Achilles tendon rupture

Doping taboos I read with interest your editorial entitled "Doping Taboos". I have a particular concern at present involving the use of drugs and asthmatic athletes. Up to 16% of children may have asthma and in adults this prevalence may approach 12 %. Conventional therapy for asthmatics involves the early introduction of anti-inflammatory agents such as inhaled corticosteroids with the use of short acting 02 agonists as required. Both these groups of substances are allowable by the International Olympic Committee, apart from the short acting 232 sympathomimetic fenoterol which is metabolised to para-hydroxyamphetamine. A problem that is arising in clinical practice is the use of long acting 12 sympathomimetics, notably the use of salmeterol. National guidelines on the management of asthma are moving towards the earlier introduction of this drug if the asthmatic's symptoms are not adequately controlled on 800 gg of budesonide or beclomethasone daily. In fact, the Swedish National Asthma Guidelines1 suggest that salmeterol should be introduced at this stage. Unfortunately salmeterol remains a banned substance, as confirmed by correspondence from the doping control unit of the Sports Council and from the International Olympic Committee Medical Commission.2 Salmeterol does not appear to have been abused to the same extent as clenbuterol, another long acting P2 agonist. Clenbuterol decreases fat content and increases lean body mass in animals. Doses to achieve repartitioning are far in excess of those required for bronchodilator activity.3 As salmeterol is a recognised part of the management of asthma, it does seem inappropriate that this drug remains a banned substance at present, resulting in a possible reduction in asthma control. Salmeterol by inhalation is particularly useful in prolonging protection against exercise induced bronchoconstriction, with its effects lasting for at least 12 hours4 and it is probably the most effective drug for this common complaint. As salmeterol remains a banned substance at present, a large group of patients is denied the conventional treatment which is used on a regular daily basis by a growing proportion of the asthmatic population. I would, therefore, fully support the editorial comment that theoretical consideration should not prevent the use of drugs which are given as first line orthodox treatment of common conditions.