Asthma is characterized by the chronic inflammation of the airways or bronchial tubes. This inflammation causes the narrowing of the airways resulting in difficulties in breathing. This process is known as constriction. Asthmatic individuals tend to have a heightened sensitivity to allergens and irritants compared to the normal population. Therefore, it is important to note that the degree of this hypersensitivity varies from person to person. One can then assume that both the type and dose of asthma medications may have different effects on different patients. This is why some individuals taking asthma medications may have had a positive drug screen.
Elevated Risk of Asthma
Asthma is a highly prevalent condition within the general population, and asthma in athletics even is more prevalent. In fact, 80% of endurance sports athletes and 20% of power or speed sports athletes suffer from a form of asthma. In these athletes, the airway diameter is significantly reduced making them hypersensitive to even small changes within their environment, such as the presence of an allergen. Furthermore, even non-asthmatic athletes suffer from some form of airway inflammation.
It is important to note that both the type of sport and the environmental conditions surrounding the sport influence the prevalence of asthma in athletes. For example, swimmers can experience airway inflammation in response to chlorine-related allergens, as well as damage to the airways due to intense breathing. While asthma can significantly reduce an athlete’s performance, many asthmatics successfully compete in international competitions such as the Olympics.
Keeping Asthma Under Control
The best means that symptoms of asthma in athletics can be controlled and athletes can enhance their performance is via the use of medications. Asthma therapies generally focus on:
- Controlling inflammation and preventing symptoms (coughing or breathlessness)
- Treating asthma attacks when they occur
- Avoiding asthma triggers
- Monitoring daily asthma symptoms by using a diary
- Monitoring airflow via with asthma tests
There are two commonly used asthma medications:
Anti-inflammatory drugs. These drugs are normally steroid based and are used to prevent asthma attacks on an ongoing basis. These steroid medications reduce swelling and mucus production in the airways. This makes the airways less sensitive to irritants and/or allergens and less likely to react to triggers.
Bronchodilators. These medications alleviate the symptoms of asthma acting on the muscles within the airways as well as by reducing airway mucus. They act by relaxing these muscles and thus reducing airway constriction. This rapidly opens the airways, lets air into the lungs and improves breathing.
While asthma medications can significantly improve an asthmatic athlete’s performance by improving their breathing, these drugs can also be associated with a positive drug screen. Moreover, certain asthma medications have been shown to be associated with a false positive drug screen for amphetamines, as well as ecstasy. Since these drugs are known to enhance athletic performance, international competitions have specific regulations on their use.
Recommendations for Athma Treatment for Athletics
In Olympic athletes, the prevention of exercise-induced bronchoconstriction will help maximize sport performance, but athletes must comply with regulations of the International Olympic Committee and the World Anti-Doping Agency for the use of all medications. The presence of asthmatic symptoms must be confirmed and diagnosed in an objective manner by a physician.
Current recommendations indicate that asthma in highly trained athletes should be managed according to existing general national and international asthma management guidelines. These guidelines state that:
- Athletes are prohibited to take certain medications. All glucocorticosteriods are permitted, where as all beta-2 agonists are prohibited except inhaled salbutamol and salmeterol. However, if the medication is present at excessive levels within the athlete’s urine, it is presumed not to be a therapeutic use and is considered as a positive drug test
- Athletes are only permitted to take inhaled medications. However, athletes with severe symptoms may take oral or intravenous medications upon permission of the governing body
- Medication should be used with an appropriate frequency. All athletes should be treated with the lowest effective dose possible. Medications should not be taken more frequent and/or at a higher dose than prescribed by a physician.
- Athletes are only permitted to take medications for their prescribed duration.
Severe sanctions for violation of these regulations have been implemented. These sanctions include removal of a won medal, suspensions from competition and even complete expulsion from international competition. Therefore, it is very important that all athletes taking asthma medications report their use and asthmatic symptoms to the governing bodies to avoid a positive drug screen.
World Anti-Doping Agency - https://www.wada-ama.org/
Nathional Heart Lung and Blood Institute - https://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html
International Olympic Commitee - https://www.olympic.org/
The Merck Manuals - https://www.merck.com/mmpe/sec05/ch048/ch048a.html