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.”
40 thoughts on “‘Maybe we are being too nice’ says Wada about salbutamol usage”
Yes, let’s reduce it and then
Yes, let’s reduce it and then just ignore it like we do now.
They have massively fucked up
They have massively fucked up and now are trying to cover themselves.
How can an organisation that EVERYBODY should be behind making such mistakes thus making people question them? How was Froomes test leaked? Would this happen to a French cyclist? Why not?
They need to start cleaning themselves up asap…And start listening to the experts that advise them!!
The whole testing system for
The whole testing system for salbutamol needs to be ripped up and started again.
For me reducing the limit is not the answer as all it will do is affect those who really need salbutamol and will ultimately be a disadvantage to them against those who dont. We need a level playing field for all.
If i was a betting man i would put my pension on the person who leaked the Froome test as having a French background, or am i being too cynical…….
Pitbull Steelers wrote:
Or on the flipside, the scientist who made “grave errors” in the handling and testing of the sample may be retired on his 100 foot yacht, courtesy of a donation from the Sky. We will never know……
sammutd88 wrote:
…except he warned wada years ago and was ignored…
sammutd88 wrote:
Did you work on Trump’s election campaign?
lol, typical reaction by an
lol, typical reaction by an organisation under pressure. Instead of coming up with a useful and constructive response they’ve outed themselves as rank amateurs.
My salbutamol dispenser says
My salbutamol dispenser says that it is suitable for 200 doses. It wouldn’t be that difficilt to put a counter on the dispenser, or manufacture dispensers with limited doses. Job done. Get around that cheating bastards! We won’t have to go through this piss take again.
don simon wrote:
I guess it hasn’t occurred to you that they could have more than one inhaler?
And just to be contrary, as a long time (30 plus years) user of a salbutamol inhaler, I can relate my personal experience which is that when used in this form it does not increase my lung capacity – it relieves the symptoms of asthma when I have an attack.
tonyleatham wrote:
I guess it hasn’t occurred to you that they could have more than one inhaler?— don simon
Obviously the teams would have to keep meticulous records…
“Maybe we need to be tougher
“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.
Maybe they should actually
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?
Rich_cb 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.
don simon wrote:
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.
Rich_cb wrote:
And bingo!
I think its been established
I think its been established that no one was cheating. Keep up Don.
john1967 wrote:
You’ve lost me on that one, you’ll have to point out where I said someone was cheating.
don simon wrote:
You implied it with the sentence “Get around that, cheating bastards!”
The clue was in the use of the word cheating.
As someone commented here:
As someone commented here:
https://twitter.com/ebbenieuweboer/status/1017859295600365568
zanf wrote:
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.
What I don’t get is that if
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.
So today any athlete can use
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?
Markus wrote:
The medical benefit is being able to breathe.
The only way to solve this,
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.
Ben12345 wrote:
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!
Ben12345 wrote:
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?
What about Dylan Van Barle
What about Dylan Van Barle who admitted to using an inhaler even though he doesn’t suffer from asthma? How will he cope?!
Rapha Nadal wrote:
You appear to have forgotten, just like Dylan until his team reminded him, that he has exercise induced asthma.
Just let everyone use it. no
Just let everyone use it. no problems then
SteveAustin wrote:
Why would you want to give someone an unfair advantage?
don simon wrote:
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.
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]
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.
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.
don simon wrote:
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?
Jeez, I’ve been having to use
Jeez, I’ve been having to use my salbutamol pump a lot recently. I was racing at the weekend. Shh, don’t tell anyone.
I have had exercise induced
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.
I have started to use a blue
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.
mattsccm wrote:
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?
My son, who has a severe
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!