who may or may not be asthmatic is irrelevant.

Why don't we just use the same theory that somebody who has very low testosterone can't even ride and compete and thus need Test to get up in the morning and just ride. Doesn't prove there is a positive effect over a normal person with normal levels.

Why are we differentiating between types of drugs that nobody has proven one way or another they benefit? Yet the argument can be applied to many drugs that are banned compared to albuterol or any other asthma drug. Why is ephedrine not allowed? It was once a primary drug used for asthma and allergic reactions...now, no go??

Where are the "studies" to show ephedrine is a performance enhancer? I'm sure we can find all sorts of conflicting information saying it benefits and it doesn't. Yes WADA have it banned, but albuterol/salbuterol is all good!!!
 
rata de sentina said:
Cloxxki,
Depends on the level of bronco construction. I have exercise induced asthma too and I can manage without salbutamol once I get over the first few hard efforts adrenalin is enough.

I like the study because it contradicts what you would expect and its intriguing to try and work out why. Could be it is only in the particular context of the study, could be broader.
When I was racing, and Salbutamol was still in the list, I found that riding HARD for ~1 hour, caughing heavily and some more intentionally, eventually got my bronchi to open up. I could DO the MTB race, just not reach my usual heart rates anymore. Partly due to fatique pre-race I suppose.
On those days I did use WADA-legal anti histaminica, but those seemed to have hardly any effect at all by themselves.

In recent years I've not been able to get through the lung blockage. It's just game over. I need to catch my breath to not go out. One race I did (MTB) had me pull over as my vision was going all black. Not cool. Doesn't feel safe to go past that point expecting lungs will clear up. Falling unconscious and suffocating feels like a very real possibility. With oxygen deprivation in hard anaerobic efforts, it can take a LONG time to catch your breath.
 
Dec 21, 2010
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Cloxxki said:
When I was racing, and Salbutamol was still in the list, I found that riding HARD for ~1 hour, caughing heavily and some more intentionally, eventually got my bronchi to open up. I could DO the MTB race, just not reach my usual heart rates anymore. Partly due to fatique pre-race I suppose.
On those days I did use WADA-legal anti histaminica, but those seemed to have hardly any effect at all by themselves.

In recent years I've not been able to get through the lung blockage. It's just game over. I need to catch my breath to not go out. One race I did (MTB) had me pull over as my vision was going all black. Not cool. Doesn't feel safe to go past that point expecting lungs will clear up. Falling unconscious and suffocating feels like a very real possibility. With oxygen deprivation in hard anaerobic efforts, it can take a LONG time to catch your breath.
Cloxxki, I have had similar experiences as yours, and it is necessary to understand the difference between Exercise-Induced Asthma (EIA) and chronic asthma which is present without exercise, but which in most cases is made worse in exercise conditions.

EIA is usually managed well enough with salbutamol or similar short-term beta2 agonists, but where there is chronic broncho-restriction (allergy-induced or other triggers) there is often the need for an inhaled cortico-steroid with a long-acting beta2 agonist to keep the chronic inflammation under control.

My asthma is nominally allergy-induced, with grass pollen and other tree/wood pollens being the triggers, so I am getting hit for 90% or more of the year, thus needing the latter (Seretide 50/250 ugm) treatment regime.
I attempted to go off the medication during low-allergy periods this year, only using anti-hystemines. The idea was a failure, with me developing pneumonia (from breathing complications, chronic sleep deprivation due to coughing, etc), requiring two rounds of anti-biotics, with systemic cortico-steroids to get the bronchial inflammation under control again.

I have had two serious asthma attacks whilst in road-races, one in a bunch whilst trying to close down a break - that landed me in hospital, and despite 1 hour on pure oxygen in the ambulance, then the maximum dosage of ventolin via nebuliser, with oxygen, I could still only register 210 L/hr flow rate, compared to my normal of 610-620 L/hr.....I hate to think what was my max flow rate during the attack:-(

As you say, the risk of black-out & loss of control is quite high, and is a risk not worth taking.
I found similar to you that if you do a hard warm-up and pushing close to the point of an acute attack, you can get the lungs working IF (and only IF) there is no underlying chronic inflammation of the bronchii.

