Bronchial challenges in athletes applying to inhale a β2-agonist at the 2004 Summer Olympics

Background: The International Olympic Committee Medical Commission required a medical justification for athletes to inhale a beta(2)-agonist before an event at the Summer Games in Athens in 2004. Objective: We sought to establish the percentage of athletes applying to use an inhaled beta(2)-agonist on the basis of the results of objective tests to establish a diagnosis of asthma or exercise-induced bronchoconstriction. We also sought to compare this percentage with the percentage of athletes simply notifying the intention to use a beta(2)-agonist at the previous Summer Games in Sydney in 2000. Methods: An analysis was made of tests that measured the change in FEV1 in response to a bronchodilator or in response to a provoking stimulus, such as exercise, eucapnic voluntary hyperpnea, hypertonic saline, or methacholine. Results: Ten thousand six hundred fifty-three athletes competed in Athens; 4.2% were approved to use a beta(2)-agonist, and 0.4% were rejected. This approval rate was 26% less than the notifications in 2000 in Sydney (5.7%). Compared with Sydney 2000, there was a significant reduction of submissions and approvals for athletes from the United States, New Zealand, Australia, and Canada and in triathlon and swimming sports. Conclusion: The need to provide objective testing has resulted in a reduction in the number of athletes seeking approval to use an inhaled beta(2)-agonist. Objective evidence has provided information for the doctor that is likely to improve the health of the athlete because many athletes appeared to be undertreated at the time of testing. Clinical implications: We show that documentation of airway narrowing in athletes, particularly in response to exercise or surrogate stimuli for exercise, aids in the diagnosis and management of asthma by providing evidence of bronchial hyperresponsiveness that will respond to treatment with inhaled corticosteroids and is usually associated with a reduction in respiratory symptoms on exercise.