Triathlon and Postmodern Era: Doping II

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).

Fig. 1

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.

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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.

https://www.wada-ama.org/sites/default/files/tpg_-_asthma_-_version_6.0_-_december_2017.pdf

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.