Save the Salbutamol or short-acting beta2 agonists for treatment of the acute attacks, to use it as a preventative medication can make an acute attack go from serious to life-threatening, as the medication has reduced effectiveness (or even making the attack worse - very uncommon, but has been seen http://www.thefreelibrary.com/Paradoxical+bronchospasm:+a+potentially+life+threatening+adverse...-a0144298834) with repeated applications over a short time period.
 
zigmeister said:
Thus, this drug allows you to get on the bike and pedal. Whether there is a positive performance effect with people who may or may not be asthmatic is irrelevant.
From an anti-doping perspective, it is entirely relevant.

There is a concern about salbutamol being used in otherwise fit people for performance enhancing reasons using 'dodgy' TUE's.
 
Dec 21, 2010
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Catwhoorg said:
From an anti-doping perspective, it is entirely relevant.

There is a concern about salbutamol being used in otherwise fit people for performance enhancing reasons using 'dodgy' TUE's.
Within the limits of it's use, even with a TUE, is there any accepted peer-reviewed research showing a performance improvement in "certified" i.e. tested and shown to be non-asthmatic, athletes?

I know of a couple of studies that have shown some indication of improvement, but there appeared to be no controls that declared them as "non-asthmatic" prior to the research.
From my understanding of Beta2 agonist treatment, it cannot further open up the respiratory tract if it is in a fully relaxed state, i.e. in a non asthmatic person.

The issue of weight loss by abuse of the drug is another question, and again it appears that vastly higher doses than the accepted limits are required to show any gain from this.
 
GreasyMonkey said:
Cloxxki, I have had similar experiences as yours, and it is necessary to understand the difference between Exercise-Induced Asthma (EIA) and chronic asthma which is present without exercise, but which in most cases is made worse in exercise conditions.

EIA is usually managed well enough with salbutamol or similar short-term beta2 agonists, but where there is chronic broncho-restriction (allergy-induced or other triggers) there is often the need for an inhaled cortico-steroid with a long-acting beta2 agonist to keep the chronic inflammation under control.

My asthma is nominally allergy-induced, with grass pollen and other tree/wood pollens being the triggers, so I am getting hit for 90% or more of the year, thus needing the latter (Seretide 50/250 ugm) treatment regime.
I attempted to go off the medication during low-allergy periods this year, only using anti-hystemines. The idea was a failure, with me developing pneumonia (from breathing complications, chronic sleep deprivation due to coughing, etc), requiring two rounds of anti-biotics, with systemic cortico-steroids to get the bronchial inflammation under control again.

I have had two serious asthma attacks whilst in road-races, one in a bunch whilst trying to close down a break - that landed me in hospital, and despite 1 hour on pure oxygen in the ambulance, then the maximum dosage of ventolin via nebuliser, with oxygen, I could still only register 210 L/hr flow rate, compared to my normal of 610-620 L/hr.....I hate to think what was my max flow rate during the attack:-(

As you say, the risk of black-out & loss of control is quite high, and is a risk not worth taking.
I found similar to you that if you do a hard warm-up and pushing close to the point of an acute attack, you can get the lungs working IF (and only IF) there is no underlying chronic inflammation of the bronchii.

Save the Salbutamol or short-acting beta2 agonists for treatment of the acute attacks, to use it as a preventative medication can make an acute attack go from serious to life-threatening, as the medication has reduced effectiveness (or even making the attack worse - very uncommon, but has been seen http://www.thefreelibrary.com/Paradoxical+bronchospasm:+a+potentially+life+threatening+adverse...-a0144298834) with repeated applications over a short time period.
Good post. I'd never heard of the "hard warm-up when wheezy to open up the lungs" and don't think it would work for me - I'm also on inhaled corticosteroids and antihistamines year-round. The only trigger I've consistently identified actually, and the only one that I would preemptively take salbutamol for is intensive exercise in cold weather (below around 5C/40F - used to happen often in Ireland but not once since I've moved to California...). I also don't seem to get sudden attacks - I can feel myself getting gradually worse over a course of days so I've never had problems during intensive cycling, soccer, 10K races etc. as I don't participate if I know I'm going to be in difficulty. I've had the O2 in the ambulance/ventolin mask in the hospital a bunch of times though, due to flu/chest infections etc - my peak flow has been as low as 200 (down from 700 normally) which was pretty scary.
 

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