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Jeppesen JS, Jessen S, Thomassen M, Backer V, Bangsbo J, Hostrup M. Inhaled beta 2 -agonist, formoterol, enhances intense exercise performance, and sprint ability in elite cyclists. Scand J Med Sci Sports 2024; 34:e14500. [PMID: 37880916 DOI: 10.1111/sms.14500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Many athletes use long-acting beta2 -agonist formoterol in treatment of asthma. However, studies in non-athlete cohorts demonstrate that inhaled formoterol can enhance sprint performance calling into question whether its use in competitive sports should be restricted. We investigated whether formoterol at upper recommended inhaled doses (54 μg) would enhance sprint ability and intense exercise performance in elite cyclists. METHODS Twenty-one male cyclists (V̇O2max : 70.4 ± 4.3 mL × min-1 × kg-1 , mean ± SD) completed two 6-s all-out sprints followed by 4-min all-out cycling after inhaling either 54 μg formoterol or placebo. We also assessed cyclists' leg muscle mass by dual-energy X-ray absorptiometry and muscle fiber type distribution of vastus lateralis biopsies. RESULTS Peak and mean power output during the 6-s sprint was 32 W (95% CI, 19-44 W, p < 0.001) and 36 W (95% CI, 24-48 W, p < 0.001) higher with formoterol than placebo, corresponding to an enhancing effect of around 3%. Power output during 4-min all-out cycling was 9 W (95% CI, 2-16 W, p = 0.01) greater with formoterol than placebo, corresponding to an enhancing effect of 2.3%. Performance changes in response to formoterol were unrelated to cyclists' VO2max and leg lean mass, whereas muscle fiber Type I distribution correlated with change in sprinting peak power in response to formoterol (r2 = 0.314, p = 0.012). CONCLUSION Our findings demonstrate that an inhaled one-off dose of 54 μg formoterol has a performance-enhancing potential on sprint ability and short intense performance in elite male cyclists, which is irrespective of training status but partly related to muscle fiber type distribution for sprint ability.
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Affiliation(s)
- Jan S Jeppesen
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Søren Jessen
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Martin Thomassen
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Bangsbo
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
| | - Morten Hostrup
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports (NEXS), University of Copenhagen, Copenhagen, Denmark
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Hostrup M, Jessen S. Beyond bronchodilation: Illuminating the performance benefits of inhaled beta 2 -agonists in sports. Scand J Med Sci Sports 2024; 34:e14567. [PMID: 38268072 DOI: 10.1111/sms.14567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/29/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
Given the prevalent use of inhaled beta2 -agonists in sports, there is an ongoing debate as to whether they enhance athletic performance. Over the last decades, inhaled beta2 -agonists have been claimed not to enhance performance with little consideration of dose or exercise modality. In contrast, orally administered beta2 -agonists are perceived as being performance enhancing, predominantly on muscle strength and sprint ability, but can also induce muscle hypertrophy and slow-to-fast fiber phenotypic switching. But because inhaled beta2 -agonists are more efficient to achieve high systemic concentrations than oral delivery relative to dose, it follows that the inhaled route has the potential to enhance performance too. The question is at which inhaled doses such effects occur. While supratherapeutic doses of inhaled beta2 -agonists enhance muscle strength and short intense exercise performance, effects at low therapeutic doses are less apparent. However, even high therapeutic inhaled doses of commonly used beta2 -agonists have been shown to induce muscle hypertrophy and to enhance sprint performance. This is concerning from an anti-doping perspective. In this paper, we raise awareness of the circumstances under which inhaled beta2 -agonists can constitute a performance-enhancing benefit.
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Affiliation(s)
- Morten Hostrup
- Department of Nutrition, Exercise and Sports, The August Krogh Section for Human Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Søren Jessen
- Department of Nutrition, Exercise and Sports, The August Krogh Section for Human Physiology, University of Copenhagen, Copenhagen, Denmark
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Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports 2024; 34:e14358. [PMID: 36965010 DOI: 10.1111/sms.14358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.
