Asthma

Medical information to support a TUE application – Asthma

Asthma is a respiratory condition typified by recurrent episodic symptoms that can include shortness of breath and wheezing due to an airway obstruction that is reversible either spontaneously or with treatment.

 

Status of medication in sport

Beta-2 agonists: All beta-2 agonists (e.g. Terbutaline, Procaterol, Vilanterol), except those listed below, are prohibited at all times in sport and require a Therapeutic Use Exemption (TUE).

The following beta-2 agonists DO NOT require a TUE:

  • Salmeterol by inhalation is not prohibited
  • Salbutamol: Inhaled Salbutamol is not prohibited. However, the presence of Salbutamol in the urine in excess of 1000 ng/mL is presumed not to be a therapeutic use. The athlete would then need to document the details of his/her, medical condition and medication use and may be required to prove that the abnormal test result was the consequence of the use of a therapeutic dose (i.e. maximum 1600 micrograms over 24 hours) of inhaled Salbutamol. Non-inhaled use of Salbutamol is prohibited.
  • Formoterol: Inhaled Formoterol is not prohibited. However, the presence of Formoterol in the urine in excess of 40 ng/mL is presumed not to be a therapeutic use. The athlete would then need to document the details of his/her, medical condition and medication use and may be required to prove that the abnormal test result was the consequence of the use of a therapeutic dose (maximum dose of 54 micrograms over 24 hours) of inhaled Formoterol. Non-inhaled use of Formoterol is prohibited.

Glucocorticoids: Systemic treatment with glucocorticoids is prohibited in-competition and requires a TUE when used during or immediately prior to competition (i.e. within 7 days). An extended TUE for up to 12 months will be considered, but further evidence regarding the severity and frequency of the asthma will be required. It is worthwhile checking with the sport what is designated as ‘in-competition’.

 

What information is required for a TUE application?

  • A completed TUE application form signed by the treating doctor and athlete.
  • Detailed typed clinical letter(s) from treating specialist(s) that includes:
    • diagnosis – summary of clinical history leading to diagnosis
    • age of diagnosis and management to date including any hospitalisations
    • clinical response to non-WADA prohibited medications (what has been tried and when)
    • rationale for the use of a WADA-prohibited medication, and
    • current treatment, including route of administration, dose and frequency of all medications.

NOTE: A clinical letter can be a copy of a specialist’s letter to another doctor (e.g. a GP), and at least one of the clinical letters submitted with the application must have been written in the last 12 months.

  • Supplementary investigations to support the diagnosis must be submitted and could include:
    • Spirometry – FEV1 pre and post-bronchodilator (12% increase in FEV1 post bronchodilator)
    • Methacholine challenge (20% fall in FEV1)
    • Mannitol inhalation test (15% fall in FEV1)
    • Eucapnic Voluntary Hyperpnea (EVH test) (10% fall in FEV1)
    • Hypertonic saline aerosol challenge (15% fall in FEV1)
    • Exercise challenge (field or lab) (10% fall in FEV1)
    • Histamine challenge test (20% fall in FEV1)

       

For additional information please refer to the medical information relating to the condition on the WADA website.