Asthma Advice

Asthma & Doping Control

Swimming is a sport at which asthmatics can and often do excel. One in seven children and one in 25 adults suffer from asthma in Great Britain, but this shouldn’t stop them from becoming good swimmers. Swimmers can help prevent attacks by using inhalers. Below is advice on how inhaler use ties in with anti-doping measures.

There are two types of medication to treat asthma – relievers and preventers. Both are inhalers and they are colour-coded to help with identification.

Relievers

These inhalers are colour-coded. Blue, for example, is salbutamol (Ventolin). They work to open up the airways and are also known as bronchodilators (or beta 2 agonists). These are mostly used after symptoms appear, but sometimes give brief protection against triggers such as exercise if they are taken before they appear.

For sport, the blue inhaler can be used to prevent attacks if you suspect that training will cause one. This should be used around 15 minutes before training, such as on arrival at the pool. The effects last two to three hours so there should not be any need for repeated use of the inhaler during the session.

It is important NOT to exceed the maximum dose of two puffs four times daily, except in an emergency, as high levels may trigger a positive Doping Control test.

Preventers

If taken regularly these can prevent an asthma attack occurring. They protect the lining of the airways and make them less likely to narrow when triggered. There are two main types:

• Steroid based inhalers – colour-coded brown, such as beclomethasone (Becotide)
• Cell membrane stabilisers – colour-coded white, such as sodium cromoglycate (Intal)

These should NOT be used for treating an acute attack as they don’t bring immediate relief. They can take up to 14 days to be fully effective when taken regularly.

Sodium cromoglycate can be helpful if there is a strong allergic component to the asthma. Other long-acting inhalers and oral tablets form a second line treatment if the above do not adequately control the condition.

The current treatment of asthma follows guidelines as laid down by the British Thoracic Association. They take the form of a step care plan, now known as the British Guidelines for the Management of Asthma.

This involves stepping up the level of treatment until satisfactory control is achieved. It is important not to over-treat and stepping down is important if the asthma is well controlled.

Inhalers & Doping

As mentioned above, overusing inhalers may trigger anti-doping alarm bells. However, the reliever inhalers such as salbutamol (Ventolin) and terbutaline (Bricanyl) are permitted substances under ASA and FINA law, as are the common steroid preventer inhalers such as beclomethasone (Becotide), budenoside (Pulmicort) and fluticasone (Flixotide).

The preventer inhaler sodium cromoglycate (Intal) can be used legally, as can the more recently introduced oral leukotrine antagonists, such as montelukast (Singulair), and the longer lasting bronchodilator inhaler salmeterol (Serevent).

However, for the competitive swimmer salbutamol tablets are NOT permitted and the older inhalers (although very rarely used these days) such as isoprenaline, ephedrine, orciprenaline are banned. Sometimes a short course of oral corticosteroid drugs is necessary to bring the asthma under control. If this is the case, the swimmer must not compete until at least two weeks after the course has finished or they may test positive if subjected to Doping Control. For those in international and domestic squads, a Standard Therapeutic Use Exemption is required before taking this medication.

The reason why declaration of asthma is essential is that the beta agonists and steroids drugs may enhance performance – by stimulatory and anabolic effects on the body – if used by an athlete without asthma. When tested at doping control you must declare the asthma medication you are taking. Never let another swimmer use your inhaler for fun.

Swimmers on international and domestic squads will require an Abbreviated Therapeutic Use Exemption in order to take approved medications.

Swimmers attending ASA or British Swimming national events, such as British Gas National Age Groups, must declare inhaler use to the ASA together with the details of the medication that they are taking using the Medical Declaration Form. This is essential to avoid falling foul of Doping Control regulations. The notification must be done on an annual basis and returned to the ASA membership team. Any subsequent changes in medication should also be notified.

Remember: it is your responsibility as a swimmer to keep the ASA informed.