Use of beta2 agonists in sport: are the present criteria right?
BACKGROUND
The regulations for doping control prohibit the use of beta2 agonist bronchodilators (salbutamol, salmeterol, formoterol, and terbutaline) unless the subject follows the procedure known as abbreviated therapeutic use exemption (ATUE).


OBJECTIVE
To highlight how the interest in discovering possible cheats may result in damage to athletes who really need bronchodilator treatment.


METHODS
Thirty one high level athletes (18 men and 13 women) with a previous diagnosis of asthma were examined in our laboratory in order to obtain an ATUE for beta2 agonists. All the subjects underwent spirometry at rest. If the results were normal, the subjects underwent an effort test and, if negative, a methacholine test inhaling progressive doses of methacholine until a fall of 20% in forced expiratory volume in one second (FEV1) was achieved. The international anti-doping regulations require that the fall in FEV1 occurs with a concentration of methacholine (PC20) lower than 2 mg/ml (4 mg/ml for Torino 2006). In clinical practice, a test is positive if the response occurs with a PC20 lower than 8 mg/ml.


RESULTS
Only one subject met the criterion for the bronchodilation test at rest. The remaining 30 athletes underwent an effort test, which was positive in nine of them. In 21 cases (13 men and 8 women) the effort test was negative so a methacholine test was carried out. Seven (33%) were negative for ATUE with a PC20 higher than 8 mg/ml, seven (33%) were positive for ATUE with a PC20 less than 2 mg/ml, in four (19%) the PC20 was 2-4 mg/ml, and in three (14%) it was 4-8 mg/ml.


CONCLUSIONS
Strict vigilance of fair play should be pursued, but excessive control can lead to situations of inequality for asthmatic athletes such that a third of athletes cannot be treated with beta2 agonists. Therefore under current regulations, asthmatic athletes are often denied the most effective therapeutic option.
Centro Andaluz de Medicina del Deporte, Sevilla, Spain. jose.naranjo@juntadeandalucia.es
J
J
Naranjo Orellana
R A
RA
Centeno Prada
M D
MD
Carranza Márquez
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004300:Doping in Sports / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D013177:Sports / Q000331:legislation & jurisprudence; D014797:Vital Capacity / Q000187:drug effects
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents