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‘Maybe we are being too nice’ says Wada about salbutamol usage

Suggestion that threshold for legal usage could be reduced

In the wake of the Chris Froome case, the World Anti-Doping Agency’s (Wada) director general, Olivier Niggli, has suggested that the body could reduce the amount of salbutamol athletes are permitted to take. “Maybe the weakness in the system is that we are being too nice,” he told the Guardian.

Athletes are allowed a maximum of 1600 micrograms of salbutamol over 24 hours, with no more than 800mg in a 12-hour period.

Froome’s test at last year’s Vuelta a Espana suggested he had taken more than this, but after assessing the evidence Wada eventually concluded that the result was, “not inconsistent with therapeutic dosages.”

Questions have consequently been raised about the accuracy of the salbutamol test and Ken Fitch, the sports scientist responsible for Wada’s salbutamol regulations, has been among those pressing Wada to change its rules.

Wada responded to the criticism earlier this week by defending the test, pointing out that breaching the threshold does not constitute a failed test, but is instead merely a trigger for further investigation.

“Unlike most substances, given the variables that exist with salbutamol depending on conditions specific to each case, the rule is designed to afford athletes found to have exceeded the threshold with the opportunity to prove how it has occurred and justify proper therapeutic use.”

But while the test is likely to remain the same, Niggli suggests that Wada may reduce the amount of salbutamol athletes are permitted to take before needing a therapeutic use exemption (TUE).

“Maybe the finger is being pointed in the wrong direction – and maybe what needs to be done is to point the finger at how much we allow athletes to take and maybe be more restrictive,” he said.

“Maybe we need to be tougher and say: ‘You are going to have to take less, otherwise you need a TUE.’”

Wada’s director of science, Dr Olivier Rabin, said that the current 800mg per 12-hour limit could be considerably reduced.

“It is certainly a question we need to raise,” he said. “Some asthma experts say we should reduce it to 500 or 600. I think it is important to allow some dosage which are used by the vast majority of athletes – maybe 200 to 400 per day – but the point we are debating is very legitimate.”

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arckuk | 5 years ago
1 like

My son, who has a severe neuromuscular condition that leaves his muscles very atrophied, is a user of oral salbutamol for at least 8 years, taking 2 mg (milligrams, ie 2,000 mcg/micrograms, which is the unit people are discussing the Froome case mean to use, but don't) three times daily, resulting in a daily dose of  6000 mcg. He's less than 30 kilos, so I would imagine that an adult dose would be considerably higher. The resulting effect is marginal at best, with the most obvious result being a permanently elevated heart rate.

I'm not a Team Sky supporter by any means, and am very cynical of their previous use of TUEs and Tramadol, but I'd give Froome the benefit of my doubt here. Given that he has a history of using inhaled Salbutamol and he is tested more often that most, including every day in the race lead, there is an higher probability of him returning a result above the threshold in a test which will have an associated standard deviation (I've never heard this discussed in all the Froome follow-up), and is subject to variations in the test subject including levels of hydration, illness/system stress, drug delivery method, dosing regime and time post dosing.

There's also a question over whether an acute increase in Salbutamol would lead to short term gains in performance, I'd be interested to know whether treating at a higher level than is typical on a single day towards the end of the Vuelta would have any effect at all. I think that if Sky/Froome were deliberately trying to gain an advantage, rather than treat acute/acknowledged symptons, they would balance the risk of being caught with the very small potential reward and look elsewhere to cheat.

The other possibility here is that they weren't subject to an unrepresentative test result, or abusing it deliberately, but were just not keeping sufficient track of how many puffs he'd had on a particular day. Then he'd be culpable, I guess. 

Disclosure: I work in an industry associated with pharmaceutical testing/pharmacokinetics, so have more exposure to these issues than most, but this probably just makes me more aware of what I don't know on the subject, and how difficult it is to do this stuff robustly and accurately!

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mattsccm | 5 years ago
0 likes

I have started to use a blue job for TT as it works and the doc says to use it. Same with the brown one. 

It helps. Makes TTs a touch nicer.

However its my problem. If , under much updated research, it proves to be an aid then ban it.  easy. So what if it stops some of us racing. Tough luck, its a hard world. Pussy footing around keeping everyone happy is why we have the world we have . TUEs shouldn't exist. If you can't do it with the body your parenst gave you then tough. 

Currently though the system is broken. 

Avatar
alansmurphy replied to mattsccm | 5 years ago
0 likes

mattsccm wrote:

Pussy footing around keeping everyone happy is why we have the world we have . TUEs shouldn't exist. If you can't do it with the body your parenst gave you then tough. 

Currently though the system is broken. 

 

Urm, i thought the elite gobbling up the world's resource in a wasteful, hateful manner was the reason for the awful world we live in.

 

I'm a diabetic, are you suggesting I have to give up insulin before riding my bike? Should Team Novo fold as they do great work? Should footballers be able to take painkilling injections? How about yoghurt, performance enhancing, tasty yoghurt?

 

As an aside, isn't one of the potential benefits of sabutumol that it can mask other drug use?

 

 

 

Avatar
pga | 5 years ago
0 likes

 I have had exercise induced asthma for sevral years and take the brown baclometasone puffer morning and night.   I am also prescribed the blue salbutamol puffer to be use when I need it.

I sometimes take the latter when cycling but rarely use it.    However, the point I would like to raise is that with both buffers the amount of discharge varies considerably in spite of the claim on the puffer that it contains 200 metered doses.   In these circumstances I fail to see how a user is able to tell how much he has taken.

I have to say when I have used salbutamol I have not noticed any dramatic increase in performance apart from stopping the wheezing.

Avatar
OldRidgeback | 5 years ago
2 likes

Jeez, I've been having to use my salbutamol pump a lot recently. I was racing at the weekend. Shh, don't tell anyone.

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SteveAustin | 5 years ago
0 likes

Just let everyone use it.  no problems then

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don simon fbpe replied to SteveAustin | 5 years ago
0 likes

SteveAustin wrote:

Just let everyone use it.  no problems then

Why would you want to give someone an unfair advantage?

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abrooks replied to don simon fbpe | 5 years ago
0 likes

don simon wrote:

SteveAustin wrote:

Just let everyone use it.  no problems then

Why would you want to give someone an unfair advantage?

 

What unfair advantage does inhaled Salbutamol give?  It has no effect on lungs that are not bronchoconstricted and Wada labs can tell the difference between oral and inhaled Salbutamol in the test so it isn't being used to mask large doses of oral drug which, like Clenbuterol can be used to strip weight.  

Even if you could dilate normal airways it wouldn't help as getting air in and out of the lungs is not a limiting factor in performance, Oxygen carriage in the blood is.

It's a genuine question - if 30-40% of the peloton were using it to cheat surely the possible benefit would be common knowledge?  I've never heard a single theory as to why it is performance enhancing, let alone a convincing one.

Avatar
don simon fbpe replied to abrooks | 5 years ago
0 likes

abrooks wrote:

don simon wrote:

SteveAustin wrote:

Just let everyone use it.  no problems then

Why would you want to give someone an unfair advantage?

 

What unfair advantage does inhaled Salbutamol give?  It has no effect on lungs that are not bronchoconstricted and Wada labs can tell the difference between oral and inhaled Salbutamol in the test so it isn't being used to mask large doses of oral drug which, like Clenbuterol can be used to strip weight.  

Even if you could dilate normal airways it wouldn't help as getting air in and out of the lungs is not a limiting factor in performance, Oxygen carriage in the blood is.

It's a genuine question - if 30-40% of the peloton were using it to cheat surely the possible benefit would be common knowledge?  I've never heard a single theory as to why it is performance enhancing, let alone a convincing one.

My understanding is that Sallbutamol taken orally does have an effect on edurance athletes to a degree that could be considered cheating, hence the limits. As you say, WADA piss tests can't determine whether the drug was administered orally or inhaled.  Equally team SKY have told us that the findings of the piss test cannot tell us how much has been ingested either.

Inhaled Salbutamol has little benefit for anyone but a wheezing elite athlete.

Avatar
abrooks replied to don simon fbpe | 5 years ago
0 likes

 

[/quote]

My understanding is that Sallbutamol taken orally does have an effect on edurance athletes to a degree that could be considered cheating, hence the limits. As you say, WADA piss tests can't determine whether the drug was administered orally or inhaled.  Equally team SKY have told us that the findings of the piss test cannot tell us how much has been ingested either.

Inhaled Salbutamol has little benefit for anyone but a wheezing elite athlete.

[/quote]

 

To answer my own question (and to agree with you)  inhaled Salbutamol is excreted largely unchanged while oral Salbutamol is part metabolized in the liver before excretion.  It seems though that this is not reliable enough to tell the difference - I actually thought that it was.   The limit was determined and implemented to deter massive use of inhaled Salbutamol or of oral Salbutamol, which WADA consider an anabolic drug with potential for enhancing performance via muscle growth.  

 

WADA don't believe that inhaled Salbutamol at a dose of 1600mg/day would be performance enhancing and they did their own work trying to establish that the urinary limit was robust.  They do however accept that individuals may excrete differently which is why breaching the limit doesn't lead to a ban, just an invitation behind closed doors to explain the result.

