Therapeutic Use Exemptions

[Cavalier]

It's funny in a way that there are currently ads on Australian TV about asthma and what happens when someone is having an attack before they can use their inhaler. Suffice to say, I'm pretty confident that riding along at 40 kph calmly in a group isn't one of those things.

 

[Pazuzu]

Yeah, hard to read that with a straight face..."her NATURAL potential, WITHOUT asthma." That would be like my natural potential as an NBA star, without my shortness.

Her NATURAL anything is "as-is, where-is".

I would get rid of the TUEs entirely. Why I am not head of the UCI, I suppose. As seen above, the TUE is a license to dope. If you can't race without it, you can't race. Sounds simple enough to me.

Objections?

Obviously that's one solution. But how far do you take it? Do you then ban the use of corrective eyewear in a sport like archery?

In granting the exemption in cross country skiing, the WADA determined that the asthma drugs only benefit those who actually have asthma and don't help those without the condition. However, this inevitably creates the perception of an unfair advantage as the drug is otherwise banned. It's for this reason WADA took the asthma drug(s) in question off the restricted list last year, so they're now available to all.

Nonetheless, this doesn't fix the problem of using the drugs as a masking agent, which is a whole other can of worms.

 

[ElChingon]

Is there any where we can see who has a supposedly approved TUE?

 

[hfer07]

Does anyone know what is the TUE for Bilharzia?

 

[AntiGravityCycling]

Good question about archery. Presently does corrective eyewear require a TUE?

NO, according to the World Archery Rule Book.
http://www.archery.org/content.asp?id=5009&me_id=827


11.1.9.3. Prescription spectacles, shooting spectacles and sunglasses may be used.
None of these may be fitted with micro-hole lenses, or similar devices, nor
may they be marked in any way that can assist in aiming.

So this is well outside the topic.

 

[sniper]

Triki Beltran in 1999: backdated TUE for cortisone.

(funny indeed that Beltran, like LA, also had his 1999 samples tested positive for EPO retrospectively in 2005, without sanctions)

 

[simo1733]

To get a TUE for Asthma meds you have to perform an ergometer test in front if an approved Doctor.You exercise to exhaustion whilst they progressively increase the amount if saline moisture in the air you breath in.At some point this stimulates an asthmatic reaction.
I believe this procedure has to be carried out annually.

 

[AntiGravityCycling]

SO...what fraction of pro cyclists have a TUE for asthma?

What fraction of athletes in other sports have asthma?

 

[slowspoke]

Back when I was swimming 15 years ago, it was supposed to be good for asthma as all the top ssimmers had it. Therefore, I knew a lot of asthma sufferers. Once we did try loading up on asthma inhaler before a race but don't remember any difference in performance. Why anyone thought that swimming in a chlorinated pool would help is anyone's guess!

 

[spalco]

Has anyone ever noticed that for an elite athlete to be able to perform at such a high level, they require an inhaler????
To me that indicates a problem. If you have asthma, statistics indicate you probably won't reach the "elite" level. I remember kids growing up with asthma...they couldn't go outside and run if it was to hot for christ sake! Somehow that doesn't seem right. Also, for being fit, healthy athletes, they always have stomach issues or a cold...totally incapacitates them. Hell, I get up everyday with the bubble guts or a stuffy nose or sore back or whatever. I still ride my bike after work 4 times a week. Maybe its my lack of TUE's that holding me from making CAT 4 LOL!

Could be the other way round, that heavy endurance sport causes asthma in athletes.

 

[the big ring]

Could be the other way round, that heavy endurance sport causes asthma in athletes.

It's called exercise-induced asthma, and is similar to suffering from hayfever during Spring classics.

http://en.wikipedia.org/wiki/Exercise-induced_asthma

 

[the asian]

Indeed there is a difference between exercise induced Asthma and Asthma due to sensitivity to temperature changes. The latter occurs mostly as a child and generally disappears around the age of ten and reappears after about 40.
I suffered from asthma as a child and it has disappeared now, but am fully aware it will most probably come back after 40. I have a weak lung capacity an cannot be a sportsman.

