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A third of Team Sky’s riders are asthmatic - and it may be a hazard of being an elite athlete

Kent University study finds exercise induced asthma rife in many elite sports

A study carried out by John Dickinson, head of the respiratory clinic at the University of Kent, has found that a third of Team Sky’s riders suffer from asthma to some degree. The Guardian reports how Dickinson’s research has revealed that a surprisingly large number of elite athletes have asthma across many different sports.

The national asthma rate is about 8-10 per cent. However, Dickinson found that rates were sometimes even higher in top level sport.  Having also tested all 33 UK-based swimmers from the British Swimming squad, 70 per cent were found to suffer.

Crucially, the form most commonly seen is not the allergy-induced one frequently seen among children but exercise induced asthma (EIA).

Dickinson explained:

“It depends which respiratory consultant you talk to on whether you put these athletes on a spectrum of asthma, or whether you think that’s purely down to them exercising really hard in a certain environment, and if you take them out of that environment they’re fine. It’s a grey zone. But my argument is it’s a form of asthma.”

EIA involves similar symptoms – contraction of the airways – but is brought about by rapid breathing through exertion rather than allergies. Atmospheric factors will often exacerbate the condition – in particular cold air. This may be why road cyclists often suffer, although cross-country skiers appear to be affected to an even greater degree with half exhibiting the condition. It is thought that the chlorine environment in pools may also be a trigger.

Dickinson tested athletes by asking them to breathe very dry air for six minutes at high ventilation. Lung function was tested before and after and the drop seen was sometimes as high as 40 per cent.

Athletes can use common bronchio-dilating inhalers like salbutamol so long as they do not exceed a certain dose. Earlier this year, Lampre-Merida’s Giro stage winner, Diego Ulissi, tested positive after nearly twice the maximum permitted level was found in his urine. While his hearing took place last week, the verdict has been postponed until January to allow Ulissi’s legal team to compile a full statement of defence.

Dickinson says that a surprising number of cyclists carry inhalers while they ride. “Cognitively, the inhaler can give you the confidence to push yourself that little bit more. Sometimes a rider will know a climb is coming, so they take a couple of puffs.”

When he was spotted using an inhaler in this year’s Tour of Romandie, Chris Froome was quoted as saying: “I have had an inhaler since childhood. I have exercise induced asthma. It is ok. I didn't need a TUE. I don’t use (the inhaler) every time I race, normally only when I have a big effort coming up.”

In May 2008, the Court of Arbitration for Sport handed a ban to Italian sprinter Alessandro Petacchi and stripped him of results including five Giro d’Italia stage wins after he tested positive for an excessive amount of salbutamol.

In its ruling, CAS acknowledged that Petacchi, who was permitted to take the medication, had not intended to cheat, but held that he had failed to exercise “utmost caution” in exceeding the permitted dosage.

Alex has written for more cricket publications than the rest of the road.cc team combined. Despite the apparent evidence of this picture, he doesn't especially like cake.

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43 comments

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joshpedal | 6 years ago
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Team Sky need to move from their HQ from the Manchester velodrome to somewhere near the coast - get some sea air in the lungs of their riders who all seem to have asthma......

The sad thing is that after all the Wiggins bullshit about asthma used to cover up him injecting steroids into his thighs Froome cannot get away with this even if it is innocent.  Wiggins finally gets his revenge on Froome for the attack on him at the 2012 Tour!

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Must be Mad | 8 years ago
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Quote:

Would someone who did not have asthma get any advantage from using an inhaler?

Depends entirely on the medication used and the dosage.

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ch | 8 years ago
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Would someone who did not have asthma get any advantage from using an inhaler?

Yes. https://en.wikipedia.org/wiki/Salbutamol#Society_and_culture

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Greebo954 | 9 years ago
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 24

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antonio | 9 years ago
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From time to time I use a peak flow meter just to see how my aged lungs are doing. Recently, amid the chatter about whether inhalers work or not, I measured my effort before and after using my reliever inhaler. I was rather surprised to find an increase from 600 to almost 700 on the scale, I am only left to wonder why I don't seem to get much benefit while cycling after taking a couple of puffs. I seem to get more relief after an event rather than during.

