Naranjo Orellana, J., Centeno Prada, R. A., & Carranza Ma'rquez, M. D. (2006). Use of b2 agonists in sport: Are the present criteria right? British Journal of Sports Medicine, 40, 363-366.

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Regulations for doping control prohibit the use of b2 agonist bronchodilators (salbutamol, salmeterol, formoterol, and terbutaline) unless the athlete follows the procedure known as abbreviated therapeutic use exemption (ATUE). This study evaluated how the interest in discovering possible cheats may result in damage to athletes who really need bronchodilator treatment.

High level athletes (M = 18; F = 13) with a previous diagnosis of asthma were examined in order to obtain an ATUE for b2 agonists. Ss underwent spirometry at rest. If the results were normal, Ss underwent an effort test and, if negative, a methacholine test inhaling progressive doses of methacholine until a fall of 20% in forced expiratory volume in one second (FEV1) was achieved. The international anti-doping regulations require that the fall in FEV1 occurs with a concentration of methacholine (PC20) lower than 2 mg/ml (4 mg/ml for Torino 2006). In clinical practice, a test is positive if the response occurs with a PC20 lower than 8 mg/ml.

Only one subject met the criterion for the bronchodilation test at rest. The remaining Ss underwent an effort test, which was positive in 9 of the 30 Ss. In 21 cases (M = 13; F = 8) the effort test was negative so a methacholine test was carried out. Seven (33%) Ss were negative for ATUE with a PC20 higher than 8 mg/ml, seven (33%) were positive for ATUE with a PC20 less than 2 mg/ml, in four (19%) Ss the PC20 was 24 mg/ml, and in three (14%) Ss it was 48 mg/ml.

Implication. Acknowledging that strict vigilance of fair play should be pursued, the current level of control can lead to situations of inequality for asthmatic athletes. In this study, one third of asthmatic athletes cannot be treated with b2 agonists, which is contrary to accepted medical treatment. Under the current regulations, asthmatic athletes are often denied the most effective therapeutic option which contravenes the concept of "fair play". [It should be noted that recent research findings have demonstrated that salbutamol is not performance enhancing.]

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