What the cyclist are having is exercise induced Asthma. This happens when the airways narrow as a result of exercises.

 

[D-Queued]

To get a TUE for Asthma meds you have to perform an ergometer test in front if an approved Doctor.You exercise to exhaustion whilst they progressively increase the amount if saline moisture in the air you breath in.At some point this stimulates an asthmatic reaction.
I believe this procedure has to be carried out annually.

Close...

The Methacoline challenge test is definitive for asthma. No exercise is involved.

The challenge is related to the aspiration of methacoline. You either react or not.

http://en.wikipedia.org/wiki/Bronchial_challenge_test

I have had TUE's for Ventolin/Salbutamol for asthma for years.

WADA rules require an annual renewal that must be signed by a physician.

In my case, my MD does not need to re-run the test annually. He knows I have asthma, the test was conclusive, and I have no problem in getting my prescriptions refilled (fortunately).

I would be better off if I didn't have the condition and need the TUE as Ventolin does not return me to 100% of expected/normal.

Dave.

 

[Caruut]

What the cyclist are having is exercise induced Asthma. This happens when the airways narrow as a result of exercises.

Doesn't always happen either - sometimes you can go for a whole ride fine other times (before I got the inhaler and other times when I've forgotten it) I could barely even stand up. The way i would manage is for the TUE to be an exemption only if you provide details of the last time you used the inhaler before the test, and the levels of other substances that should have been in the medicine are consistent with that.

 

[zigmeister]

It's called exercise-induced asthma, and is similar to suffering from hayfever during Spring classics.

http://en.wikipedia.org/wiki/Exercise-induced_asthma

I have this condition, every since I was a child. Also, allergy induced asthma and cold/moist weather can set it off.

But, I believe nobody needs a TUE anymore for inhalers. Allergies/asthma in the US have increased significantly over the past 20yrs. Some claim it is due to heavy pollution from fossil fuel burning power plants in the US and the emissions.

Also have food allergies that cause asthma and other GI problems.

So yes, not everybody that has a TUE or use some medication do it for doping. You do it to salvage your life and quality of such.

But this is the clinic...so one can only expect less than normal IQ responses to things like this.

 

[taiwan]

Yes, not to imply that every TUE is automatically suspicious, as clearly athletes suffer illnesses which need treated, like everyone else. Common sense says, though, that there is some gaming the system, and it would be interesting to know the extent of it.

The 63% of tested athletes at the 2006 TDF with a TUE is food for thought. Is that a reasonable number?

 

[ElChingon]

Yes, not to imply that every TUE is automatically suspicious, as clearly athletes suffer illnesses which need treated, like everyone else. Common sense says, though, that there is some gaming the system, and it would be interesting to know the extent of it.

The 63% of tested athletes at the 2006 TDF with a TUE is food for thought. Is that a reasonable number?

Nope. If we're talking about the best cycling athletes on the planet, hence at the top race on the schedule there should be 0 TUE's not N of them. Had you been talking about the special Olympics or other physically handicapped race then I'd expect TUE's to be listed.

 

[simo1733]

Close...

The Methacoline challenge test is definitive for asthma. No exercise is involved.

The challenge is related to the aspiration of methacoline. You either react or not.

http://en.wikipedia.org/wiki/Bronchial_challenge_test

I have had TUE's for Ventolin/Salbutamol for asthma for years.

WADA rules require an annual renewal that must be signed by a physician.

In my case, my MD does not need to re-run the test annually. He knows I have asthma, the test was conclusive, and I have no problem in getting my prescriptions refilled (fortunately).

I would be better off if I didn't have the condition and need the TUE as Ventolin does not return me to 100% of expected/normal.

Dave.

People with exercise induced asthma often have perfectly normal respiration at rest, and therefore have to exercise to provoke a reaction which will prove their condition.Hence the following.No 3 in particular.

