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Impact of Changes in Anti-doping Regulations (WADA Guidelines) on Asthma Care in Athletes

Couto, Mariana MD*,†; Horta, Luís MD, PhD; Delgado, Luís MD, PhD*,†; Capão-Filipe, Miguel MD*,§; Moreira, André MD, PhD*,†

Clinical Journal of Sport Medicine: January 2013 - Volume 23 - Issue 1 - p 74–76
doi: 10.1097/JSM.0b013e31826869ef
Brief Report

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 (

The authors report no financial or conflicts of interest.

Received January 8, 2012

Accepted July 5, 2012

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