title: Impact of changes in anti-doping regulations (WADA Guidelines) on asthma care in athletes.
abstract: OBJECTIVE
  To investigate how changes to the World Anti-Doping Agency (WADA) guidelines on asthma medication requests have impacted the management of asthmatic athletes in Portugal.
  
  
  METHODS
  Retrospective analysis of asthma medication requests submitted in 2008 to 2010.
  
  
  METHODS
  Portuguese Anti-Doping Authority database.
  
  
  METHODS
  Athletes requesting the use of inhaled corticosteroids and/or β2-agonists.
  
  
  METHODS
  Demographic, therapeutic, and diagnostic test data.
  
  
  METHODS
  Yearly changes in number of asthma medication requests and diagnostic procedures.
  
  
  RESULTS
  We analyzed 326 requests: 173 abbreviated Therapeutic Use Exemptions (TUEs) in 2008 (objective tests not required), 9 Declaration of Use (DoU) and 76 TUEs in 2009, and 39 DoU and 29 TUEs in 2010. Spirometry was performed in 87% and 37% of athletes in 2009 and 2010, respectively; the corresponding figures for bronchoprovocation were 59% and 16%, almost all positive in both years.
  
  
  CONCLUSIONS
  Applications for inhaler use have decreased by approximately half since objective asthma testing became mandatory. Our findings show that WADA guidelines have an impact on asthmatic athletes care: In 2009 a more rigorous screening was possible, leading to withdrawal of unnecessary medication. Constant changes, however, jeopardize this achievement and nowadays introduce safety issues stemming from the unsupervised use of inhaled β2-agonists.
authors.affiliation: Allergy, Asthma & Sports Unit, Immunoallergology Department, Centro Hospitalar São João E.P.E., Porto, Portugal. marianafercouto@gmail.com
authors.forename: Mariana
authors.initials: M
authors.lastname: Couto
authors.forename: Luís
authors.initials: L
authors.lastname: Horta
authors.forename: Luís
authors.initials: L
authors.lastname: Delgado
authors.forename: Miguel
authors.initials: M
authors.lastname: Capão-Filipe
authors.forename: André
authors.initials: A
authors.lastname: Moreira
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D056352:Athletes / Q000706:statistics & numerical data; D004300:Doping in Sports / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D004335:Drug and Narcotic Control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents