Recent major advances in pharmacological management have provided asthmatics with a satisfactory range of drugs to control asthma. These include sodium cromoglycate (cromolyn sodium), H1-antagonists, belladonna alkaloids, methyl xanthines, glucocorticoids and beta 2-adrenoceptor stimulants. Despite the tendency for most asthmatics to develop bronchoconstriction after exercise, sport and physical activity are now accepted as valuable in the overall management of patients with asthma. Thus, control of exercise-induced asthma (EIA) is essential, if asthmatics are to participate safely in physical activity and without respiratory disadvantage in competitive sport. Fortunately, inhibition or minimization of exercise-induced asthma may be achieved in most asthmatics by pre-exercise aerosol beta 2-agonists supplemented if necessary by sodium cromoglycate and/or theophylline. Regular medication as required to attain and maintain normal ventilatory function throughout each day is the objective in all patients with asthma and appears to be a prerequisiste to control exercise-induced asthma. The introduction of anti-doping controls into high performance sport has presented added difficulties for the asthmatic athlete. Although not always so, currently all of the classes of drugs previously noted are acceptable for the treatment of asthma and exercise-induced asthma. Anomalies may exist in the banning of 2 beta 2-adrenoceptor agonists, fenoterol and orciprenaline (metaproterenol). All sympathomimetic amines with alpha- or predominantly beta-stimulation are banned. The perpetuation of the need to report the use of beta 2-agonists prior to competition appears unnecessary. Although relatively little specific research has been undertaken, there is minimal evidence to suggest that asthmatics can derive any additional ergogenic advantage from medication to control asthma and exercise-induced asthma. beta 2-agonists, sodium cromoglycate and glucocorticoids administered by the aerosol route are not considered to be ergogenic. Some doubts have been raised concerning theophylline and its enhancement of both cardiac and respiratory muscle function. Investigations as to the validity of the suggestion that theophylline could augment physical performance appear warranted. It is reported that some athletes may be unnecessarily taking oral and perhaps parenteral glucocorticoids to obtain certain side effects. Any decision to ban these agents except for aerosol or local use could be supported.
