Naranjo Orellana J, Centeno Prada R A, Carranza Márquez M D
Centro Andaluz de Medicina del Deporte, Sevilla, Spain.
Br J Sports Med. 2006 Apr;40(4):363-6; discussion 366. doi: 10.1136/bjsm.2005.024513.
The regulations for doping control prohibit the use of beta2 agonist bronchodilators (salbutamol, salmeterol, formoterol, and terbutaline) unless the subject follows the procedure known as abbreviated therapeutic use exemption (ATUE).
To highlight how the interest in discovering possible cheats may result in damage to athletes who really need bronchodilator treatment.
Thirty one high level athletes (18 men and 13 women) with a previous diagnosis of asthma were examined in our laboratory in order to obtain an ATUE for beta2 agonists. All the subjects underwent spirometry at rest. If the results were normal, the subjects 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 30 athletes underwent an effort test, which was positive in nine of them. In 21 cases (13 men and 8 women) the effort test was negative so a methacholine test was carried out. Seven (33%) 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%) the PC20 was 2-4 mg/ml, and in three (14%) it was 4-8 mg/ml.
Strict vigilance of fair play should be pursued, but excessive control can lead to situations of inequality for asthmatic athletes such that a third of athletes cannot be treated with beta2 agonists. Therefore under current regulations, asthmatic athletes are often denied the most effective therapeutic option.
兴奋剂控制规定禁止使用β2激动剂支气管扩张剂（沙丁胺醇、沙美特罗、福莫特罗和特布他林），除非受试者遵循被称为简化治疗用药豁免（ATUE）的程序。
强调对发现可能作弊行为的关注如何可能对真正需要支气管扩张剂治疗的运动员造成损害。
31名先前被诊断患有哮喘的高水平运动员（18名男性和13名女性）在我们实验室接受检查，以获得β2激动剂的ATUE。所有受试者均进行静息肺量测定。如果结果正常，受试者进行运动试验，如果运动试验结果为阴性，则进行乙酰甲胆碱试验，吸入递增剂量的乙酰甲胆碱，直至一秒用力呼气量（FEV1）下降20%。国际反兴奋剂规定要求FEV1下降时乙酰甲胆碱浓度（PC20）低于2毫克/毫升（2006年都灵冬奥会为4毫克/毫升）。在临床实践中，如果PC20低于8毫克/毫升时出现反应，则试验为阳性。
只有一名受试者符合静息支气管扩张试验标准。其余30名运动员进行了运动试验，其中9人运动试验结果为阳性。在21例（13名男性和8名女性）中运动试验结果为阴性，因此进行了乙酰甲胆碱试验。7例（33%）ATUE为阴性，PC20高于8毫克/毫升；7例（33%）ATUE为阳性，PC20低于2毫克/毫升；4例（19%）PC20为2 - 4毫克/毫升；3例（14%）PC20为4 - 8毫克/毫升。
应严格秉持公平竞赛原则，但过度管控可能导致哮喘运动员面临不平等状况，致使三分之一的运动员无法使用β2激动剂进行治疗。因此，根据现行规定，哮喘运动员常常被剥夺了最有效的治疗选择。
