Athletes suffer from a high prevalence of respiratory disorders. Asthma and exercise-induced bronchoconstriction (EIB), particularly, are very commonly found in endurance sport athletes, and generally require a specific medication. Short-acting inhaled β2-agonists taken as prevention or after exercise remain the preferred treatment to reverse EIB or asthma in athletes. Inhaled β2-agonists may be accompanied by inhaled corticosteroids, themselves potentially taken with long-acting Beta2-agonists. High dose of β2-agonists has been suggested to play a role on some variables of performance, dividing the scientific community on its use in sport. In this symposium, we will explore the various respiratory issues experienced by athletes, to clarify when the medication is required and when it is not. We will then present the various β2-agonists used by athletes, and their impact on the reversibility of EIB. Finally, the most recent knowledge in the literature will be discussed regarding the potential ergogenic effects of β2-agonists on performance. By the end of the session, delegates will know how to systematically review an athlete for respiratory conditions, understand when athletes with asthma/EIB may benefit from inhaled β2-agonists, understand the current Anti-Doping rules on the permitted use of inhaled β2-agonists and understand when the use of β2-agonists may lead to ergogenic action.
ECSS Paris 2023: IS-MH06
Exercise respiratory symptoms such as tight chest, cough, mucus production and difficulty in breathing are the most common symptoms reported by athletes. The problem for a practitioner supporting an athlete with respiratory symptoms, is that the symptoms are not exclusive to one condition. Excluding cardiovascular disease and fitness status, five respiratory issues are the most common cause of respiratory symptoms. The five issues are asthma/EIB, rhinitis, allergy, breathing pattern disorder (BPD) and exercise induced laryngeal obstruction (EILO). This presentation will discuss how practitioners can systematically assess an athlete to provide a profile of their respiratory function and identify whether they may have any of the five main respiratory issues. The presentation will then discuss an overview of best therapy and management to best support for an athlete to maintain and optimise their respiratory function. An athlete who can optimise the management of their respiratory symptoms is able to maintain respiratory health and compete on a level playing field against athletes who do not have respiratory symptoms. A key focus of the will be on how to differentiate between asthma/EIB, BPD and EILO. In particular, BPD and EILO and are frequently mis-diagnosed as asthma/EIB. An accurate diagnosis is crucial as BPD, EILO will not respond to asthma therapy such as inhaled β2-agonists. A different approach including breathing pattern training, education and anxiety management is required. This approach will highlight to delegates the steps that can be taken to minimise the inappropriate use of asthma therapy, such as inhaled β2-agonists.
Read CV John DickinsonECSS Paris 2023: IS-MH06
Among the previously cited lower airway disease, exercise-induced bronchoconstriction (EIB) and asthma are the two conditions that may require the use of bronchodilators (e.g. inhaled β2-agonists) and/or inhaled corticosteroids to prevent or reverse bronchoconstriction/asthma crisis in athletes. We will talk here about these medications taken in therapeutic doses. Various bronchodilators, generally short-acting β2-adrenergic agonists (SABA), but also long-acting β2-agonists (LABA) combined with an inhaled corticosteroids are generally prescribed to treat EIB/asthma. They cause a rapid relaxation of airway smooth muscle and act rapidly on respiratory symptoms. SABA, especially Salbutamol, remain the most used drugs to treat asthma or EIB in athletes. An overview of the different β2-agonists used and authorized in the sports world to treat asthma/EIB and their efficacy on respiratory symptoms, lung function, and disease control, when taken alone or in combination with another treatment will be discussed. Their effect on various aspects of performance at therapeutic doses will also be reviewed as well as on the physiopathology of EIB. It is to note that asthma remains a rare but important cause of sudden death in young athletes. Up to now, no evidence of overuse of SABA/LABA has been observed in elite athletes, compared with the general population. However, (1) there is no real gold standard for diagnosing EIB but a range of tests that probably measure different aspects of the effects of exercise on the bronchi; (2) In a great majority of athletes EIB is mild to moderate, sometimes without any symptom. Based on these two points, we will question the necessity of using especially β2-agonists in all athletes diagnosed by a laboratory-based bronchial test. Finally, the talk will end on the on future research needs in the area of EIB management.
Read CV Valerie BougaultECSS Paris 2023: IS-MH06
The widespread use of inhaled β2-agonists among athletes has raised concerns as to their performance-enhancing potential. While systemic use of β2-agonists (such as oral ingestion) is generally perceived as being performance enhancing, inhaled β2-agonists are often claimed not to affect physical performance and ‘only make asthmatic athletes able to compete at same level as non-asthmatic athletes’. These claims are often stated without much consideration of dosing or exercise modality. But considering basic β2-agonist pharmacokinetics, for which the inhaled route is a more efficient way to achieve a high systemic exposure than oral ingestion, acknowledging performance-enhancing effects of orally ingested β2-agonists while denying these effects for inhaled administration is contradictory. Furthermore, the claim that inhaled β2-agonists only put asthmatic athletes on par with their peers cannot be based solely on their bronchodilator effect if these drugs also impose extrapulmonary effects that enhance performance beyond their peers. This talk challenges the notion that inhaled β2-agonists are without any relevant effect on athletic performance and raise awareness of their ability to constitute performance-enhancing benefits – mainly at supratherapeutic doses but also at close-to-therapeutic doses.
Read CV Morten HostrupECSS Paris 2023: IS-MH06