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.
*Allergy, Asthma & Sports Unit, Immunoallergology Department, Centro Hospitalar São João E.P.E., Porto, Portugal
†Immunology Laboratory, Faculty of Medicine, University of Porto, Porto, Portugal
‡Anti-Doping Authority of Portugal, Lisbon, Portugal
§Internal Medicine Department, Baixo-Vouga Hospital Center, Aveiro, Portugal.
Correspondence Author: Mariana Couto, MD, Serviço de Imunoalergologia, Centro Hospitalar São João, EPE, Alameda Prof. Hernâni Monteiro 4200-319 Porto, Portugal (firstname.lastname@example.org).
The authors report no financial or conflicts of interest.
Received January 8, 2012
Accepted July 5, 2012