Status of asthma medication in sport
Beta-2 agonists
All beta-2 agonists (for example Terbutaline and Procaterol), are prohibited at all times in sport and require permission for use.
This permission is in the form of a Therapeutic Use Exemption (TUE), which can be applied for via a medical committee. In Australia this committee is called the Australian Sports Drug Medical Advisory Committee (ASDMAC).
However, the following beta-2 agonists, when INHALED, can be used up to the limits listed below WITHOUT a Therapeutic Use Exemption. If use is required above these levels, then they also require a Therapeutic Use Exemption.
- Salbutamol: Inhaled Salbutamol is permitted up to a maximum dose of 1600 mcg (16 puffs) per 24 hours, not to exceed 600mcg (6 puffs) in an 8-hour period.
- Salmeterol: Inhaled Salmeterol is permitted up to a maximum dose of 200 micrograms (approximately 8 puffs when using Seretide MDI inhaler 250/25) over 24 hours.
- Formoterol: Inhaled Formoterol is permitted up to a maximum dose of 54 micrograms (12 puffs when using Rapihaler 200/6) over 24 hours.
- Vilanterol: Inhaled Vilanterol is permitted up to a maximum dose of 25 micrograms over 24 hours (1 puff when using Breo Ellipta 100/25 or 200/25).
Glucocorticoids
Inhaled and intranasal glucocorticoids, used in the management of asthma and hay fever, are permitted and a Therapeutic Use Exemption is not required.
Systemic treatment (oral or intravenous) with glucocorticoids (for example prednisone) is prohibited in-competition* only and requires a Therapeutic Use Exemption when used during or immediately prior to competition (within 3 days).
An extended Therapeutic Use Exemption for up to 12 months will be considered for chronic, unstable asthma, but further medical evidence regarding the severity and frequency of the asthma will be required.
*The definition of ‘in-competition’ does vary between sports and events but is generally considered to start at 11.59 pm on the day before the match/game and ends after any drug testing has been performed at the end of the match/game.
Asthma medication quick reference guide—common medications
| Substance | Status in Sport |
|---|---|
| INHALED Salbutamol (Ventolin, Asmol) |
Therapeutic Use Exemption NOT Required – with specific conditions. Inhaled Salbutamol is permitted up to a maximum threshold of 1600 micrograms (16 puffs) over 24 hours, not to exceed 600mcg (6 puffs) in an 8-hour period. This threshold is not valid in the presence of diuretics. If using a diuretic, a Therapeutic Use Exemption is required to use both the diuretic and salbutamol. If maximum threshold is exceeded, a Therapeutic Use Exemption is required. |
| INHALED Formoterol (Symbicort) |
Therapeutic Use Exemption NOT Required – with specific conditions. Inhaled Formoterol is permitted up to a maximum threshold of 54 micrograms (12 puffs when using Rapihaler 200/6) over 24 hours. This threshold is not valid in the presence of diuretics. If using a diuretic, a Therapeutic Use Exemption is required to use both the diuretic and formoterol. If maximum threshold is exceeded, a Therapeutic Use Exemption is required. |
| INHALED Salmeterol (Seretide/Serevent) |
Therapeutic Use Exemption NOT Required – with specific conditions. Inhaled Salmeterol is permitted up to a maximum threshold of 200 micrograms (approx. 8 puffs when using Seretide MDI inhaler 250/25) over 24 hours This threshold is not valid in the presence of diuretics. If using a diuretic, a Therapeutic Use Exemption is required to use both the diuretic and salmeterol. If maximum threshold is exceeded, a Therapeutic Use Exemption is required. |
| INHALED Terbutaline (Bricanyl) |
Therapeutic Use Exemption Required. Prohibited both in and out of competition. |
| INHALED Vilanterol (Breo) |
TUE NOT Required – with specific conditions. Inhaled Vilanterol is permitted up to a maximum dose of 25 micrograms over 24 hours (One (1) puff when using Breo Ellipta 100/25 or 200/25). This threshold is not valid in the presence of diuretics. If using a diuretic, a TUE is required to use both the diuretic and vilanterol. If maximum threshold is exceeded, a TUE is required. |
| INHALED Budesonide (Symbicort, Pulmicort) |
Therapeutic Use Exemption Not Required. Permitted in and out of competition. |
| INHALED Ciclesonide (Alvesco) |
Therapeutic Use Exemption Not Required. Permitted in and out of competition. |
| INHALED Fluticasone (Flixotide, Seretide) |
Therapeutic Use Exemption Not Required. Permitted in and out of competition. |
| ORAL or INJECTED Salbutamol |
Therapeutic Use Exemption Required. Prohibited both in and out of competition. |
| ORAL Formoterol |
TUE Required. Prohibited both in and out of competition. |
| ORAL Prednisolone/Prednisone |
Therapeutic Use Exemption Required In-Competition Only. Permitted out-of-competition. If taking Prednisolone/Prednisone out-of-competition (not competing), allow 3 days once ceasing medication before competing. Therapeutic Use Exemption required if taking oral Prednisolone in competition. |
Note 1: Use of Asthma medications with Diuretics or Masking Agents. If you are taking a diuretic or masking agent (for which a Therapeutic Use Exemption is required) then the use of a threshold substance such as Salbutamol or Formoterol requires an additional Therapeutic Use Exemption to the one granted for the diuretic or masking agent.
Note 2: The updated WADA Prohibited List comes into effect from 1 January each year. Please ensure that you check the status of your medications.