 

So there you go, either you believe Froome has EIB and excretes Salbutamol in such as way as to trigger a false positive, or you don't and you believe the rules are being stretched to gain a possible advantage.  

 

 

Avatar
don simon fbpe replied to abrooks | 5 years ago
0 likes

abrooks wrote:

 

My understanding is that Sallbutamol taken orally does have an effect on edurance athletes to a degree that could be considered cheating, hence the limits. As you say, WADA piss tests can't determine whether the drug was administered orally or inhaled.  Equally team SKY have told us that the findings of the piss test cannot tell us how much has been ingested either.

Inhaled Salbutamol has little benefit for anyone but a wheezing elite athlete.

[/quote]

 

To answer my own question (and to agree with you)  inhaled Salbutamol is excreted largely unchanged while oral Salbutamol is part metabolized in the liver before excretion.  It seems though that this is not reliable enough to tell the difference - I actually thought that it was.   The limit was determined and implemented to deter massive use of inhaled Salbutamol or of oral Salbutamol, which WADA consider an anabolic drug with potential for enhancing performance via muscle growth.  

 

WADA don't believe that inhaled Salbutamol at a dose of 1600mg/day would be performance enhancing and they did their own work trying to establish that the urinary limit was robust.  They do however accept that individuals may excrete differently which is why breaching the limit doesn't lead to a ban, just an invitation behind closed doors to explain the result.

 

So there you go, either you believe Froome has EIB and excretes Salbutamol in such as way as to trigger a false positive, or you don't and you believe the rules are being stretched to gain a possible advantage.  

 

 

[/quote]

I believe that WADA and UCI have backed themselves into a corner, but not totally. I believe that this is the single AAF that we know about, I believe that we will never know the quantity of Salbutamol ingested and whether it was taken orally or not. I believe that Team SKY knew this flaw in the regulation. Orally taken Salbutamol is a performance enhancing drug. I therefore believe that the rules are being broken rather than being stretched.

I believe that other riders are breaking the regulations too, just not failed any tests yet that we know of.

He hasn't been found guilty, which is different from innocent and therefore he has the right to race. I personally believe that he's guilty as hell and not good for the sport, that Team SKY are taking the piss and are not good for the sport.

I think that leaking the results was not a bad thing as it has brought the whole debate into the spotlight, it may have been any other rider and possibly unfortunate that it was Froome. I might not believe 100% that final statement.

 

Avatar
efail replied to don simon fbpe | 5 years ago
1 like

don simon wrote:

abrooks wrote:

 

My understanding is that Sallbutamol taken orally does have an effect on edurance athletes to a degree that could be considered cheating, hence the limits. As you say, WADA piss tests can't determine whether the drug was administered orally or inhaled.  Equally team SKY have told us that the findings of the piss test cannot tell us how much has been ingested either.

Inhaled Salbutamol has little benefit for anyone but a wheezing elite athlete.

 

To answer my own question (and to agree with you)  inhaled Salbutamol is excreted largely unchanged while oral Salbutamol is part metabolized in the liver before excretion.  It seems though that this is not reliable enough to tell the difference - I actually thought that it was.   The limit was determined and implemented to deter massive use of inhaled Salbutamol or of oral Salbutamol, which WADA consider an anabolic drug with potential for enhancing performance via muscle growth.  

 

WADA don't believe that inhaled Salbutamol at a dose of 1600mg/day would be performance enhancing and they did their own work trying to establish that the urinary limit was robust.  They do however accept that individuals may excrete differently which is why breaching the limit doesn't lead to a ban, just an invitation behind closed doors to explain the result.

 

So there you go, either you believe Froome has EIB and excretes Salbutamol in such as way as to trigger a false positive, or you don't and you believe the rules are being stretched to gain a possible advantage.  

 

 

[/quote]

I believe that WADA and UCI have backed themselves into a corner, but not totally. I believe that this is the single AAF that we know about, I believe that we will never know the quantity of Salbutamol ingested and whether it was taken orally or not. I believe that Team SKY knew this flaw in the regulation. Orally taken Salbutamol is a performance enhancing drug. I therefore believe that the rules are being broken rather than being stretched.

I believe that other riders are breaking the regulations too, just not failed any tests yet that we know of.

He hasn't been found guilty, which is different from innocent and therefore he has the right to race. I personally believe that he's guilty as hell and not good for the sport, that Team SKY are taking the piss and are not good for the sport.

