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Home , Fenoterol, Reproterol, Tulobuterol

and doping in sports

Many athletes have a diagnosis of asthma (Paul Scholes, David Beckham, Paula Radcliffe, Jackie Joyner-Kersee, Mark Spitz, Dennis Rodman, Amy Van Dyken, Simon Yates etc.). Besides, many of them have an exercise-induced asthma (EIA) or exercise-induced bronchoconstriction (EIB), or bronchial hyperreactivity (BHR).

ASTHMA TREATMENT AND THE PROHIBITED LIST The List of Prohibited Substances and Methods identifies the substances and methods prohibited in- and out-of-competition, and in particular sports.The substances and methods on the List are classified by different categories (e.g. steroids, stimulants, gene doping, etc.). Which medicines for asthma treatment are banned in sports? Glucocorticosteroids - all oral/intravenous are prohibited. Inhaled glucocorticoids are allowed. Beta-2-agonists - all beta-2 agonists, including all optical isomers, e.g. d- and l- where relevant, are prohibited. Except: inhaled (maximum 1600 micrograms over 24 hours); inhaled (maximum delivered dose 54 micrograms over 24 hours); and inhaled in accordance with the manufacturers’ recommended therapeutic regimen. Other non-prohibited treatments: leukotriene receptor antagonists, , cromones, theophyllines (), anti-IgE agents,...

Athletes can use prohibited substances for treatment of their asthma, but only if they get TUE (Therapeutic Use Exemption). Only in this case, if the athlete is tested and the prohibited substance is found, he or she will not be suspended. Medical file to support TUE application: medical history; clinical examination; spirometry report or bronchial provocation test; treating physician contact info; explanation as to why salbutamol, salmeterol or formoterol are not appropriate.

WORLD ANTI-DOPING AGENCY (WADA) Substances identified in beta-2-agonists drug class as a doping (2010-2018)

year % of all number of the most others detected doping doping positive frequently beta-2-agonists positive cases athletes detected beta-2- (number of agonist (number athletes) of athletes) 2010. 3,8 209 (111) formoterol (78) salbutamol (9) salmeterol (6) (5) 2011. 4,0 225 terbutaline (130) formoterol (84) salbutamol (6) fenoterol (2) salmeterol (1) (1) (1) 2012. 2,9 131 terbutaline (117) salbutamol (6) fenoterol (5) salmeterol (3) 2013. 2,6 138 terbutaline (103) fenoterol (15) salbutamol (11) salmeterol (9) 2014. 4,0 122 terbutaline (93) fenoterol (9) salbutamol (8) salmeterol (7) (5) 2015. 3,0 115 terbutaline (87) salbutamol (16) fenoterol (10) reproterol (1) salmeterol (1) 2016. 4,0 172 terbutaline (89) (55) salbutamol (15) fenoterol (6) (4) reproterol (2) salmeterol (1) 2017. 4,0 157 terbutaline (78) higenamine (58) salbutamol (12) fenoterol (4) vilanterol (4) reproterol (1) 2018. 4,0 164 terbutaline (87) higenamine (42) vilanterol (13) salbutamol (13) fenoterol (7) tulobuterol (2)

CONCLUSION Many athletes did not let asthma stop them from achieving their goals and sport victories. On the other hand, they are supposed to do everything in sport without doping. The most important thing for any athlete with asthma is to submit their application for TUE directly to National Anti-doping Agency or National or International Sport Federation. Pulmonologists play a crucial role in supplying the medical information necessary for the approval of a TUE. Also, pulmonologists often inform athlete that they must apply for TUE because athletes are not aware of it (they consider their asthma as medical condition, with no possibility of doping) and may accidentally commit a doping offence. All athletes need further education on every aspect of doping in sports. An athlete is not entitled to make a step towards the use of forbidden substances due to the lack of knowledge. Whether is by accident or on purpose, doping is against the rules of the sport and fairplay.