Testing for EIA
With the above mechanistic basis in mind, there are three recommended methods of ‘challenging’ the airways in order to test for EIA. These are as follows:

1. Eucapnic voluntary hyperventilation
challenge(2): This test involves breathing dry air at a level of breathing that is equivalent to 30 times the athlete’s FEV1 for at least six minutes. This test simulates the dehydrating effect that high levels of breathing during exercise exert on the airways, and is therefore highly specific to EIA. Lung function is measured at discrete time intervals for up to 30 minutes after cessation of hyperventilation. A positive diagnosis is made with a fall in FEV1 greater than 10% from baseline at two or more time points post-challenge.

2. Mannitol challenge (3): Mannitol is a harmless sugar that is inhaled progressively increasing doses to induce airway dehydration. Dehydration occurs because the sugar particles that are deposited in the airways draw moisture from the airway lining cells, dehydrating them in a similar way to exercise. Mannitol therefore triggers EIA in a very similar way to exercise, but without all the ‘puffing and panting’. In this respect a mannitol challenge is also a very specific test of EIA. Lung function is measured after each dose, and compared to the baseline value. A positive diagnosis is made with a fall in FEV1 greater than 15% from baseline at any inhaled dose or a 10% incremental fall in FEV1 between doses.

3. Exercise challenge: This is the most specific test of EIA and normally consists of a single bout of exercise lasting a minimum of six minutes at an intensity equivalent to 80-90% of maximal heart rate. However, this can be the least reliable challenge, since its outcome is highly dependent upon environmental conditions. Because the trigger for EIA is airway dehydration, the response to an exercise challenge is highly dependent upon the magnitude of ventilatory response achieved during the challenge bout of exercise, as well as the water content of the inhaled air. If the test is undertaken in, say, an air conditioned laboratory, airway dehydration may be insufficient to trigger EIA. However, an exercise challenge that is conducted in the athletes’ competitive environment, eg, snow clad mountains, may provide the only setting in which EIA is triggered. A positive diagnosis is made with a fall in FEV1 greater than 10% from baseline at two or more time points post-exercise.

Selection of the test will be ‘situation specific’, and dependent upon the facilities that are available to the athlete and physician.

 

[Cloxxki]

People with exercise induced asthma often have perfectly normal respiration at rest, and therefore have to exercise to provoke a reaction which will prove their condition.Hence the following.No 3 in particular.

Testing for EIA
With the above mechanistic basis in mind, there are three recommended methods of ‘challenging’ the airways in order to test for EIA. These are as follows:

1. Eucapnic voluntary hyperventilation
challenge(2): This test involves breathing dry air at a level of breathing that is equivalent to 30 times the athlete’s FEV1 for at least six minutes. This test simulates the dehydrating effect that high levels of breathing during exercise exert on the airways, and is therefore highly specific to EIA. Lung function is measured at discrete time intervals for up to 30 minutes after cessation of hyperventilation. A positive diagnosis is made with a fall in FEV1 greater than 10% from baseline at two or more time points post-challenge.

2. Mannitol challenge (3): Mannitol is a harmless sugar that is inhaled progressively increasing doses to induce airway dehydration. Dehydration occurs because the sugar particles that are deposited in the airways draw moisture from the airway lining cells, dehydrating them in a similar way to exercise. Mannitol therefore triggers EIA in a very similar way to exercise, but without all the ‘puffing and panting’. In this respect a mannitol challenge is also a very specific test of EIA. Lung function is measured after each dose, and compared to the baseline value. A positive diagnosis is made with a fall in FEV1 greater than 15% from baseline at any inhaled dose or a 10% incremental fall in FEV1 between doses.