I think that leaking the results was not a bad thing as it has brought the whole debate into the spotlight, it may have been any other rider and possibly unfortunate that it was Froome. I might not believe 100% that final statement.

 

[/quote]

You aren't one of The Bachelors, by any chance, are you, Don?

Avatar
Rapha Nadal | 5 years ago
0 likes

What about Dylan Van Barle who admitted to using an inhaler even though he doesn't suffer from asthma?  How will he cope?!

Avatar
don simon fbpe replied to Rapha Nadal | 5 years ago
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Rapha Nadal wrote:

What about Dylan Van Barle who admitted to using an inhaler even though he doesn't suffer from asthma?  How will he cope?!

You appear to have forgotten, just like Dylan until his team reminded him, that he has exercise induced asthma.

Avatar
Ben12345 | 5 years ago
0 likes

The only way to solve this, is to ban Salbutamol all together.

What about those cyclists who claim to be asthmatic? I actually work in a job where we had to have a medical and asthma was one of the conditions that barred you from joining.

I think if I turned up with a list of TUE's I would have been laughed out the medical. 

Avatar
Innerlube replied to Ben12345 | 5 years ago
2 likes

Ben12345 wrote:

The only way to solve this, is to ban Salbutamol all together.

What about those cyclists who claim to be asthmatic? I actually work in a job where we had to have a medical and asthma was one of the conditions that barred you from joining.

I think if I turned up with a list of TUE's I would have been laughed out the medical. 

 

4.3 million adults in UK have asthma. Salbutamol is an effective treatment. If you ban it you effectively ban all those people, just for treating their clinical condition. Not the answer!

Avatar
BehindTheBikesheds replied to Ben12345 | 5 years ago
0 likes

Ben12345 wrote:

The only way to solve this, is to ban Salbutamol all together.

What about those cyclists who claim to be asthmatic? I actually work in a job where we had to have a medical and asthma was one of the conditions that barred you from joining.

I think if I turned up with a list of TUE's I would have been laughed out the medical. 

How many athletes in para competiton might that effect also, or are you happy to discriminate against those that are less able due to no fault of their own?

Sorry, you can't have that carbon/titanium leg/arm or whatever because it's giving you an advantage. Powered wheelchair to help to get to the stadium, no-way, you're going to have to push yourself. What, you want a sighted rider to sit in front of you and who has won an olympic gold medal in non para games to boot so you can win a medal, I don't think so mr Fachie!

How is an allowed drug that is used so that a person can compete on a level pegging which shows no performance enhancing effect at any level any different to restricting para athletes in other ways?

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Markus | 5 years ago
0 likes

So today any athlete can use a little of the stuff but higher doses needs an TUE? Is there any medical benefit to the smaller dose?

Avatar
vonhelmet replied to Markus | 5 years ago
3 likes

Markus wrote:

So today any athlete can use a little of the stuff but higher doses needs an TUE? Is there any medical benefit to the smaller dose?

The medical benefit is being able to breathe.

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ktache | 5 years ago
0 likes

What I don't get is that if someone needs salbutamol for their asthma, and they still have asthma but they may have been mixed up in a bit of a controversy, why would that asthmatic not make use of the life saving drug salbutamol anymore?

I do support Froome, wish him the best, enjoying the spectacle of the best month of the year, just wondering that's all.

 

Avatar
zanf | 5 years ago
2 likes

As someone commented here:

https://twitter.com/ebbenieuweboer/status/1017859295600365568

Quote:

To sum up:
- Froome caught 100% over limit
- They then adjusted measurements. He was still 43% over limit
- They then RAISED limit (and won't share research). He was still 19% over limit
- They then let him off (and won't prove reasoning)
- They will now LOWER limit again

Avatar
massive4x4 replied to zanf | 5 years ago
1 like

zanf wrote:

As someone commented here:

https://twitter.com/ebbenieuweboer/status/1017859295600365568

Quote:

To sum up:
- Froome caught 100% over limit
- They then adjusted measurements. He was still 43% over limit
- They then RAISED limit (and won't share research). He was still 19% over limit
- They then let him off (and won't prove reasoning)
- They will now LOWER limit again

So let's break this down:

- Froome wasn't "caught" because there isn't a "limit"

- There is a maximum allowed therapeutic dosage (no of puffs), which they cannot test, instead they use a proxy of concentration in urine.

- The test hadn’t included the factor of de-hydration because the actual research which was used to generate the level at which an AAF is investigated used swimmers who do not get de-hydrated (short duration efforts, no sweating). This was a straight up mistake by WADA.

- Once de-hydration was factored in this reduced the value down significantly, the fact that it was over the “limit” was in itself not relevant.

