Overuse of Short-Acting Beta-2 Agonists (SABAs) in Elite Athletes: Hypotheses to Explain It

Abstract

The use of short-acting beta-2 agonists (SABAs) is more common in elite athletes than in the general population, especially in endurance sports. The World Anti-Doping Code places some restrictions on prescribing inhaled β2-agonists. These drugs are used in respiratory diseases (such as asthma) that might reduce athletes’ performances. Recently, studies based on the results of the Olympic Games revealed that athletes with confirmed asthma/airway hyperresponsiveness (AHR) or exercise-induced bronchoconstriction (EIB) outperformed their non-asthmatic rivals. This overuse of SABA by high-level athletes, therefore, raises some questions, and many explanatory hypotheses are proposed. Asthma and EIB have a high prevalence in elite athletes, especially within endurance sports. It appears that many years of intensive endurance training can provoke airway injury, EIB, and asthma in athletes without any past history of respiratory diseases. Some sports lead to a higher risk of asthma than others due to the hyperventilation required over long periods of time and/or the high environmental exposure while performing the sport (for example swimming and the associated chlorine exposure). Inhaled corticosteroids (ICS) have a low efficacy in the treatment of asthma and EIB in elite athletes, leading to a much greater use of SABAs. A significant proportion of these high-level athletes suffer from non-allergic asthma, involving the th1-th17 pathway.

Fatores fisiopatológicos, benefícios e recomendações na natação para asmático

“…Health guidelines suggest practicing sports for anyone with a chronic disease, when it is controlled and by medical clearance. Regular practice helps people with these diseases to maintain a better quality of life (VERTADIER et al, 2022).…”

“…French researchers warn that, specifically in swimming athletes, there may be a greater risk of having asthma than those who practice other sports due to the hyperventilation necessary for long periods of time and/or the high environmental exposure to chlorine during the practice of the sport (VERTADIER et al, 2022).…”

Annual banned‐substance review—Analytical approaches in human sports drug testing 2021/2022–

“…On the one hand, an overuse particularly of short-acting β 2 -agonists among elite endurance athletes was debated, and the fact that those athletes with therapeutic use exemptions (TUEs) for confirmed asthma or airway hyperresponsiveness frequently outperformed their non-asthmatic competitors was scrutinized. 112 On the other hand, maintaining respiratory health while protecting the integrity of sport is of utmost importance, which is why selected β 2 -agonists are permitted when used within defined maximum allowed daily dose. Model-based metaanalyses concerning the pharmacokinetics of salbutamol corroborated the appropriateness of these limits, whereas adjustments regarding permissive dosages were discussed, 113 fueled also by a recent study indicating a potential performance-enhancing effect of inhaled salbutamol at allowed dosages (i.e., 800 μg via inhalation).…”

“…The use of β 2 ‐agonists in the context of asthma medication has required distinct considerations in anti‐doping. On the one hand, an overuse particularly of short‐acting β 2 ‐agonists among elite endurance athletes was debated, and the fact that those athletes with therapeutic use exemptions (TUEs) for confirmed asthma or airway hyperresponsiveness frequently outperformed their non‐asthmatic competitors was scrutinized 112 . On the other hand, maintaining respiratory health while protecting the integrity of sport is of utmost importance, which is why selected β 2 ‐agonists are permitted when used within defined maximum allowed daily dose.…”

Ionic liquid wrapped Co3O4 embedded N doped porous carbon for the precise monitoring of salbutamol in urine samples for dope tests

“…b2-agonists are a class of medication used to treat various diseases including asthma, exercise-induced bronchoconstriction and chronic obstructive pulmonary disease. 1,2 However, in the past, some athletes have misused them as performanceenhancing drugs because they enable increased oxygen uptake, thus improving their performance. 3 Therefore, the use of such b2-agonists are strictly regulated and controlled by anti-doping authorities to ensure fair competition in sports.…”