Asthma Medication & Nutritional Supplements

There are both permitted and prohibited asthma medications. Therefore, a request for a Therapeutic Use Exemption (TUE) for asthma should include a complete medical file with a clear explanation of why an alternative medication not on the prohibited list would be unsatisfactory and therefore not prescribed.

Permitted Asthma medication

Salbutamol, salmeterol and formoterol are permitted in competition and out of competition in dosages considered to be appropriate for the treatment of asthma.

Regarding salbutamol, the daily dosing time intervals are modified to 600 micrograms over eight hours starting from the time any dose is taken (previously 800 micrograms over 12 hours). This is to reduce the risk of any potential Adverse Analytical Finding’ (AAF): arising after high doses are taken at once. The total permitted daily dose remains at 1,600 micrograms over 24 hours. A TUE should be sought for doses in excess of these limits.

Inhaled Asthma medications that include salbutamol are: Airomir, Atrodual, Buventol, Ipramol, Salipra, Ventilastin and Ventoline. Inhaled Asthma medications that include salmeterol are: Seretide and Serevent. Asthma medications that include formoterol are for example: Foradil, Formoterol, Innovair, Oxis and Symbicort.

Inhaled glucocorticosteroids are permitted, do not require a Therapeutic Use Exemption (TUE)

Asthma medication requiring a TUE

Some Beta-2 agonists e.g. terbutaline is prohibited and require a Therapeutic Use Exemption (TUE). The request for a TUE should include a complete medical file with a clear explanation of why an alternative medication not on the prohibited list would be unsatisfactory and therefore not prescribed. Download the IFF TUE application form from here.

Summary of requirements for the medical file in case of asthma (attach to TUE application):

1. A complete medical history
2. A comprehensive report of the clinical examinations with specific focus on the respiratory system
3. A report of spirometry with the measure of the Forced Expiratory Volume in 1 second (FEV1)
4. If airway obstruction is present, the spirometry will be repeated after inhalation of a short acting Beta-2 agonist to demonstrate the reversibility of bronchoconstriction
5. In the absence of reversible airway obstruction, a bronchial provocation test is required to establish the presence of airway-hyper responsiveness

Examples of Beta-2 agonists including terbutaline: Bricanyl and Terbasmin.

THERAPEUTIC USE EXEMPTION (TUE) CHECKLISTS:

Nutritional Supplements

Extreme caution is recommended regarding supplement use and the IFF rather recommends a “food-first” approach.

What is a supplement?

• Supplements are manufactured products likes pills, capsules, powders, gels, drinks and bars that contain nutrients, herbs, amino acids or other substances that can affect the body.
• Typically, available over-the-counter and meant to “supplement” the diet.
• A thorough “needs analysis” and “risks analysis” should be done prior to use.

Why is supplement use a concern?

• Unlike medications, which are produced to very thorough regulatory standards (can check ingredients against the Prohibited List), the manufacturing standards for supplements are less thorough.
• While nutritional supplements are generally marketed as being healthy, taking supplements can prove risky as sometimes they can contain a prohibited substance. There are three main reasons why this can happen:
  1. The manufacturer failed to list the substance on the label
  2. The manufacturer listed the substance using a different name
  3. Cross contamination occurred during the manufacturing process.
• Neither WADA or the IFF is involved in any supplement certification process and therefore do not certify or endorse manufacturers or their products. WADA and the IFF do not control the quality of the claims of the supplement industry.

In the below WADA Talks video the dietary supplements expert, Professor Ron Maughan, to discuss supplements and their associated risks.

Useful resources:

• Informed-sport.com – A quality assurance programme for sports nutrition products, suppliers to the sports nutrition industry, and supplement manufacturing facilities.

IFF wishes to warn athletes about the risk associated with supplements and has produced a video which raises the issue: