Why isn’t his mum writing him a PE excusal note when his asthma gets bad?

What, like Wiggins and his TUE you mean?

Hehe, not quite! That was using a pharmaceutical sledgehammer to crack a nut.

If I turned up at my doctors asking for a triminaclone jab because I had a big event coming up and felt a bit bunged up and wheezy, he’d tell me to bugger off, but he might up my dose of inhaled preventer medicine to get my symptoms under control so I didn’t need to use salbutamol.

Short term large dosage of reliever (salbutamol) is a product of failure to manage correctly in the longer term in most cases involving otherwise fit and healthy adults.

Well then I dread to think how much I’d weigh without salbutamol!

Reduced salbutamol use is the only possible explanation for my weight gain since my asthma was better managed. <fetches mince pie>

Well then I dread to think how much I’d weigh without salbutamol!

Well it won’t make much difference if you are just using it at levels to control asthma. But as noted on the last page, when people get the dosage a bit high it gives them the shakes, that is the effect it has on metabolism.

https://www.livestrong.com/article/381131-albuterol-for-weight-loss/

Why isn’t his mum writing him a PE excusal note when his asthma gets bad?

She would but her laptop got stolen on holiday..

I must be a hardened doper – I have no real problems with it, bit of tremor, but nothing like you’ve described.

I also avoid taking it at all costs. So when i do take it, i may not have touched it for 6 months or more (last time i needed a hit the puffer was still sealed and 3 months out of date, think they last 2 years. Probably why i get side effects.)

Again, it is used for weight control, you cycle faster by being lighter.

Guess it takes a lot of energy to shake all the time……..

People have been banned for less – from Daniel Friebe on Twitter:
Sky say Froome’s salbutamol concentration was 2000ng/ml.

Diego Ulissi got a nine-month ban for 1920ng/ml in 2014.

Petacchi got a year for
1320ng/ml in 2007.

BUT Leonardo Piepoli got no ban for levels reportedly similar to Petacchi’s in 2007

My understanding is that they weren’t banned for these concentrations; these concentrations just trigger a requirement to explain why the concentrations would be as they are. If there is a (legit) reason, then there is no price to pay. Simply triggering the threshold is not necessarily indicative of an offence. So you can’t say they were banned (or not) for these (similar) levels, they were banned because they couldn’t explain the levels.

Hence

That said, there IS a limit (as there is with caffeine) which has been breached.
That’s it, unfortunately rules are rules.

to parrot my learned friend from another thread – Nope.

A good analogy on a similar case from a cycling friend is that it’s like a police car triggering a traffic light camera. Does he automatically get a ticket? No, if he can show he was on a call and needed to then it’s wiped off; if he was just heading to Dunkin’ Donuts for a round for the station then yes he’ll get the punishment the offence deserves.

On one hand, salbutamol is not exactly tasty steak/epo/transfusion. If it was I’d be going a lot quicker up hills.

this. It’s hardly a drug that has a significant effect if any at all even though it is steroid based. I don’t have Asthma and never have, but did go through a period for a couple of years of Asthma like symptoms. It was never diagnosed as anything because in true NHS style they were not interested in actually understanding what the cause of the issue was and just treated the symptoms, so just chucked me a repeat prescription of Salbutamol which did ease my symptoms. Eventually the condition, whatever it was, subsided and I’ve been fine and off Salbutamol ever since.

What I can say it didn’t to anything to improve any aspect of performance in my life other than enabling me to breathe normally. I noticed no improvement in any physical activity and certainly didn’t become a ripped gym god over the time I was using it. I’m sure if Froome was going to go to the trouble of abusing the TUI system to legitimate take a performance enhancing drug then he’d have gone for something that would have actually had a performance enhancing effect unlike Salbutamol. Why risk the fall out and doubt over something that is not going to actually provide a performance benefit. He’s got the benefit of my doubt on this one. False news.

Only one study but oral delivery appears to have a different effect than inhaled, 4.1% increase in power output.

oral v inhaled

As others have said, not surprised

My understanding is that they weren’t banned for these concentrations; these concentrations just trigger a requirement to explain why the concentrations would be as they are. If there is a (legit) reason, then there is no price to pay. Simply triggering the threshold is not necessarily indicative of an offence. So you can’t say they were banned (or not) for these (similar) levels, they were banned because they couldn’t explain the levels.

Good point. Would be interesting to see what they did to try and explain it, that got rejected.

A good analogy on a similar case from a cycling friend is that it’s like a police car triggering a traffic light camera. Does he automatically get a ticket? No, if he can show he was on a call and needed to then it’s wiped off; if he was just heading to Dunkin’ Donuts for a round for the station then yes he’ll get the punishment the offence deserves.

It’s not quite like that. The WADA permitted intake is based on a specific number of actual inhaled doses. The urine concentration is just an indicator that the actual intake may have been exceeded. It’s up to the rider/team to show that the urine levels can be explained by something other than an excessive intake of the salbutamol.

If he’s used too much, that’s illegal regardless of whether it’s performance enhancing or not. However if he’s used a legal dosage, but there are other factors that could have increased its concentration in the urine – some sort of kidney problem or interaction with other medicine for example – and Sky can demonstrate that, then he hasn’t broken any rules.

Your analogy suggests that he could come up with a reason for having exceeded the legal-permitted dosage, but that’s not quite the same. He has to show that he didn’t exceed the dose and the urine levels can be explained by other factors.

Wiggo’s gonna be rubbing his hands together reading this, eh? Christmas come early.

all analogies will fall down in the end. The point is that triggering the camera is just an indication that the light was jumped. It’s not an offence if there’s a reason why they jumped the light.

The high urine result is at this stage just an indication there was a higher than permitted conc in the urine. It’s now up to Froome / Sky to justify why which includes showing he didn’t exceed the dose.

Thank God it is only this, from the title I was expecting to see him in a provocative pose in a revealing santa suit, and was wondering why I was actually drawn to open the thread!! Let us hope its cleared up for Christmas and he will be able to take his new bike out. 🙂

I just hope that this is concluded quickly and not dragged out until next season…

WADA: The presence in urine of salbutamol in excess of 1000 ng/mL […] will be considered as an Adverse Analytical Finding (AAF) unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic dose

So Froome has to take the legal amount of puffs under supervision then thrash himself on the turbo trainer with the heating on full blast to try to replicate the result?

the principle with Froome should be that if he is having a major asthma exacerbation in competition, his medical team should be managing it better out of competition with long-acting preventer drugs so he doesn’t need to take a larger dose on the day.

This is a really good point that deserves repeat, why is he needing big does of Salbutamol?

TBH looks dodgy to me, I think at least a ban like Petacchi got seems fair.

Only one study but oral delivery appears to have a different effect than inhaled, 4.1% increase in power output.

So about the same performance boost that some studies have shown caffeine to produce. So Salbutomol is no better performance enhancing drug than a good stiff espresso.

Why does it look dodgy?

Given the preventers (ie what asthmatics take daily to try and minimise the use of salbutamol) are cortico steroids, is there a disincentive for athletes to take them?

Would be intersting to know how accurate and reliable the test is ? If you drink more during a race does your result go down ? That’s why this is being challenged scientifically as many if these tests are less accurate than you might think.

For most stuff it’s done relative to other chemicals in the blood/urine which give a correlation for that compound to the amount in the blood.

Some drugs/chemicals only get flushed out at the same concentration they exist in the body (sweeteners like aspartame for example), some the kidneys actively filter out (or the body metabolises them into compounds they can filter out e.g. Urea), and others go the other way and the kidneys pass them back into the blood (unless you have a problem like diabetes or a kidney disease, normal sugar).

So in theory you could claim a false positive because your kidneys were doing the wrong thing (after two grand tours in a season that might not be too much of a stretch that they might be). But I’d assume WADA/UCI have validated the tests and that SKY have probably exhausted that deffence if they haven’t.

Why does it look dodgy?

Because he’s tested positive with levels that would imply he took 32 successful puffs (which is difficult in itself) on his inhaler a day.

Given the preventers (ie what asthmatics take daily to try and minimise the use of salbutamol) are cortico steroids, is there a disincentive for athletes to take them?

Yes, I do wonder if Froome has resisted TUEs and cortico-steroids after seeing Wiggo’s woes.

Still rules is rules, I’m sure he’ll be treated reasonably but if there’s no valid excuse I won’t cry if he gets a ban. Would certainly shake things up a bit.

The news has come out three months after the test as Team Sky have been trying to explain it so I think it isn’t explainable otherwise they wouldn’t have released it like this.

Why does it look dodgy?

It looks dodgy because there are better ways to control asthma, and the amount of salbutamol taken is way above the WADA limit.

Clearly what they need to prevent abuse is a gadget that automatically administers drugs when it detects the rider is at risk of death through asphyxiation. Only then can we know for sure they really needed them.

