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Elite athletes taking asthma medication - why?

The WADA leaks rumble on and it's not over yet. In the meantime we now know that more Elite athletes are using asthma medication

Revelations that Bradley Wiggins had TUE's for a number of drugs for asthma and breathing problems has come under an increasing spotlight, with both Wiggins and Brailsford defending themselves in the media.

Wiggins is just one of a number of athletes to be named by the hacking group Fancy Bears, which has been leaking certification for theraputic use exemptions (TUE) for banned substances granted by the World Anti Doping-Agency (WADA).

But asthma until recently was not a condition widely associated  with elite althletes. The WADA leaks being revealed by Fancy Bears is leading to suspicion about the drugs being administered.

A 2014 study carried out by Dr John Dickinson, a leading expert on asthma in sport at the University of Kent, found that members of Team Sky – the British cycling squad – were three times as likely to suffer from the condition than the wider population, while 70% of swimmers tested suffered from forms of asthma.

Research carried out by Dr Dickinson suggested sports with a sustained "high-minute ventilations" or heavy breathing were among those affected.

Asthma attacks can be triggered by exercise as exertion cauyses the athete to breathe faster. The changes to the humidity and temperature of air caused by this can lead to a narrowing of the airwaves in asthma sufferers who are more sensitive to this.

Exercise-induced asthma, can cause inflammation and the production of mucus in the airwaves. Symptoms are only experienced during exercise, and not at other times. These symptoms are usually most intense after exercising, the treatment is, however, the same.

Inhalers

Dr Dickinson said: "There is a lack of education on why athletes develop asthma. People do not understand that medicating against it helps them to compete on an equal playing field, but doesn't increase their advantage."

Dickinson said: "At a higher level, people need to be educated so that they understand that asthma medication doesn't give you super lungs. Does an athlete using an inhaler have an advantage, based on research, the answer is probably no."

Injections

The issue, says Dickinson, is where athletes take supertherapeutic doses, begging the question as to whether or not they should be competing in the first place?

Wiggins was prescribed Triamcinolone acetonide (Kenacort), which is a known as a corticosteroid hormone (glucocorticoid). It works by decreasing the body's immune response to these diseases and reduces symptoms such as swelling. This is given by injecting into different locations such as a muscle or joint. 

South African exercise physiologist Dr. Jeroen Swart recently stated in an interview "The benefits of corticosteroids are documented. Not only in peer-reviewed scientific manuscripts that have demonstrated statistically-significant performance enhancing effects of corticosteroids in endurance sport."

"We have also got the testimony from a large number of riders, ex professionals. David Millar’s testimony in his book. Armstrong admitted to the use of corticosteroids."

"The use of corticosteroids as a performance-enhancer in cycling is, from an anecdotal perspective, is very well founded and from a performance perspective in science in competition, definitely evidence is there."

"So you are taking a long-acting corticosteroid just before a Grand Tour, you may gain a performance benefit out of it."

David Millar recently shared his experience of Kenacort asking for it to be banned “You would do all the training but my weight would stick,” he said, referencing his own use of EPO and testosterone patches. “But if I took Kenacort, 1.5-2kgs would drop off in like a week. And not only would the weight drop off I would feel stronger.

“If you are non-asthmatic and you take Ventolin it’s not going to give you any advantage. But if you take Kenacort it’s not only going to make a sick person better, it’s going to make a sick person better than a healthy person. That’s a very grey area."

“I’m sure there are other forms of cortisone that could be used for allergies which aren’t so potent or performance-enhancing.” He added: “We [athletes] shouldn’t have to face this. If it’s that strong we shouldn’t be allowed to take it unless there is a serious issue."

“And if we’re suffering from that serious an issue, we shouldn’t be racing. I don’t know how a doctor could prescribe it before a race. I can’t fathom it.”

In Wiggins's case, having consulted with team doctor Richard Freeman, he went to see an ENT specialist, Simon Hargreaves, a Consultant Otolaryngologist in Bolton, who recommended injectable triamcinolone. Team Sky then applied to the UCI whose race doctor Mario Zorzoli signed off on the drug, in accordance with guidelines from the World Anti-Doping Agency.

There is no suggestion of wrongdoing by Wiggins or anyone involved in his applications for TUEs and no rules were broken at the time.

Elite athletes taking asthma medication - why?