Expert Comment: Chris Froome and high salbutamol urine concentration

Dr John Dickinson, the UK's foremost expert in asthma in elite athletes, comments on the news that champion cyclist Chris Froome returned an 'adverse' drugs test at the Vuelta a Espana (Tour of Spain).

Has he cheated?

At this stage it’s not clear. It is possible for an athlete to provide salbutamol concentration despite using inhaled doses within the Anti-Doping rules (no more than 800 µg inhaled salbutamol in a 12 hour period, equivalent to 8 puffs of a standard inhaler). Furthermore at the doses he will have used his inhaler there is no evidence he will gain a performance enhancing effect, as shown in our own and others research.

If he has taken doses within the normal limit why has his salbutamol level got so high?

There are complex medical and physiological issues which affect the metabolism and excretion of Salbutamol. Therefore in some individuals they may have a greater metabolism and excretion rate of salbutamol that may cause the salbutamol concentration to be increased. The World Anti-Doping Agency are aware of this and they will ask any athlete with adverse levels of salbutamol to provide evidence to explain why.

How could this be avoided?

Athletes can manage their asthma related condition using a variety of therapy.

Optimisation of therapy should focus on prevention rather than emergency care.

Prevention therapy includes using inhaled medication that reduces airway inflammation (inhaled corticosteroids) and in some cases using inhaled medication that relaxes the muscle around the tubes carry air in the lungs to keep them open (inhaled long acting β2-Agonists). Using a combination of these inhalers reduces incidence of asthma symptoms and the need to use emergency inhalers such as salbutamol. If symptoms start to present prevention therapy can be modified to reduce the symptoms and therefore reduce the need to frequently use high doses inhaled salbutamol therapy to treat respiratory symptoms.

Dr John Dickinson is head of the respiratory clinic at the University of Kent and lecturer in the School of Sports and Exercise Sciences. He carries out breathing assessments at Medway Park Sports Centre. He has tested Olympians and elite athletes from almost every sport, including GB cyclists and members of Team Sky.

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