Impact of changes in anti-doping regulations (WADA Guidelines) on asthma care in athletes.

OBJECTIVE

To investigate how changes to the World Anti-Doping Agency (WADA) guidelines on asthma medication requests have impacted the management of asthmatic athletes in Portugal.

DESIGN

Retrospective analysis of asthma medication requests submitted in 2008 to 2010.

SETTING

Portuguese Anti-Doping Authority database.

PARTICIPANTS

Athletes requesting the use of inhaled corticosteroids and/or β2-agonists.

INDEPENDENT VARIABLES

Demographic, therapeutic, and diagnostic test data.

MAIN OUTCOME MEASURES

Yearly changes in number of asthma medication requests and diagnostic procedures.

RESULTS

We analyzed 326 requests: 173 abbreviated Therapeutic Use Exemptions (TUEs) in 2008 (objective tests not required), 9 Declaration of Use (DoU) and 76 TUEs in 2009, and 39 DoU and 29 TUEs in 2010. Spirometry was performed in 87% and 37% of athletes in 2009 and 2010, respectively; the corresponding figures for bronchoprovocation were 59% and 16%, almost all positive in both years.

CONCLUSIONS

Applications for inhaler use have decreased by approximately half since objective asthma testing became mandatory. Our findings show that WADA guidelines have an impact on asthmatic athletes care: In 2009 a more rigorous screening was possible, leading to withdrawal of unnecessary medication. Constant changes, however, jeopardize this achievement and nowadays introduce safety issues stemming from the unsupervised use of inhaled β2-agonists.