- What Sky showed was Froome’s values for salbutamol across multiple tests was highly variable even though dose was not, therefore they were also able to demonstrate that given the number of tests and the variability of the sample it was a statistical inevitability that eventually Froome would go over the trigger value.

- The substance in question, its usage pattern (small doses in competition) was also not in line with what an athlete would  take to gain an advantage (very large sustained doses out of competition).

- The process is not that a reading over 1000 is a failed drug test; it is a value that an athlete must demonstrate that their usage of the substance fell within therapeutic usage.

- Froome/Sky proved this, in the process they also demonstrated that the test is highly flawed.

- This whole process is meant to be confidential because as we’ve seen the media and population are unable to differentiate between an investigation and cheating.

- It shouldn’t be Sky’s job to explain themselves, it should be the job of the UCI to explain why this leaked and why the evidence was insufficient to even charge Froome never mind convict him.

- From a drugs enforcement perspective Sky have "helped" WADA/UCI, as a result of their "study" of Froome they have actually generated considerably more data than the study which WADA used to set the testing proceedure.

The key learning elements are that:

1: Confidentiality needs to be more strictly imposed, names need to be redacted and information needs to be limited to a very small number of people, those people can then be held collectively financially responsible if the information leaks.

2: The findings need to be made public and we need transparency as to who is making decisions and the details of those decisions even if the name of the athlete is kept secret. The same rule should be applied for TUE.

Avatar
john1967 | 5 years ago
1 like

I think its been established that no one was cheating. Keep up Don.

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don simon fbpe replied to john1967 | 5 years ago
0 likes
john1967 wrote:

I think its been established that no one was cheating. Keep up Don.

You've lost me on that one, you'll have to point out where I said someone was cheating.

Avatar
CygnusX1 replied to don simon fbpe | 5 years ago
3 likes
don simon wrote:
john1967 wrote:

I think its been established that no one was cheating. Keep up Don.

You've lost me on that one, you'll have to point out where I said someone was cheating.

You implied it with the sentence "Get around that, cheating bastards!"

The clue was in the use of the word cheating.

Avatar
Rich_cb | 5 years ago
2 likes

Maybe they should actually evaluate whether Salbutamol is actually performance enhancing?

I'd be in favour of scrapping all testing for Salbutamol.

If you lower the limit you're going to put more pressure on asthmatic riders to delay treating acute asthma attacks in order to avoid possible violations.

That delay could potentially be fatal.

Unless there's unequivocal proof that it's a performance enhancer then why take the risk?

Avatar
don simon fbpe replied to Rich_cb | 5 years ago
0 likes
Rich_cb wrote:

Maybe they should actually evaluate whether Salbutamol is actually performance enhancing?

I'd be in favour of scrapping all testing for Salbutamol.

If you lower the limit you're going to put more pressure on asthmatic riders to delay treating acute asthma attacks in order to avoid possible violations.

That delay could potentially be fatal.

Unless there's unequivocal proof that it's a performance enhancer then why take the risk?

Totally agree, there's another case of a rider who was banned for taking a non-performance enhancing drug, I just can't remember who it was. We could then start a debate on what we think is performance enhancing.

Avatar
Rich_cb replied to don simon fbpe | 5 years ago
1 like
don simon wrote:

Totally agree, there's another case of a rider who was banned for taking a non-performance enhancing drug, I just can't remember who it was. We could then start a debate on what we think is performance enhancing.

Slight difference in that clenbuterol (I assume you're talking about your beloved Pistolero) isn't a commonly used treatment so shouldn't be present at all.

Bobybuilders use clenbuterol to prevent muscle loss so it could conceivably be used in the same fashion during a grand tour or when cutting weight pre race.

What the evidence base is for that use is anyone's guess.

Avatar
don simon fbpe replied to Rich_cb | 5 years ago
0 likes
Rich_cb wrote:
don simon wrote:

Totally agree, there's another case of a rider who was banned for taking a non-performance enhancing drug, I just can't remember who it was. We could then start a debate on what we think is performance enhancing.

Slight difference in that clenbuterol (I assume you're talking about your beloved Pistolero) isn't a commonly used treatment so shouldn't be present at all.

Bobybuilders use clenbuterol to prevent muscle loss so it could conceivably be used in the same fashion during a grand tour or when cutting weight pre race.

What the evidence base is for that use is anyone's guess.

And bingo!

Avatar
Yorkshire wallet | 5 years ago
3 likes

“Maybe we need to be tougher and say: ‘You are going to have to take less, otherwise you need a TUE.’”

So I guess.......just maybe.......they'll all then get a TUE.

Round and round it goes. 

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