The Use of Anti-Asthmatic Drugs

Abstract

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.

No variation of physical performance and perceived exertion after adrenal gland stimulation by synthetic ACTH (Synacthen®) in cyclists

“…Glucocorticoids are primarily used for their anti-inXammatory (Rook 1999) and analgesic properties in order to decrease pain and increase feelings of well-being (Bogdanov and Yarushkina 2004). Glucocorticoids are also becoming more popular for the treatment of acute and chronic asthmatic symptoms (Fitch 1986). Due to the higher physical exertion, pain and incidence of injuries in some sports, glucocorticoids have also been widely used for improving performance since the 1960s (Dvorak et al 2006;Nichols 2005).…”

Specific probiotics in elite athlete injuries: indication for usage

“…Drugs such as sodium cromoglycate, H1-antagonists, belladonna alkaloids, methyl xanthines, glucocorticoids and beta 2-adrenoceptor stimulants are choices for treatment ("Asthma. A summary of first-choice treatments", 2016; Fitch, 1986), however athletes in sporting competitions have restrictive treatment possibilities, considering the Prohibited List presented by the World Anti-Doping Agency (WADA) ("WADA publishes 2016 Prohibited List (29 September 2015)", 2015). Drugs such as beta2 agonist bronchodilators, salbutamol, formoterol, salmeterol (Kalsen, Hostrup, Bangsbo, & Backer, 2014;Pillard et al, 2015) have controlled use in treatment, while terbutaline and all glucocorticoids such as budesonide (Kaliszewski et al, 2016) are prohibited for use.…”

Exercise-Induced Asthma Symptoms and Nighttime Asthma: Are They Similar to AHR?

“…Physical activity is an important release of asthma symptoms, revealing exercise-induced bronchoconstriction [3, 4], which is widely believed to be related to either airway inflammation [3] or smooth muscle dysfunction [5–8]. The primary treatment strategy in airway inflammation should be inhaled steroid [9]; whereas smooth muscle dysfunction should be treated primarily with inhaled beta-agonist [6].…”