Thursday, September 11, 2014

Albuterol / Salbutamol Doping Works! Cyclists Just Have to Take One Pill For a 4.1% Increase in Peak Power. Plus: Its Chronic (Ab)Use Makes Their Training More Efficient

Inhaling salbutamol, which is the most appropriate way to combat asthma, will not provide the same beneficial effects to athletes as taking a much higher doses pill and thus "going systemic" will (Norris. 1996; Koch. 2013)
Salbutamol (INN) or "albuterol", as it is called in the US, is a short-acting β2-adrenergic receptor agonist. Just like its longer-acting brother clenbuterol, it has been developed to be used for the relief of bronchospasm in conditions such as asthma and chronic obstructive pulmonary disease; and just like its brother clenbuterol, it has been and still is abused by athletes all around the world as a doping agent. For good reasons?

Well, a recent study from the University of Copenhagen would suggest just that. After all, the scientists from the Department of Nutrition, Exercise & Sports, Section of Integrated Physiology found acute and long(er) term beneficial effects of salbutamol (ab)use on peak power in their subjects, 20 male endurance athletes competing in classic cycling (n = 6), mountain biking (n = 7), and triathlon (n  = 7).
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The subjects were competitive at highest national level of their class. Included subjects had a weekly training volume of 14.9 ± 1.0 h/week and a VO2max of 69.4 ± 1.8 mL/min/kg. The athletes had no history of asthma or airway symptoms and had never used anti-asthmatic medication such as beta2-agonists. Needless to say that this changed with the onset of the study, in the course of which the subjects were randomized to either a salbutamol (SAL) (n = 10) or a placebo "supplement" (PLA) (n = 10).
Didn't this have terrible side effects? The subjects in the active treatment group experienced only minor acute side effects, including tremor and tachycardia. Over the course of the intervention, these side effects surpassed within a few days. No side effects were reported in PLA.
At the beginning of the study, there were no differences in subject characteristics between the groups. Just like the "drug free status", this changed after only one day (!) on 8 mg salbutamol (Ventoline®, GlaxoSmithKline, Brentford, UK).
Figure 1: Effects of acute and chronic (2 week) administration of salbutamol / albuterol on peak power during wingate tests (left) and maximal voluntary contractile force in competitive cyclists (Hostrup. 2014)
As you can see in Figure 1, the drug increased the peak power during the first Wingate test by 4.1 ± 1.7% (P < 0.05). Its "chronic" ingestion for two weeks, lead to increases of 6.4 ± 2.0 and 4.2 ± 1.0% in peak power during the first and second Wingate test. Unfortunately, we don't know if a complete month would have brought about even greater increases in peak power, which would then not necessarily have been due to accumulating effects of the drug, but rather the result of an increased training efficacy (~15h of training per week). Interestingly, the provision of salbutamol did not have an effect on maximal voluntary contractile force (MVC), exercise performance at 110% of VO2max or isometric endurance (all could have been accomplished by adding caffeine, though).

Due to the short study duration, it would have been stupid to measure increases in muscle size or reductions in body fat, as they have repeatedly been observed in rodent studies with albuterol's longer-acting beta-agonist cousin, clenbuterol (you can read up on the less-known muscle building effects beta agonists and their relation to myostatin in "The Myostatin <> Clenbuterol Connection - More Muscle, Less Fat: Is an Orphan Nuclear Receptor the Missing Link?" | more).
Unlike the inhaled microgram-doses of albuterol, which have been shown to have no significant acute ergogenic effects in cyclists by Norris (1996) and Koch (2013), for example,  Ventoline (8mg) pills deliver the results "chemical athletes" are looking for.
Bottom line: While the scientists obviously draw the politically correct conclusion that "the present study supports the restriction of oral salbutamol in competitive sports" (Hostrup. 2014). I can afford to say that Hostrup et al. were able to show that "salbutamol doping" works, when the drug is taken in significant amounts, orally. Even taking it once and to monetize on the 4.1% increase in peak power could help athletes attain an unfair advantage that can well make the difference between victory and defeat.

No wonder so many cyclists (e.g. 45% of the US cyclists participating in the 1996 Olympic Games, for example; Weiler, 1998) claim to have... ah, I mean "have been diagnose" with asthma, ha?
  • Hostrup, M., Kalsen, A., Auchenberg, M., Bangsbo, J. and Backer, V. "Effects of acute and 2-week administration of oral salbutamol on exercise performance and muscle strength in athletes." Scandinavian Journal of Medicine & Science in Sports (2014). Accepted Manuscript.
  • Koch, Sarah, et al. "Inhaled salbutamol does not affect athletic performance in asthmatic and non-asthmatic cyclists." British journal of sports medicine (2013): bjsports-2013.
  • Norris, S. R., S. R. Petersen, and R. L. Jones. "The effect of salbutamol on performance in endurance cyclists." European journal of applied physiology and occupational physiology 73.3-4 (1996): 364-368.
  • Weiler, John M., Teresa Layton, and Margaret Hunt. "Asthma in United States Olympic athletes who participated in the 1996 Summer Games." Journal of Allergy and Clinical Immunology 102.5 (1998): 722-726.