Status of asthma medication in sport

 

Beta-2 agonists

All beta-2 agonists (for example Terbutaline, Procaterol, Vilanterol), are prohibited at all times in sport and require permission for use.

This permission is in the form of a Therapeutic Use Exemption (TUE) which can be applied for via a medical committee. In Australia this committee is called the Australian Sports Drug Medical Advisory Committee (ASDMAC).

However, the following beta-2 agonists, when INHALED, can be used up to the limits listed below WITHOUT a TUE. If use is required above these levels then they also require a TUE.

  • Salbutamol: Inhaled Salbutamol is permitted up to a maximum dose of 1600 mcg (16 puffs) per 24 hours, not to exceed 800mcg (8 puffs) in a 12 hour period
  • Salmeterol: Inhaled Salmeterol is permitted up to a maximum dose of 200 micrograms (approximately 8 puffs when using Seretide MDI inhaler 250/25) over 24 hours
  • Formoterol: Inhaled Formoterol is permitted up to a maximum dose of 54 micrograms (approximately 9 puffs when using Rapihaler 200/6)  over 24 hours

 

Glucocorticoids

Inhaled and intranasal glucocorticoids, used in the management of asthma and hayfever, are permitted and a TUE is not required.

Systemic treatment (oral or intravenous) with glucocorticoids (for example prednisone) is prohibited in-competition* only and requires a TUE when used during or immediately prior to competition (within 5 to 7 days). An extended TUE for up to 12 months will be considered for chronic, unstable asthma, but further medical evidence regarding the severity and frequency of the asthma will be required.

*The definition of ‘in-competition’ does vary between sports and events but is generally considered to start 12 hours before the match/game and to end after any drug testing has been performed at the end of the competition.

 

Asthma medication quick reference guide—common medications

Substance

Status in Sport

INHALED Salbutamol (Ventolin, Asmol)

TUE NOT Required - With specific conditions.

Inhaled Salbutamol is permitted up to a maximum threshold of 1600 micrograms (16 puffs) over 24 hours, not to exceed 800 micrograms every 12 hours. This threshold is not valid in the presence of diuretics. If using a diuretic a TUE is required to use both the diuretic and salbutamol. If maximum threshold is exceeded a TUE is required.

INHALED Formoterol (Symbicort)

TUE NOT Required - With specific conditions.

Inhaled Formoterol is permitted up to a maximum threshold of 54 micrograms (approx. 9 puffs when using Rapihaler 200/6) over 24 hours. This threshold is not valid in the presence of diuretics. If using a diuretic a TUE is required to use both the diuretic and formoterol. If maximum threshold is exceeded a TUE is required.

INHALED Salmeterol (Seretide/Serevent)

TUE NOT Required - With specific conditions.

Inhaled Salmeterol is permitted up to a maximum threshold of 200 micrograms (approx. 8 puffs when using Seretide MDI inhaler 250/25) over 24 hours This threshold is not valid in the presence of diuretics. If using a diuretic a TUE is required to use both the diuretic and salmeterol. If maximum threshold is exceeded a TUE is required.

INHALED Terbutaline (Bricanyl)

TUE Required.

Prohibited both in and out of competition. See ‘medical evidence needed for TUEs’.

INHALED Vilanterol (Breo)

TUE Required.

Prohibited both in and out of competition. See ‘medical evidence needed for TUEs’.

INHALED Budesonide (Symbicort, Pulmicort)

TUE Not Required.

Permitted in and out of competition.

INHALED Ciclesonide ( Alvesco)

TUE Not Required.

Permitted in and out of competition.

INHALED Fluticasone (Flixotide, Seretide)

TUE Not Required.

Permitted in and out of competition.

ORAL or INJECTED Salbutamol

TUE Required.

Prohibited both in and out of competition. See ‘medical evidence needed for TUEs’.

ORAL Formoterol

TUE Required.

Prohibited both in and out of competition. See ‘medical evidence needed for TUEs’.

ORAL Prednisolone/Prednisone

TUE Required In-Competition Only.

Permitted out-of competition. If taking Prednisolone/Prednisone out-of competition (not competing), allow 5-7 days once ceasing medication before competing. TUE required if taking oral Prednisolone in competition. See ‘medical evidence needed for TUEs’.

Note1: Use of Asthma medications with Diuretics or Masking Agents. If you are taking a diuretic or masking agent (for which a TUE is required) then the use of a threshold substance such as Salbutamol or Formoterol requires an additional TUE to the one granted for the diuretic or masking agent.​

Note2: The updated WADA Prohibited List comes into effect from 1 January each year. Please ensure that you check the status of your medications.

 

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