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Matt_S | 9 years ago
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Rider A:

I have a slightly lower red blood cell count than some other athletes, therefor I use EPO to bring my oxygen carrying capacity up to realise my full potential.

Rider B:

I have a slightly lower airflow capacity than some other athletes, therefor I use Salbutamol to bring my oxygen intake capacity up to realise my full potential.

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don simon fbpe replied to Matt_S | 9 years ago
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Matt_S wrote:

Rider A:

I have a slightly lower red blood cell count than some other athletes, therefor I use EPO to bring my oxygen carrying capacity up to realise my full potential.

Why yes sir, I'll pop a little EPO in order to get your cell count back up to natural occuring levels after your recent illness, it will, of course, come with a TUE.
What?
You want to go above the 50% permitted level? Piss off you cheating bastard!

Rider B:

I have a slightly lower airflow capacity than some other athletes, therefor I use Salbutamol to bring my oxygen intake capacity up to realise my full potential.

[/quote]
No problem, but it will only take you to your max level and not to the level of others. Feel free to try it and come back with the study results when you've actually increased your capacity to over 100%
.
.
.
.
.

Man in the street A:
Can I have an apple, please?
Why yes, here's your orange.
Thank you.

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Paul Highley | 9 years ago
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My understanding is that salbutamol is/was on the banned list not because it is performance enhancing but because it masks the presence of performance enhancing agents.

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Paul Highley | 9 years ago
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My understanding is that salbutamol is/was on the banned list not because it is performance enhancing but because it masks the presence of performance enhancing agents.

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Awavey | 9 years ago
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I think half the problem is people without asthma just dont understand the condition, Its not a case of simply being a bit out of breath doing physical exertion, so dont understand what the medication for it actually does. it certainly doesnt give you a free pass on performance at all.

Ive had asthma since I was a kid and with the cold weather at the moment,Im certainly experiencing exercise induced asthma attacks on rides Id have no problems completing in the warmer summer months.

You cant breath is simply how best to describe an asthma attack, you start to gasp for air trying to force almost, just some oxygen into your lungs, your heart races,your chest feels like you are being crushed and you begin to feel dizzy, its as much as you can do to grab or even hold your inhaler to get some initial partial relief,because it maybe 5-10mins before your airways relax back and are breathing normally again, whatever normally really means for someone with asthma.

and thats with reasonably mild asthma, thats medicated daily, three people die every day in the UK from having an asthma attack like that, its not an excuse to skip PE & its certainly not performance enhancing.

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levermonkey | 9 years ago
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 26 Here's a thought. If you don't look then you don't find.

Has anyone stopped to think maybe, just maybe, a high percentage of the entire population may suffer from asthma to varying degrees in all its various forms (and I'm quite happy to accept that EIA is a form of asthma).

Because athletes are pushing their bodies further than most and are poked, prodded and peered at more than most then you are going to be more likely to find underlying health conditions.

How many times has someone got to the top of a flight of stairs, stopped, drawn a deep breath and said "God! I'm unfit!" Maybe they have a form of asthma or maybe they are just unfit. Unless someone actually checks how will you, or they, know.

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mingmong | 9 years ago
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Just a side note on asthma. I have asthma and I've found that taking fish / krill oil high in 'EPA' (Eicosapentaenoic acid) really helps my asthma in winter. My general condition is better throughout the year also.

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tomturcan | 9 years ago
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Some great points, but also many debatable ones.

On Wada, I'm not sure I'm willing to leave it all to "the experts" there. See this, for example.

http://www.theguardian.com/sport/blog/2013/nov/13/world-anti-doping-agen...

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jacknorell | 9 years ago
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Sidenote on childhood asthma:

There's no real understanding on whether this is a different thing or whether it's a scale. Given the prevalence of asthma diagnosis among athletes (who are checked out by doctors much more often than other people), I'd say that what you recognise as 'normal asthma' is simply quite a severe case on a reasonably stretched out scale of bronchial constriction issues.

