Asthma medication in Sport

Asthma inhalers with glucocorticoids (=cortisone, eg. beclometasone, budesonide, fluticasone) or cromoglicic acid are permitted and can be used directly.

The following active ingredients from the group of so-called beta-2 agonists may be inhaled. However, a certain permitted dose must not be exceeded:

• salbutamol up to 600 µg over 8 hours and a maximum of 1600 µg over 24 hours
• salmeterol up to 200 µg over 24 hours
• formoterol up to 54 µg over 24 hours
• vilanterol up to 25 μg over 24 hours

Thus, for example, an asthma inhaler containing salbutamol at the common dose of 100 µg/puff may be inhaled 6 times in 8 hours. After 8 hours, another 6 puffs may be inhaled, and after another 8 hours, another 4 puffs (equivalent to 1600µg of salbutamol over 24 hours).

No Therapeutic Use Exemption is required for the use of salbutamol, salmeterol, formoterol or vilanterol if the permitted dosages are observed.

Pharmaceuticals the can be inhaled to a certain dosage are marked with a yellow exclamation mark in or database NADAmed. The information text always states up to which dosage this pharmaceutical may be used.

The inhalation of the beta-2 agonists salbutamol, salmeterol, formoterol or vilanterol is prohibited if the permissible dosage is exceeded.

The inhalation of other beta-2 agonists such as fenoterol, reproterol, indacaterol, olodaterol or terbutaline is also prohibited.

Furthermore all beta-2 agonists are prohibited when used orally (e.g. as tablets or syrup) or when given per injection.

Oral glucocorticoids (=cortisone, eg. as tablets or syrup), which are sometimes used for severe cases of Asthma, are prohibited in-competition, but permitted out-of-competition.

Prohibited substances and pharmaceuticals are marked with a red X in our medical database NADAmed.

In some cases, asthma medications are inhaled via an electric nebuliser. Please see question 4 “What do I have to consider when using nebulisers?” for more information.

Inhalers for asthma therapy often contain several active ingredients. These can be:

• beta-2 agonists (e.g. salbutamol)
• glucocorticoids (e.g. fluticasone, budesonide)
• anticholinergics (e.g. ipratropium bromide)

Since inhaled glucocorticoids and anticholinergics are permitted at all times, it is primarily the beta-2 agonists contained in them that must be checked for their doping relevance. If these are salbutamol, salmeterol, formoterol or vilanterol, their use is permitted up to the above-mentioned dosages. Inhalers containing other beta-2 agonists, e.g. fenoterol, indacaterol or reproterol, are prohibited at all times.

In some cases, beta-2 agonists, especially salbutamol, are inhaled with a so-called nebuliser. Nebulisers are electrically operated devices into which a medication solution is filled and which produce a continuous fine mist for inhalation.

The use of salbutamol, salmeterol, formoterol or vilanterol by nebuliser is not explicitly prohibited, but due to the high and uncontrolled release of the active ingredient, the permitted limits can quickly be exceeded. Such administration via a nebuliser is considered a prohibited use and requires a Therapeutic Use Exemption (see question 6 for more information).

The use of active substances that are permitted at any time (e.g. saline solution, ipratropium bromide or inhaled glucocorticoids) is also permitted by means of a nebuliser.

Diuretics (“water pills”) are prohibited at all times under WADA's doping regulations. Athletes who use both a diuretic and salbutamol or formoterol must apply for a Therapeutic Use Exemption for both the diuretic and the asthma medication. This also applies if salbutamol or formoterol are used below the maximum permitted dosage.

For more information on how and when to apply for a Therapeutic Use Exemption, see the next section.

If athletes need to use prohibited asthma medication, they need a Therapeutic Use Exemption (TUE).

Testing pool athletes and athletes in certain professional leagues must apply to NADA Germany for a TUE before use. Further information on the application process can be found at nada.de/en/medicine/in-case-of-disease/regulation-for-testing-pool-athletes.

Non-testing pool athletes must apply for a TUE only after a doping test. Should this become necessary, NADA Germany will inform them in writing about the further procedure. Further information for non-testing pool athletes can be found at nada.de/en/medicine/in-case-of-disease/regulation-for-non-testing-pool-athletes.

No, according to WADA's rules, such medical certificates are not necessary. It is sufficient to declare all medications used on the doping test form during a test. Should further steps become necessary, NADA will notify you.

However, athletes in the testing pool who were granted a therapeutic use exemption should carry a copy of the approval with them when competing.

The WADA Prohibited List is valid worldwide. This means that substances that are banned or permitted in Germany are also banned or permitted in other countries.

Non-testing pool athletes who have to use a prohibited substance and are competing in international competitions should, however, enquire in advance at the international sports federation about the regulations for Therapeutic Use Exemptions that apply there. It is possible that non-testing-pool athletes will also have to apply for a therapeutic use exemption in advance.