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Affiliation(s)
- Morten Hostrup
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erik S H Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Søren Jessen
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
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Hostrup M, Weinreich C, Bjerre M, Kohlbrenner D, Bangsbo J, Jessen S. Inhaled salbutamol induces leanness in well-trained healthy females but not males during a period of endurance training: a randomised controlled trial. ERJ Open Res 2023; 9:00657-2023. [PMID: 38152086 PMCID: PMC10752270 DOI: 10.1183/23120541.00657-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/24/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction Many athletes use short-acting inhaled β2-agonists multiple times weekly during training sessions to prevent exercise-induced bronchoconstriction, but it is unclear if treatment impairs training outcomes. Herein, we investigated performance adaptations in well-trained females and males training with prior inhalation of salbutamol. Methods 19 females and 21 males with maximal oxygen uptake (V'O2max) of 50.5±3.3 and 57.9±4.9 mL·min-1·kg-1, respectively, participated in this double-blinded, placebo-controlled, parallel-group study. We randomised participants to placebo or salbutamol inhalation (800-1600 µg·training day-1) for 6 weeks of combined endurance (1× per week) and high-intensity interval training (2× per week). We assessed participants' body composition, V'O2max and muscle contractile function, and collected vastus lateralis muscle biopsies. Results Salbutamol induced a sex-specific loss of whole-body fat mass (sex×treatment: p=0.048) where only salbutamol-treated females had a fat mass reduction compared to placebo (-0.8 kg at 6 weeks; 95% CI: -0.5 to -1.6; p=0.039). Furthermore, salbutamol-treated females exhibited a repartitioning effect, lowering fat mass while gaining lean mass (p=0.011), which was not apparent for males (p=0.303). Salbutamol negatively impacted V'O2max in both sexes (treatment main effect: p=0.014) due to a blunted increase in V'O2max during the initial 4 weeks of the intervention. Quadriceps contractile strength was impaired in salbutamol-treated females (-39 N·m; 95% CI: -61 to -17; p=0.002) compared to placebo at 6 weeks. Muscle electron transport chain complex I-V abundance increased with salbutamol (treatment main effect: p=0.035), while content of SERCAI, β2-adrenoceptor and desmin remained unchanged. Conclusion Inhaled salbutamol appears to be an effective repartitioning agent in females but may impair aerobic and strength-related training outcomes.
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Affiliation(s)
- Morten Hostrup
- August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Weinreich
- August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Bjerre
- August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Dario Kohlbrenner
- August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bangsbo
- August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Søren Jessen
- August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Panchal T, Baldwin S, Østergaard M, Hansen ESH, Backer V, Hostrup M, Daley-Yates P. Assay validation for vilanterol and its metabolites in human urine with application for doping control analysis. Drug Test Anal 2022; 15:495-505. [PMID: 36581315 DOI: 10.1002/dta.3433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
A bioanalytical method for detecting the ultra-long-acting beta2 -agonist (U-LABA) inhaled vilanterol and its metabolites, GSK932009 and GW630200, in urine was developed to potentially monitor permitted therapeutic versus prohibited supratherapeutic use in sport. The World Anti-Doping Agency (WADA) has established urinary concentration thresholds for the beta2 -agonists salbutamol and formoterol. Therapeutic use of vilanterol (25 μg once daily) was recently permitted by WADA; however, there is no established decision limit for adverse analytical findings due to insufficient urine concentration data. In this study, we validated an assay to detect vilanterol in urine collected from four healthy male and female athletes 0-72 h who received inhaled corticosteroid fluticasone furoate/U-LABA vilanterol (800/100 μg) combination, four times the normal therapeutic dose. After administration, subjects performed 1 h of bike ergometer exercise. The experiment was conducted again after repeat dosing for 1 week. Our method utilised liquid chromatography with tandem mass spectrometry and was validated over urine concentrations of 5-5000 (vilanterol) and 50-50,000 pg/ml (GSK932009 and GW630200). Plasma samples were analysed for vilanterol, using a previously validated assay. The peak concentration values for urine vilanterol, GSK932009 and GW630200 were 9.5, 10.4 and 0.17 ng/ml, for single dosing, and 18.6, 19.5 and 0.20 ng/ml, for repeat dosing. Urine samples from four volunteers using the final validated method are reported, demonstrating this assay has sensitivity to detect vilanterol or GSK932009 in urine for ≥72 h post single or repeat dosing with 800/100 μg fluticasone furoate/vilanterol, whereas GW630200 was quantifiable ≤4 h post dose.