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Flying Scot | 9 years ago
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My take on this, just like Scotland is often painted the sick man of Europe, this may just be a case if too much testing and too many statistics.(Scotland has more health stats than any other country in the world)

If you do wider testing, you get more positive results.

Perhaps these numbers are the same as the general population, it's just that they haven't all been tested.

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tomturcan | 9 years ago
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"...It’s a grey zone. But my argument is it’s a form of asthma."

That seems a key statement, implying others do not agree these symptoms should be called Asthma. The ethical question would be whether a exercise-induced condition for an athlete is equivalent to similar symptoms not associated with exercise, and which qualifies for an exempted treatment having the effect of improving performance.

Potentially open to abuse and worthy of discussion, I'd think.

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jacknorell replied to tomturcan | 9 years ago
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tomturcan wrote:

Potentially open to abuse and worthy of discussion, I'd think.

Except, as I linked to above, salbutamol doesn't improve performance in non-asthmatic athletes. Which is why WADA has approved it for use.

Round and round this discussion does go...

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don simon fbpe replied to jacknorell | 9 years ago
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jacknorell wrote:
tomturcan wrote:

Potentially open to abuse and worthy of discussion, I'd think.

Except, as I linked to above, salbutamol doesn't improve performance in non-asthmatic athletes. Which is why WADA has approved it for use.

Round and round this discussion does go...

but it's a drug I don't know anything about and the headline writers make it sound sinister and it must be sinister because I don't know anything about it but I have to have an opinion and I think that any pro cyclist that is taking a drug is doping mainly because I know nothing about it and the journalists can't be wrong can they? Hey, you don't think I'm going to do my own research do you? Obviously it's an abuse because someone told me what to think and the internet says that there's a survey about it too.
So ner!

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tomturcan replied to jacknorell | 9 years ago
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Erm, that's my point jacknorrell - it improves the performance in some who get short of breath. It's not clear (philosophically, if not ethically) why one group of competitors should be able to "cancel out" a naturally occurring, performance limiting condition (which might or might not appropriately be referred to as asthma, but isn't the same as classic childhood asthma).

The same question applies to painkillers. If some athletes can cancel out the pain they feel, and thereby regain their competitiveness, is that fair on those who don't feel it or can endure it? Not clear cut IMO.

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jacknorell replied to tomturcan | 9 years ago
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Well, that depends... It doesn't improve their max, the salbutamol simply removes a, somewhat random in when it strikes, impediment in favour of a normal physical response.

Again, the drug doesn't improve performance, it allows a normal level of performance for that athlete.

I, myself, have asthma. It's sometimes exercise induced, and sometimes just strikes. Definitely has a lot to do with pollution levels, but sometimes I've no idea. When I'm affected, I use an inhaler. Other random days, same circumstances, I'm absolutely fine and breathe as well or better than when using the medication.

Personal anecdote warning: While I'm not a competitive athlete, I've never felt this use has 'enhanced' my performance. In fact, the side effects (nausea, headaches, heart fibrillations... for example) seem to hold me back at times, and mine are definitely very mild.

WADA thinks that therapeutic use of salbutamol is a non-issue, though it used to be banned. I think that discussion has already been had by more knowledgeable people, with more consulting, medical research, and thought, than what we'd see in a discussion here.

The allowed use of painkillers is similar. Should an athlete not be allowed to take a painkiller to reduce the pain from a crash the previous day? Or simply smacking their side on a railing walking to the dinner buffet?

There are upper limits on these substances, above which they can be performance enhancing, and which are as such banned under doping rules.

It'd be a lot more useful to have a discussion about whether doping should be fully allowed (since so many do it). Or whether penalties for breaching the rules should be more severe (though in cycling that doesn't seem possible at the moment).

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banzicyclist2 | 9 years ago
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Storm in a tea cup in my opinion. I get a tight chest when I'm pushing hard in cold weather. Often wondered if an inhaler might help loosen it a bit  39 . But I usually keep efforts down and concentrate on getting distance in and work on pedalling style, stuff that will give me a good base for summer.
Some of the climbs in the Lake District can have you gasping like a fish out of water no matter if it's warm, cold or anyway in between.  31

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ronin | 9 years ago
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Interesting...

