β-2 agonists in sport: are the anti-doping rules meeting the needs of asthmatic athletes?
OBJECTIVE
(a) To review the methacholine tests performed in our laboratory up until 2008; (b) to compare them with previously reported data in 2006 and (c) to examine if the anti-doping rules are meeting the needs of asthmatic athletes who really need bronchodilator treatment.


METHODS
Between April 2004 and September 2008, 89 high-level athletes were examined in our laboratory in order to obtain an abbreviated therapeutic use exemption for β-2 agonists. Of these, 50 men (23.31 (7.05) years) and 23 women (20.68 (5.94) years) performed a methacholine inhalation test with increasing concentrations of methacholine (0.025, 0.25, 2.5, 5, 10 and 25 mg/ml) until a fall of 20% in forced expiratory volume in 1 s (FEV(1)) was achieved.


RESULTS
31 candidates (42.5%) had a provocative concentration causing a 20% fall in FEV(1) (PC(20)) <2 mg/ml; 12 (16.4%) were between 2 and 4 mg/ml; 8 (11%) between 4.1 and 8 mg/ml and 22 candidates (30.1%) had a PC(20) >8 mg/ml. Seven of the 73 candidates had an obstructive pattern in the spirometry at rest, demonstrated by a FEV(1)% <70% but with a FEV(1) >70% of the reference value.


CONCLUSIONS
The anti-doping regulations with respect to β-2 agonists need to be reviewed, and measures should be adopted to include a fall of 70% in FEV(1)% as an obstruction criterion to indicate a bronchodilation test and to extend the criterion for a positive methacholine test to a PC(20) of 8 mg/ml.
Orellana
J Naranjo
JN
Centro Andaluz de Medicina del Deporte, 41092 Sevilla, Spain. jose.naranjo@juntadeandalucia.es
Márquez
M D Carranza
MD
D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D000402:Airway Obstruction / Q000175:diagnosis / Q000503:physiopathology; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis* / Q000503:physiopathology; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004300:Doping in Sports / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D016210:Methacholine Chloride; D020380:Needs Assessment; D055815:Young Adult
D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D016085:Bronchoconstrictor Agents; D001993:Bronchodilator Agents; D016210:Methacholine Chloride