It appears that corticoids (prednisolone and
metilprednisolone) are the drugs of choice for triathletes: Schoemen and Barraza were positive for these
drugs. The effect on recovery is well
known and the drug disappears in 72 hours when taking it orally and a little
longer when giving as a depo. It is a well-known
drug to control and to administer. Lance
Armstrong always said that it was a corticoid cream that he used regularly for
saddle sores but now the TUE is for asthma.
Let see what the experts say about treating asthma:
Treatment: current guidelines
The treatment of EIA and of asthma in athletes should follow the same
international guidelines as for the individual with general asthmatic symptoms.
In all international guidelines for treating asthma in children and adults, a
major aim of the treatment is to master EIA, as physical activity is seen as
very important for the development and growth of children and for the
self-perception. Fitness was found to correlate with psychological functioning
in children with asthma (11). Considering
that inflammation is the final result of the osmolar and vascular modifications
described, anti-inflammatory
treatment through inhaled steroids is often effective and sufficient to achieve
a good EIA/EIB control (93). It should be noted that ICSs are the only anti-inflammatory
drugs that improve respiratory epithelial healing (107). ICSs reduce the damage induced
by repeated training and competitions, as we have seen for the phenotype of the
‘athlete's asthma’, enabling the athletes to master their sports and improving
the long-term prognosis (10). However, a study in cross-country skiers showed no
benefit from budesonide 800 µg/day during 3 months of treatment (108).
Inhaled short-acting β2-agonists are frequently needed and strongly
suggested as pre-treatment before competition. If insufficient, long-acting β2-agonists
(LABAs) and leukotriene antagonists may be added. Ipratropium bromide can be
tried in addition to other treatments and after individual assessment (see flow
chart in Fig. 1) (109). Based on the
finding of increased parasympathetic tone in endurance athletes (110), the
contribution of increased parasympathetic activity in the development of asthma
in athletes would suggest a speculation for the role of inhaled ipratropium
bromide or tiotropium in the treatment of asthma in athletes (15).
Simplified flow-chart for EIA treatment.
It is important to underline some concerns raised about tolerance of
regular use of β2-agonists in
EIA/EIB. First, there is a significant minority (15–20%) of asthmatics whose
EIA is not prevented by β2-agonists, even
when ICSs are used concomitantly; second, β2-agonists long-term regular use induces tolerance,
with a decline in duration of the protective effect with their daily use, and
lacks of sufficient safety data (111, 112). In addition,
a recent report raised attention on a potential loss of bronchoprotection for
athletes using LABAs, independent from the Arg16Gly polymorphisms that may
affect the efficacy of these medications (113).
Non-pharmacological measures are also of importance: nasal breathing and
pre-exercise warm-ups (15–30 sec exertions alternate with 60–90 sec rest)
followed by a warm-down segment are suggested (114), together
with anti-cold masks for cold environments.
Anti-doping: current regulations
For many years, the WADA issued strict regulations for the use of asthma
drugs in sports. Initially, one feared that these drugs might improve
performance, but after several studies on maximum performance in healthy
subjects after inhaled β2-agonists, both
short- and long-acting, it is generally accepted that inhaled steroids and
inhaled β2-agonists do
not improve performance. In a recent study combining three β2-agonists
(salbutamol, formoterol, and salmeterol) all in WADA permitted doses, small but
significant improvements could be seen in isometric quadriceps contraction and
swim ergometric sprint performance. However, swim performance in an exhaustive
race of 110 m did not improve (115). Since 1
January 2012, all ICSs have not been on the prohibited list, as well as the
inhaled β2-agonists
salbutamol, salmeterol, and formoterol. At present, there are no restrictions
for the use of inhaled steroids; inhaled ipratropium bromide; leukotriene
antagonists; and the inhaled β2-agonists salbutamol, salmeterol, and formoterol.
Still, inhaled terbutaline is restricted in competitive sports, and objective
measurements of AHR, EIB, or bronchodilator reversibility must be documented
for approval of its use. Oral
corticosteroids and oral or intravenous β2-agonists
are prohibited. The list of prohibited drugs is usually updated every year and
can be found on the WADA website (www.wada-ama.org).
Metilprednisolone or prednisolone do not come as
inhalers. As it is said above, oral corticosteroids are prohibited and should
be used for real emergencies according to above protocol.
Systemic glucocorticoids: The systemic use (e.g. oral
or intravenous administration) of glucocorticoids is prohibited incompetition
only and requires a TUE if the athlete competes before the drug has ceased to
be identifiable in his/her urine. In emergency situations, a retroactive TUE
application should be submitted as soon as possible to the appropriate
anti-doping organization if the athlete intends to compete while taking the
systemic GC or soon afterwards.
We can take a look at a study done in Portugal. It is clear that the political treatments of
these violations are not the right ones from the doping stand point. There is very little correlation between oral
steroid and triathlon. If you are so ill
that need steroids orally, please do not do triathlon as a professional.
