Anti-doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations

Abstract

Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. Pharmacological inhaler therapy currently forms the mainstay of treatment; however, for elite athletes competing under the constraints of the World Anti-Doping Code (Code), a number of established therapies are prohibited both in and/or out of competition and/or have a maximum permitted dose. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma.

Beta2‐adrenergic agonists can enhance intense performance and muscle strength in healthy individuals

“…These regulations are in place to lessen the burdens associated with TUE applications and to ensure that athletes with asthma and exerciseinduced bronchoconstriction are able to compete without fear of committing an anti-doping rule violation (ADRV). 5,6 When discussing the potential advantages of drugs included on the Prohibited List, it is important to consider the multiple effects that may constitute a competitive advantage. Beta 2 -agonists have the potential to enhance anaerobic-dominated performances when used at high doses.…”

β2‐adrenergic agonists and doping: Where do we stand?

“…So, it is advisable for professional athletes with asthma and/or bronchial hyperreactivity to apply for a therapeutic use exemption (TUE). 9 As our article was proposed to be written as a letter to the editor, the authors had a series of limitations (namely concerning the number of words) that conditioned the discussion of some topics, such as these proposed by Hostrup.…”

Annual banned‐substance review – Analytical approaches in human sports drug testing

“…The latter group needs to consider applicable antidoping rules, which are multifaceted and, depending on the substance in question and the route of administration, stipulate different regulations concerning the necessity of a therapeutic use exemption or the allowed maximum daily dosages. Adequate therapies for athletes have to be guaranteed, and several groups have identified the need for guidance concerning appropriate diagnostics and subsequent treatment whilst respecting boundaries resulting from antidoping rules, arising from the suspected, purported, and/or proven misuse of β 2 ‐agonists in sports . The fact that β 2 ‐agonists such as terbutaline can significantly affect the athlete's body composition was demonstrated by Jessen et al, who conducted a placebo‐controlled study with a “sedentary lifestyle” cohort, a resistance‐training cohort, and an endurance‐training cohort .…”