Australian Government: Australian Sports Drug Medical Advisory Committee

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Medical conditions and TUEs

Certain medical conditions are more likely to require medications that will be on the Prohibited List, or have special conditions on their use.

If you have one of the following conditions, read the information below and show it to your doctor when you are receiving treatment.

Asthma and asthma medications (Beta-2 agonists)

Ventolin/ Asmol (Salbutamol)
Salbutamol is permitted in and out of competition in all sports when inhaled.
No TUE is required.

 However,  salbutamol is a “Threshold substance” which means its use is limited to 1600 micrograms per 24 hours or 16 puffs  (from a 100mg/puff inhaler) in a day.  If Salbutamol is required above this threshold, (as it may be for severe exacerbations or asthma emergency) AND if you are drug tested around this time then, a retroactive TUE should be applied for with support from physician.

Bricanyl (Terbutaline)
Terbutaline is prohibited both in and out of competition.  A valid TUE is required for its use.

Symbicort (Eformoterol and budesonide)
Eformoterol is permitted in and out of competition in all sports when inhaled, no TUE is required.

However, as it is a Threshold substance its use is limited to 54 micrograms per 24 hours or 9  puffs (200/6mg inhaler) in a day. If Eformoterol  is required above this threshold as it maybe for severe exacerbation or asthma emergency and if subjected to doping control, a retroactive TUE should be applied for with support from physician .

Budesonide is permitted in and out of competition in all sports when inhaled. No TUE is required

Seretide (Salmeterol/Fluticasone), Alvesco (Ciclesonide), Pulmicort (Budesonide), Flixotide (Fluticasone), Atrovent (Ipratropium), Qvar (beclomethasoneAlvesco (Ciclesonide) ARE ALL permitted in and out of competition in ALL sports when used by inhalation – no TUE is required.

ASDMAC recommends that you talk with your Doctor before using any medication.


NOTE:
Oral Prednisolone/Prednisone – are both  Prohibited In-Competition only. If you are taking this medication on a regular basis for a long period of time or if you need to use this medication during or  within 7 days of competition , then; you will require a TUE with supporting medical information to accompany the application.

Use of Asthma medication with Diuretics or other masking agents
If you are taking a diuretic (for which you will need a TUE) then The use of a Threshold substances such as Salbutamol and Eformoterol with a Diuretics (or other masking agents) requires the deliverance of a specific TUE for that substance in addition to the one granted for the diuretic or other masking agent

NOTE: ALL athletes and athletes who are in an International Federation Registered Testing Pool (RTP), ASADA's RTP and athletes in ASADA's Domestic Testing Pool (DTP) must have an in-advance TUE to inhale a prohibited beta-2 agonist. - If an athlete is unsure whether they are in an RTP or DTP they should contact their national sporting organisation.

 

Requirements for an application for a TUE for terbutaline

  1. History
    • Age of onset of asthma
    • Symptoms including trigger factors, for example exercise or allergies
    • Any associated allergic or atopic conditions
    • Relevant family history
    • History of any hospitalisation, including presentation at emergency (if any)
    • All current medication, and any previous asthma medications trialled
    • Previous requirements for oral glucocorticosteroids (if any)
  2. Examination
    • Clinical examination with particular reference to respiratory system
  3. Previous investigations
    • Any spirometry
    • Previous or current bronchodilator or bronchial provocation tests
    • Relevant tests including skin prick, RAST etc.
  4. Current evidence of asthma This includes either a positive bronchodilator or bronchial provocation test performed in the past four (4) years. The evidence must include either:
    • Reversible airway obstruction (bronchodilator test):
      • Evidence of airway obstruction with a 12% increase in FEV1 after the administration of an inhaled beta-2 agonist, or
    • A positive bronchial provocation test e.g.
      • Mannitol - 15% fall in FEV1
      • Hypertonic Saline - 15% fall in FEV1
      • EVH - 10% fall in FEV1
      • Exercise Challenge tests - 10% fall in FEV1
      • Methacholine - 20% fall in FEV1

Helpful hints:

Ensure the athlete ceases inhaled steroids and long acting Beta-2 agonists before the test (a minimum of 24 hours is suggested) and short acting Beta-2 agonists for at least 8 hours prior to the test.

The longer an athlete is off the medication, the more likely that he/she will return a positive bronchodilator test or bronchial provocation test.

Apply for a TUE

ADHD

Common medications (stimulants) that are prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD) are prohibited in sport during competition (WADA’s 2012 Prohibited List, section 6).

If you do not have a TUE and test positive for a prohibited substance, you may be sanctioned or banned from participation for a period of time.

You must get a TUE before being tested (for example before you compete) if you are classed as an athlete by the Australian Sports Anti-Doping Authority (ASADA). If you are unsure of whether or not you are classified as an athlete by ASADA, you should contact your national sporting organisation.

What medical evidence needs to be provided?

There is no specific medical test to determine the presence of ADHD, so we need more than a statement from your GP stating the condition exists.

You must also submit a separate letter from the treating specialist (paediatrician or psychiatrist) outlining:

  • the age of onset of the condition
  • the diagnostic criteria met
  • treatments trialled, in particular current and previous medications
  • history of any time off stimulant medication and the response to this.

This letter can be in the form of a summary or a recent review letter used in communication between your GP and your specialist within the last 12 months.

Apply for a TUE

Hypertension

Under the WADA 2012 Prohibited List, some medications used to treat
hypertension may be prohibited in sport.

  • Diuretics are prohibited in sport at all times (WADA’s 2012 Prohibited List, section 5).
  • Beta-blockers are prohibited in some sports only during competition, and prohibited in other sports at all times (WADA’s 2011 Prohibited List, section 2).

If you do not have a TUE and test positive for a prohibited substance, you may be sanctioned or banned from participation in sport for a period of time. This could have a serious impact on your sporting career.

You must get a TUE before being tested (for example before you compete) if you are classed as an ‘athlete’ by the Australian Sports Anti-Doping Authority (ASADA).

If you compete in shooting or archery, you are unlikely to have a TUE approved for beta blockers. This is because this medication can give you an unfair advantage over others. (Refer to WADA’s 2012 Prohibited List, section 2 for complete list of the particular sports that prohibit Beta- Blockers)

What medical evidence needs to be provided?


As well as completing the TUE form for any prohibited medications associated with the condition
hypertension, you are required to submit a separate letter from your doctor detailing:
  • your history of the condition (including blood pressure history)
  • the current treatment you are on and any treatments that have been previously tried.

If you have visited a specialist for hypertension you can also include any reports or letters from them to support your application.

Apply for a TUE