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Affiliation(s)
- Tina Panchal
- Bioanalysis, Immunogenicity and Biomarkers, GSK, Research and Development, Stevenage, UK
| | - Sandra Baldwin
- Drug Metabolism & Pharmacokinetics, GSK, Research and Development, Ware, UK
| | - Martin Østergaard
- Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
| | - Erik Soeren Halvard Hansen
- Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark.,Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark.,Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hostrup
- Department of Nutrition, Exercise and Sports, The August Krogh Section for Human Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Peter Daley-Yates
- Clinical Pharmacology & Experimental Medicine, GSK, Research and Development, Stockley Park, UK
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Helge T, Godhe M, Berglund B, Ekblom B. Inhaling salbutamol may decrease time to exhaustion in some contexts of heavy endurance performances. Eur J Sport Sci 2022; 23:766-773. [PMID: 35392766 DOI: 10.1080/17461391.2022.2063071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To study the effect of inhaling a beta-agonist (salbutamol) compared to placebo on skiing and cycling performance in well-trained elite athletes. METHODS Three different exercise protocols were used, all with a cross-over double blind placebo-controlled design. Participants inhaled 800 µg salbutamol or a placebo prior to the test, which was repeated on a following day with the participants inhaling the other substance. Fifteen junior elite skiers performed four free-style high intensity sprints (1100 m/work time 3.5 - 4.5 min). Twelve elite cyclists carried out a short cycling protocol, starting with two 5 min submaximal workloads followed by a maximal intermittent performance test to exhaustion. Another 12 elite cyclists performed the maximal intermittent performance test to exhaustion after a 150 min long submaximal cycling protocol. RESULTS Group mean time for the ski sprints increased, with no difference between treatment groups. In the short cycling protocol time to exhaustion was 9.1% (95% CI 52 to 161) lower after inhaling salbutamol compared to placebo and in the long cycling protocol time to exhaustion was 9.1% (95% CI -121 to 267) lower after inhaling salbutamol compared to placebo. Blood lactate, heart rate and ventilation increased during submaximal exercise with salbutamol compared to placebo in the short cycling protocol (p < 0.05). CONCLUSION This study could not confirm any positive performance effects from inhaling 800 µg salbutamol compared to placebo in skiing and cycling high-intensity intermittent performance. Instead, time to exhaustion in the maximal intermittent performance test was lower in both cycling protocols.
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Affiliation(s)
- T Helge
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - M Godhe
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - B Berglund
- Inst. Med, Karolinska University Hospital, Stockholm, Sweden
| | - B Ekblom
- Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
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Lourenço O, Cardoso A, Mónico B, Gama JMR, Neiva HP, Marinho DA. β2-adrenergic agonists and doping: Where do we stand? Allergy 2021; 76:2320-2321. [PMID: 34192372 DOI: 10.1111/all.14830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Olga Lourenço
- Faculty of Health Sciences University of Beira Interior Covilhã Portugal
- CICS‐UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | - Ana Cardoso
- Faculty of Health Sciences University of Beira Interior Covilhã Portugal
| | - Beatriz Mónico
- Faculty of Health Sciences University of Beira Interior Covilhã Portugal
| | - Jorge M. R. Gama
- Centre of Mathematics and Applications (CMA‐UBI) University of Beira Interior Covilhã Portugal
| | - Henrique P. Neiva
- Department of Sport Sciences University of Beira Interior Covilhã Portugal
- Research Center in Sports Sciences Health Sciences and Human DevelopmentCIDESD Covilhã Portugal
| | - Daniel A. Marinho
- Department of Sport Sciences University of Beira Interior Covilhã Portugal
- Research Center in Sports Sciences Health Sciences and Human DevelopmentCIDESD Covilhã Portugal
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