“I am not getting any younger but I am getting faster and stronger, so Houshang must be doing something right.”
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athletes, cycling, willock, plaxton

Asthma and Exercise Induced Bronchospasm in Cycling

by: Dr. Ben Sporer, Sport Physiologist

September 09, 2009

Cycling is a sport that for many of us presents an arena in which to challenge ourselves both mentally and physically. In both training and competition, you push yourself through physical barriers regularly trying to improve your times and ability to tolerate pain. Now imagine yourself on a long climb, breathing hard trying to push the pace (or stay with the pack in my case) and someone asks you to breathe through a straw the size of a quarter. You’d probably laugh at them and dismiss the request as ludicrous — maybe even respond with a few curses and requests of your own. However, this is exactly what it would feel like if you experienced asthma type symptoms while riding.

I’ve often been asked about why so many cyclists use inhalers — sometimes with the cynical undertones that many use it to enhance performance. As much as cycling fans have been rightfully disheartened by recent doping scandals, it isn’t a fair assessment to automatically lump inhaler use into this same category. Rather, I’d suggest that one looks to the science and evidence than rely on conjecture and subjective opinion. First off though it is important to understand what asthma is and why it can affect performance.

Asthma is a lung disorder that results in a reduced ability to move air in and out due to a narrowing of the airways. This narrowing is often due to an inflammatory response but can also be a result of bronchospasm in response to different triggers. One such trigger is the high breathing rate associated with exercise that causes the smooth muscles of the airways to contract. This asthma like response is often referred to as exercise induced bronchospasm (EIB). As you could imagine, breathing would be extremely difficult and for those riders with asthma or EIB; they are clearly competing at a disadvantage.

Fortunately there are medications to help manage the symptoms allowing athletes to compete on a level playing field. The most commonly prescribed medications for management of asthma and EIB symptoms are inhaled corticosteroids and β2-agonists. Inhaled corticosteroids are effective in minimizing the inflammation associated with asthma while inhaled β2-agonists provide short term relief and prevention of bronchospasm.

So why the large numbers of cyclists using inhalers? The current research suggests that the high number is likely indicative of an increased awareness of EIB in addition to asthma. Although asthma is present in about 5-10% of the general population, data suggests that up to 50% of some athlete subgroups experience compromised lung function. In recent testing prior to the 2008 Beijing Olympic Games approximately 70% of swimmers and 20% of cyclists tested positive for asthma or EIB in Canada. In another group of cyclists and triathletes we found that ~18% of those tested produced a positive result for airway bronchospasm. What does this mean? It would suggest that many of the cyclists you see using inhalers at competition are likely doing so for medical reasons. Another factor to consider is that many athletes have been prescribed inhalers by their physicians without ever having being tested for asthma or EIB. Rather than having intent to enhance performance, these cyclists are simply following recommendations to deal with occasional symptoms that may only be related to previous colds or allergies. It would be fair to assume that this would apply to a portion of those observed using inhalers at races.

But what about those athletes that don’t have a medical reason for an inhaler — are they getting an unfair advantage? Rest assured they are not. There is little evidence to suggest that inhaled asthma medications provide an unfair advantage. The current research overwhelmingly suggests that inhaled salbutamol (the most commonly used asthma medication in sport) does not enhance athletic performance. Still, one might argue that athletes believe in its effectiveness and potentially misuse the medication by taking higher doses than prescribed. However we recently investigated the dose response of up to 800g of inhaled salbutamol (4x recommended therapeutic dose) in 27 competitive cyclists and triathletes on time trial performance. No differences were found in performance time, average power output, average heart rate, or ventilatory parameters regardless of dose. If anything, athletes misusing asthma inhalers run the risk of doping violations (β2-agonists are monitored by WADA and banned for athletes without a therapeutic use exemption) and possible health implications.

With further education and awareness in the cycling community, hopefully there will be a greater understanding of the challenges asthmatic athletes face. Asthma medications play an important role in a comprehensive management plan for many cyclists and allow them to compete on a level playing field. Although the possibility for misuse exists, the end result is more likely to have negative implications for the athlete (doping violations, health, etc.) than performance enhancement.

Dr Ben Sporer is an applied sport physiologist working out of the Canadian Sport Centre Pacific in Victoria, BC, Canada. He brings a variety of experiences in applying science to practical planning and training solutions and currently works with the Canadian Cycling, Triathlon and Snowboard Teams. His areas of interest include performance optimization, athlete monitoring, and environmental influences on exercise and athletic performance. Ben currently holds adjunct appointments in the Faculty of Medicine at UBC and the School of Exercise Science, Physical and Health Education at the University of Victoria.


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