3. Exercise challenge: This is the most specific test of EIA and normally consists of a single bout of exercise lasting a minimum of six minutes at an intensity equivalent to 80-90% of maximal heart rate. However, this can be the least reliable challenge, since its outcome is highly dependent upon environmental conditions. Because the trigger for EIA is airway dehydration, the response to an exercise challenge is highly dependent upon the magnitude of ventilatory response achieved during the challenge bout of exercise, as well as the water content of the inhaled air. If the test is undertaken in, say, an air conditioned laboratory, airway dehydration may be insufficient to trigger EIA. However, an exercise challenge that is conducted in the athletes’ competitive environment, eg, snow clad mountains, may provide the only setting in which EIA is triggered. A positive diagnosis is made with a fall in FEV1 greater than 10% from baseline at two or more time points post-exercise.

Selection of the test will be ‘situation specific’, and dependent upon the facilities that are available to the athlete and physician.

Indeed. I got symptoms (suffocating on a casual city bike, basically) in 2003, after I had pretty much peaked in cycling volume/intensity. I could still put the hammer down mind you, even when pretty out of shape (fat) to my standards, but only in autumn/winter/spring time when my allergy wasn't provoked. I the summer, I suppose my VO2max without meds bottomed somewhere around 100W, in stead of 500W. It's really, really scary to then try to race. The legs want, but will die only after vision has gone all black.
In those days, if you didn't know the right docs, it was pretty hard to get a TUE. I just quit racing in summers, apart from a few occasions where I had done an extensive provocation/time trial/coughing effort pre-race. Exhaustive, but I was able to race. Lost 5-10bpm from my typical heartrate and associated power output (I basically sucked), but I could race to some degree. Then in october, I'd feel reborn and would pick up some training and especially racing.
Long story short : athletic capacity doesn not exclude getting athma. The meds (salbutamol) don't make me any quicker when I don't experience a respiratory problem. After September I don't inhale it once until June, and get to win races and overall just as before.
Still no TUE, as salbutamol has been pretty much unlisted now. So tonight I will run an 800m and take 200ug beforehand.

 

[Cavalier]

Isn't the issue that it acts as a masking agent rather than directly provides any performance bonus?

 

[Darryl Webster]

Not sure how widely known this is ?

The "better medicine" part made me

"Talking about his asthma, cyclist Bradley told Asthma UK: 'It's only a hindrance if you make it one - it does sound quite bad if you are diagnosed with asthma and your natural instinct is to think that's it. But there is better medicine available now and I am an Olympic champion - the evidence is out there that you can succeed."

http://www.asthma.org.uk/news-centr...-hopefuls-who-are-flying-the-flag-for-asthma/

 

[JeffreyPerry]

Bah humbug! Every time I go for a bike ride I can't freaking breathe...does that mean I have exercise induced asthma? LOL! I thought that was the point? Good lungs and legs= better rider.

 

[MrRoboto]

The point is not that the muscles around your windpipe tightens so you can barely breathe (Asthma is not a problem with the lungs).


Edit: My sentence didn't make any sense

 

[AntiGravityCycling]

TUEs are obviously out of control when Wiggo can openly brag about "better drugs".

Maybe if TUEs were: 1. Public and 2. Temporary. As in 7 days or so.

No offence intended to anyone with respiratory issues of course...but lungs, legs, training are the issues here. Or they should be. Not better racing through modern chemistry.

 

[Fearless Greg Lemond]

Not sure how widely known this is ?

The "better medicine" part made me

"Talking about his asthma, cyclist Bradley told Asthma UK: 'It's only a hindrance if you make it one - it does sound quite bad if you are diagnosed with asthma and your natural instinct is to think that's it. But there is better medicine available now and I am an Olympic champion - the evidence is out there that you can succeed."

http://www.asthma.org.uk/news-centr...-hopefuls-who-are-flying-the-flag-for-asthma/

Wow, do you want some wheeeeeeeeeeeeeeed to go with that salbutamol Bob - Ziggy Wiggo?

Lol.

In some parts of my family asthma was quite common, children in and out special clinics et all. When I heard of PRO cyclists having tues for asthma medication I knew enough, it is insane an asthma patient would ride a bike at pro level. Salbutamol in every lunch sachet of the pro peloton riders, it's a must.

Mind you, wasn't trying to diss forum members here who have some sort of asthma!