Me, I have asthma. Had it since I was a kid. I used to hate running because of it.

I used to like cycling though, so I'd go out around the lanes and at first my breathing would be restricted, it'd just continue without using the inhaler. After about half an hour my lung function would improve. I kept going like this until I didn't need to use my inhaler.

Later I liked running, and tried to run 10 miles at least once a week, then cut back to five miles most days. That was all weathers I could. I was still doing OK.

Then, older, and less fit, moving around and lived in a flat that had damp. It almost killed me. Couldn't believe mold could be that deadly. Couldn't walk up a flight of stairs without needing the inhaler. The mold was hidden at first and then damp and the mold started to appear (the flat had been newly painted).

well I thank God that I moved from there to a nice place, and then went to work in the middle east for a few years. The dryer hotter environment must have been good, because I don't think I used my inhaler once.

Now, some days I do feel like I need to take the inhaler. Sometimes at night, but not very often, but If I do feel that way, most likely I go cycling. That really helps. Perhaps it's the steady breathing that does it.

Breath control takes concentration but I guess it's not something you think about that much when you don't have asthma. It can make a difference for me though, especially on climbs.

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danlindfield | 9 years ago
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Agree. No benefit for "normals". No airway constriction to reverse. Indeed, the tachycardia (increased Heart Rate) that also occurs with Salbutamol and other beta agonists would adversely impact on performance.

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carytb | 9 years ago
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Would someone who did not have asthma get any advantage from using an inhaler?

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jacknorell replied to carytb | 9 years ago
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carytb wrote:

Would someone who did not have asthma get any advantage from using an inhaler?

No. Clinical studies show no benefit for otherwise healthy people:

http://en.wikipedia.org/wiki/Salbutamol#Doping

For more, see:

http://lmgtfy.com/?q=will+salbutamol+help+healthy+athletes+improve

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Fried replied to jacknorell | 9 years ago
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jacknorell wrote:
carytb wrote:

Would someone who did not have asthma get any advantage from using an inhaler?

No. Clinical studies show no benefit for otherwise healthy people:

http://en.wikipedia.org/wiki/Salbutamol#Doping

For more, see:

http://lmgtfy.com/?q=will+salbutamol+help+healthy+athletes+improve

Inhalers can give non-asthamtic athletes a benefit. Depending on the dose, the effect is even considered anabol. Why should it be banned otherwise?

Smiling is my way when listening to doping discussion in almost any sport.

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pwake | 9 years ago
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Back in my day we used to call it 'pursuiter's cough'! Even now I know I've done a really hard training session if I get it.

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jollygoodvelo | 9 years ago
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So here's a theory... do people who have had restricted airways throughout their formative years (during exercise, or in general) develop higher red cell counts, do their red cells hold more oxygen, does it 'train' the body to be more efficient than someone who does not have that impairment?

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kwi replied to jollygoodvelo | 9 years ago
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Gizmo_ wrote:

So here's a theory... do people who have had restricted airways throughout their formative years (during exercise, or in general) develop higher red cell counts, do their red cells hold more oxygen, does it 'train' the body to be more efficient than someone who does not have that impairment?

No, having this condition leads to earlier fatigue than others would experience, I didn't use any inhalers for years and was generally exhausted all the time. It took a few weeks of retaking my medication to achieve having a normal life past working and sleeping. Cold air can devastate me on a run out and I find myself desperately reaching for an inhaler after any major anaerobic effort if I haven't pre-empted it.
In fact I started cycling again in an attempt to not have my Asthma kill me, it kills more people in a year than breast cancer and the number is on the increase.

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jacknorell replied to jollygoodvelo | 9 years ago
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Gizmo_ wrote:

So here's a theory... do people who have had restricted airways throughout their formative years (during exercise, or in general) develop higher red cell counts, do their red cells hold more oxygen, does it 'train' the body to be more efficient than someone who does not have that impairment?

Highly unlikely.

Same mechanism means someone with a smaller lung volume would also have a higher VO2 max, and there's no indication of it.

Asthma simply restricts how much air you can get into your lungs.

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