Salbutamol is renally excreted, but one of the issues is accumulation. Although it only has a relatively short active half-life at the beta adrenergic receptor in the lung, it is eliminated with a half-life of 4-6 hours. If you take it every half-life, then you will see concentrations in blood effectively double. A bit like when you drink more than one unit of alcohol per hour 😉

Now the urine bit… Salbutamol can be concentrated in urine. Cyclists have to give a sample immediately after a race – when they are dehydrated. That leads to an over-concentration of salbutamol in urine, and the thresholds take this into account. We were asked to review this issue for WADA a few years ago – it was possible to fail a salbutamol urine test (and test for inactive metabolite) without having taken excessive doses.

Nothing to see here, and back to my day job (Oncology today)

A Clinical Pharmacologist

EDIT: and this publication may be useful in the defence https://www.ncbi.nlm.nih.gov/pubmed/21083771

The news has come out three months after the test as Team Sky have been trying to explain it so I think it isn’t explainable otherwise they wouldn’t have released it like this.

They released it because it had been leaked to the Guardian and Le Monde rather than because they’d failed to explain it I think. The process is ongoing. Otherwise he’d have been sanctioned no?

When I was at school the asthmatic kid was always the last to be picked for playground footie. It’s fabulous to see so many pro cycling teams righting that wrong.

Thanks for that input TiRed, good to have some facts.

@JeroenSwart on Twitter is making some good points on this subject this morning. (I can’t get onto twitter on work laptop to copy & paste).

Probably as the vast majority of the people commenting get their “understanding” of the rules from reading the papers. Rather than the rule book.

I have low level asthma, i never get attacks as such, and very rarely use inhalers at all in summer months, i only seem to get symptoms when it is cold and when i am going down with something.

The GP states to take 1-2 puffs first thing in morning, then the same in evening, but when i get a thick cold and this goes down on to my chest, then the advice is to up the dose to 7-8 times a day, so could easily be 14-16 puffs a day, even then it doesn’t seem to have much effect.

The thing is he would have declared to WADA his condition and the fact that he was Salbutomol, he would of been tested every day as well so to purposefully taken to excess such a simple drug that gives little performance enhancement and for which he knows they would definitely have been testing for as he’d declared would be pretty stupid by anyones standard?

Yeah, it’s amazing how they actually manage illnesses these days, rather than assuming it’s due to not doing enough exercise.

Why does it look dodgy?
Because he’s tested positive with levels that would imply he took 32 successful puffs (which is difficult in itself) on his inhaler a day.

We were asked to review this issue for WADA a few years ago – it was possible to fail a salbutamol urine test (and test for inactive metabolite) without having taken excessive doses.

scotroutes » When I was at school the asthmatic kid was always the last to be picked for playground footie.

nah to be fair it was because I was crap.

Because he’s tested positive with levels that would imply he took 32 successful puffs (which is difficult in itself) on his inhaler a day.

As an asthma sufferer and if it flares up then 32 puffs in a day would be very easy to do. That’s only 2 – 3 puffs an hour for 12 hours.

It’s no smoking jiffy bag.

Probably as the vast majority of the people commenting get their “understanding” of the rules from reading the papers. Rather than the rule book.

I quoted WADA upthread. It’s dodgy.

I’m sure Dave B. will have all the necessary paperwork. Won’t he?

So, is this an actual technical anti-doping violation?

I’d piss myself laughing if it turns out Wiggins gets away with ‘legal’ doping but Froome gets popped for ‘legal’ use. 😆

Now, where’s that DAF youtube clip of Froome sucking on a respirator then disappearing up the mountain leaving everyone for dead…. DAF is DAF…

As an asthma sufferer and if it flares up then 32 puffs in a day would be very easy to do. That’s only 2 – 3 puffs an hour for 12 hours.

As a fellow sufferer I agree. However if I was that sick I’d barely be able to ride a bike let alone at world class pace.

My thoughts:

Contador was busted because he was using Clen in the off season to control his weight and extracted a blood bag when he thought it was out of his system. When he microdosed the blood bag at the 2010 TdF, he tripped the test for Clen. That’s why the amount was so miniscule.

Froome has been busted as he’s been using Salbutamol (taken orally) during the off season to control his weight. He has also extracted a blood bag. When he’s microdosed the blood after his bad stage 17 performance, the amount of Sal was enough that, when combined with his normal usage of Sal the next day, it tripped the test for excessive Sal.

Contador took the punishment for Clen as it was much less than the punishment for blood manipulation. Froome will probably do the same.

Just a theory. Feel free to demolish it! (and everyone should read “The Secret Race”. There’s nothing in there that still couldn’t be done today.)