WADA's 2011 Prohibited List includes a change of status to the therapeutic use of inhated Beta-2 agonists, salbutemol (e.g. ventolin) and salmeterol (e.g. seretide and serevent):

• Therapeutic use of inhaled salbutamol (maximum 1600 micrograms per day) and salmeterol will be permitted in sports as of 1 January 2011. No Therapeutic Use Exemption (TUE) application is necessary. WADA have also removed the need for athletes to declare the use for these substances during a doping control (testing) session. Athletes are free to use salbutamol (maximum 1600 micrograms per day) and salmeterol in and out of competition in their chosen sport.
  
  CONDITION:
  Salbutamol will still be prohibited in urinary concentrations above 1000 nanograms per millilitre. There will be a presumption that the substance was not taken by inhalation and the athlete will have to demonstrate through a controled pharmokinetic study that the level found in their urine was the result of therapeutic inhaled use. Athletes are advised not to overuse their salbutamol inhalers.
  
  
• Prohibited Beta-2 agonists including formoterol and terbutaline will still require an in-advance TUE and meet WADA's specific criteria of a positive bronchial provocation test or positive bronchodilator test as per the 'Suggested Medical File Requirements' [below].
  
  
• ALL athletes and athletes who are in an International Federation Registered Testing Pool (RTP), ASADA's RTP and athletes in ASADA's Domestic Testing Pool (DTP) must have an in-advance TUE to inhale prohibited Beta-2 agonists.

For an athlete with well documented asthma who undertakes one or more bronchial provocation tests which are negative, there is a possibility that a TUE may be approved if a comprehensive medical file is submitted together with all details of the negative bronchial provocation test(s).

 

Suggested Medical File Requirements for Prohibited Beta-2 agonists TUE

1. History
• Athlete's age of onset
• Symptoms
• Trigger factors, for example exercise or allergies
• Associated allergic or a topic conditions
• History of any hospitalisation, including accident and emergency presentations (if any)
• All current medication, and any previous asthma medications trialed
• Previous requirements for oral glucocorticosteroids
• Relevant family history
2. Examination
• Clinical examination with particular reference to respiratory system
3. Previous investigations
• Relevant tests including skin prick, RAST etc.
• Any spirometry
• Any previous bronchial provocation tests, regardless of age
4. Current evidence of asthma

One positive result is required, but if a bronchial provocation test is negative, athletes can submit the application with the medical file and negative test for consideration.

The evidence must include either:

• Reversible airway obstruction:
• Evidence of airway obstruction with a 12% increase in FEV1 after the administration of an inhaled Beta-2 agonist, or
• Bronchial provocation tests
  • Mannitol - 15% fall in FEV1
  • Hypertonic Saline - 15% fall in FEV1
  • EVH - 10% fall in FEV1
  • Exercise Challenge tests - 10% fall in FEV1
  • Methacholine - 20% fall in FEV1

Helpful hints:

• Ensure the athlete ceases inhaled steroids and long acting Beta-2 agonists before the test (a minimum of 24 hours is suggested) and short acting Beta-2 agonists for at least 8 hours prior to the test. The longer an athlete is off the medication, the more likely that he/she will return a positive bronchodilator test or bronchial provocation test.
• If an athlete is unsure whether they are in an RTP or DTP they should contact their national sporting organisation.

Apply for a TUE

Common medications (stimulants) that are prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD) are prohibited in sport during competition (WADA’s 2010 Prohibited List, section 6).

If you do not have a TUE and test positive for a prohibited substance, you may be sanctioned or banned from participation for a period of time.

You must get a TUE before being tested (for example before you compete) if you are classed as an athlete by the Australian Sports Anti-Doping Authority (ASADA). If you are unsure of whether or not you are classified as an athlete by ASADA, you chould contact your national sporting organisation.

What medical evidence needs to be provided?

There is no specific medical test to determine the presence of ADHD, so we need more than a statement from your GP stating the condition exists.

You must also submit a separate letter from the treating specialist (paediatrician or psychiatrist) outlining:

• the age of onset of the condition
• the diagnostic criteria met
• treatments trialled, in particular current and previous medications
• history of any time off stimulant medication and the response to this.

This letter can be in the form of a summary or a recent review letter used in communication between your GP and your specialist within the last 12 months.

Apply for a TUE

Under the World Anti-Doping Agency (WADA) 2011 Prohibited List, some medications used to treat
hypertension may be prohibited in sport.

• Diuretics are prohibited in sport at all times (WADA’s 2011 Prohibited List, section 5).
• Beta-blockers are prohibited in some sports only during competition, and prohibited in other sports at all times (WADA’s 2011 Prohibited List, section 2).

If you do not have a TUE and test positive for a prohibited substance, you may be sanctioned or
banned from participation in sport for a period of time. This could have a serious impact on your
sporting career.

You must get a TUE before being tested (for example before you compete) if you are classed as an
‘athlete’ by the Australian Sports Anti-Doping Authority (ASADA). Refer to the TUE Fact Sheet TUE Fact Sheet to
determine if you meet this definition.

If you compete in shooting or archery, you are unlikely to have a TUE approved for beta blockers.
This is because this medication can give you an unfair advantage over others.

What medical evidence needs to be provided?

As well as completing the TUE form for any prohibited medications associated with the condition
hypertension, you are required to submit a separate letter from your doctor detailing:

• your history of the condition (including blood pressure history)
• the current treatment you are on and any treatments that have been previously tried.

If you have visited a specialist for hypertension you can also include any reports or letters from
them to support your application.

Apply for a TUE