Sky High on Salbutamol?

Twitter has reacted quite badly, in the normal way expected to the piece on road.cc about ‘A third of Team Sky’s riders are asthmatic‘. It’s probably worth taking a look at some pretty obvious reasons why asthma diagnosis is higher in professional athletes than it is through a sedentary population.

For convenience, lets split the UK’s population into four groups, I’m going to make some estimates on percentages of the population, it’s not necessary to be precise on this small study, just indicative of what’s actually going on & where the statistics come from.

  1. The professional sportspeople. Lets be very generous & include the top amateurs in each sport too & give this lot 1% of the total population. These people test themselves to the limits in training & competition, if there’s any exercise induced asthma going on here, it’s going to be caught & diagnosed as such. It’s a condition that cannot go unnoticed at this level.
  2. The fun, competitive & hobby athlete. These may account for up to 10% of the population, I’m including people who take part in any sport, at any level other than elite. So runners, cyclists, martial arts, etc. These people probably push themselves quite hard, if they’re getting serious about their sport it’s likely that they’ve pushed themselves beyond the point where exercise induced asthma may kick in. So there’s a reasonably high chance that somebody in this category will have been to the doctor if it’s happened & got themselves an inhaler, but not nearly as many as in the category above, it may just not be that important to them or affect them that much for what they want to achieve.
  3. Obese & overweight sadly account for approximately 63% of the adult population according to studies. It’s highly unlikely that many of this lot actually push themselves to induce exercise induced asthma. We can assume if they did regular exercise, they wouldn’t be overweight. So I’m also assuming that the bulk of them don’t get diagnosed with asthma due to this. A very hefty part of the population who will be almost removed from the statistics based on this assumption.
  4. The normal fit & healthy part of the population. Unfortunately we’re left with only 26% of the population who fit into this category. I would imagine that they do some sort of exercise, so are reasonably likely to have been diagnosed if there is a problem.

The Assumption

I think asthma exists in many more than the 8 to 10% that have been diagnosed, probably more likely at the levels noticed in elite athletes. If we look at the groups above, I would assume that the same percentage across each group have exercise induced asthma, but the diagnosed percentage is very different. If Asthma is present in an individual, it probably has very little effect on groups 3 & 4, some effect on many in group 2 & would cause anybody in group 1 very big problems. So asthma is more likely to be diagnosed in groups 1,2 & 4, but less so in group 3. So we’re missing a huge proportion from the statistics, 8 to 10% is simply wrong, it’s much more prevalent than that.

You’ve probably noticed that in your bike club there’s plenty of folks using inhalers, probably more than that 10%. You wouldn’t assume that your club-mates are doping salbutamol in order to beat you on your local chain gang, would you? If you do, that’s the same mindset that assumes that somebody on team Sky is doping with¬†salbutamol.

We can obviously discount the extremes here, there are some riders who have been caught with huge quantities of salbutamol in their bodies, they probably are cheating. As an asthmatic myself, I’ve found that if I felt a bit wheezy before a race I’d take a couple of puffs, that usually sorted it, but if not 2 more later. If I still felt wheezy I normally didn’t start. My peak flow was never more than 15% below what it should be for somebody like me, so even with 4 puffs I was still at a disadvantage to an ‘able bodied’ rider. I did experiment once to see if I could get my breathing level with a ‘normal’ person, I couldn’t, beyond 4 puffs across an hour it made no difference whatsoever, I was still well below average, plus the additional puffs made me feel particularly ill, probably not ideal if you were in a race.

If somebody’s cheating with salbutamol, they’re not going to be doing it with an inhaler, it’ll be injected in large quantities, an inhaler will make little difference, if at all to a non asthmatic. The guy in your club, Chris Froome, or any of the huge percentage of pro cyclists who use an inhaler & are diagnosed with asthma are not cheating, they’re still below the peak flow of a non asthmatic. The nonsense posted on twitter has probably got road.cc plenty of hits, which I suspect is what it’s all about, but it’s a non story.

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5 Responses

  1. Stu

    I’m an asthmatic myself and have been since I was about 5 years old. Used to to be in hospital at least once a month due to asthma attacks until my mum and dad paid a small fortune for a nebuliser for the house. Back then they were dear, and probably still are.

    I now find that the fitter I am the less I need to use my inhaler. I find if it’s an extremely cold or warm day, the later we rarely get in Scotland, I need a couple of puffs.

    I don’t race but do Sportives and social rides raising money for our local Cancer Charity. Certainly when I need to take my inhaler, due to having a wheezy chest, I notice a difference but wouldn’t say it gave me super energy or catapulted my ability further than my capabilities or gained me an advantage over anyone else.

    As you said you’d really need to inject high levels of Salbutamol to gain any form of advantage if any at all. A couple of puffs of your inhaler ain’t going to give you that advantage.

  2. Alex

    Thanks for writing a reasoned piece on this, it does a good job of expressing something I’ve felt for a while. I don’t doubt that TUE abuses happen but as with most things it’s probably marginal as you’ve demonstrated.

    Worth also noting that a side effect of abusing ashma inhalers is an increased risk of heart attack (the reason you felt I’ll after overdosing, a lot like downing 6 shots of espresso), something which I doubt amateur racers realise but pro’s probably do so I suspect pros looking for a marginal gain will look elsewhere first.

  3. Rob Booth

    So unlike a genetic limit in one’s hematocrit level that cannot be manipulated up with EPO as that’s doping, it’s OK to dope for a genetic condition that limits one’s breathing known as exercise induced asthma?

    1. Alex

      That is a valid point. I think I’d argue thought that there is a difference in that EPO gives a huge boost and its a huge boost above what you are physically capable of while medicine allows you to compete up to your physical ability.

      Its a huge grey area though as you point out, what defines ‘physically capable’ is a tangle of many factors in the same way that it’s a grey area between treating a weakness (allowed, medicine) compared to doping (not allowed, performance enhancement).

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