Fear factor might deter players from pursuing proper treatment

Ian O'Riordanhears from Dr Éanna Falvey who argues salbutamol should be removed from the banned list of performance-enhancing substances

AN EXPERT on the subject of asthma in sport has further questioned the necessity of keeping salbutamol on the banned list of performance-enhancing substances, believing it could result in athletes and players with the condition failing to pursue the proper course of treatment.

Dr Éanna Falvey, who until last year worked with the Munster rugby team and now co-ordinates the sports and exercise medicine facility at the new Sports Surgery Clinic in Santry, was responding to the yesterday's statement confirming Kerry footballer Aidan O'Mahony had a Therapeutic Use Exemption (TUE) for the use of salbutamol with regard to his asthmatic condition, and yet still produced a positive doping test following last September's All-Ireland final.

"If you review the literature there is no definite evidence of there being an anabolic effect to salbutamol," says Falvey. "So it raises the question as to why it's on the banned list in the first place.

"There are also a number of reports where people on salbutamol have produced extremely high levels of salbutamol in their urine. It seems there can be a very large difference in these individual levels produced in urine tests, for whatever reason. Of course the fact of the matter remains that it is on the list, and in that scenario, everyone has to play by the rules."

Falvey, a former national boxing champion, has undertaken a study on the subject with the Department of Respiratory Medicine at Cork University Hospital. Titled Exercise-induced Broncho-constriction and Asthma after Field Testing in an International Rugby Union Team, it revealed interesting findings related to asthmatic conditions, including the possibility many players or athletes aren't being properly diagnosed. "We looked at professional rugby players, and the Irish squad, and in that squad, we diagnosed two people with asthma, who had never been diagnosed before. And there were four people who were already on some asthma treatment, except they were being under-treated for their symptoms.

"So it's a very real problem, which people need to be treated for, and when issues like this arise, and all the hysteria that is generated by it, then it can, I feel, lead to more people being under-treated. We're out there to look after the athlete, and the last thing we want to see happen is people not being treated for the sake of fear or controversy. All this can be very detrimental for a sport to find itself in, again because the powers that be have decided it should be on the banned list.

"We had another situation where a rugby player we tested had a forced expiratory volume in one second (an FE1) increased by a litre and a half, in that he went from breathing just over four and a half litres per second, to breathing over six litres a second, by taking two puffs of Ventolin (the most common asthma inhaler containing salbutamol). In sport, we all train for fraction of percentages in improvement, and when we see improvements like that, in something people should be treated for, I think it would be dreadful if people were to be under-treated for fear of the repercussions.

"The faculty of Sport and Exercise Medicine in Ireland are actively considering this matter, and whether they come forward with something to try to clarify the situation is something we'll be very much looking out for."

Falvey started working with the Munster rugby team shortly after the Frankie Sheahan case, which saw the team hooker facing a two-year ban for testing positive for illegal levels of salbutamol, only for that to be reduced to three months: "I think the really nasty thing about the Frankie Sheahan case was that it was put forward that he was on something that was performance-enhancing.

"It did have a massively detrimental effect for Frankie in that he missed an awful lot of rugby in his prime. And it is tough, when a player has done everything right, and still through no fault of their own, tests above the limit, because of their metabolism versus someone else's, or whatever. But again the rules are the rules and for now everybody has to be guided by them."