Impact of changes in anti-doping regulations (WADA Guidelines) on asthma care in athletes.

Objective: To investigate how changes to the World Anti-Doping Agency (WADA) guidelines on asthma medication requests have impacted the management of asthmatic athletes in Portugal.

Design: Retrospective analysis of asthma medication requests submitted in 2008 to 2010.

Setting: Portuguese Anti-Doping Authority database.

Participants: Athletes requesting the use of inhaled corticosteroids and/or β2-agonists.

Independent Variables: Demographic, therapeutic, and diagnostic test data.

Main Outcome Measures: Yearly changes in number of asthma medication requests and diagnostic procedures.

Results: We analyzed 326 requests: 173 abbreviated Therapeutic Use Exemptions (TUEs) in 2008 (objective tests not required), 9 Declaration of Use (DoU) and 76 TUEs in 2009, and 39 DoU and 29 TUEs in 2010. Spirometry was performed in 87% and 37% of athletes in 2009 and 2010, respectively; the corresponding figures for bronchoprovocation were 59% and 16%, almost all positive in both years.

Conclusions: Applications for inhaler use have decreased by approximately half since objective asthma testing became mandatory. Our findings show that WADA guidelines have an impact on asthmatic athletes care: In 2009 a more rigorous screening was possible, leading to withdrawal of unnecessary medication. Constant changes, however, jeopardize this achievement and nowadays introduce safety issues stemming from the unsupervised use of inhaled β2-agonists.