Vol. 18 •Issue 5 • Page 22
Albuterol and Heroin
Enhance Sports Performance
From an outsider’s standpoint, albuterol and heroin may not appear to have much in common. That notion is a bit erroneous because both are ergogenic aids, meaning they are considered useful to enhance sports performance.
Professional and amateur athletes alike use the drugs. In fact, various surveys suggest 76 percent of college athletes use some sort of supplement. If we look at body building specifically, nearly 100 percent of those athletes are believed to take performance enhancement products.
The scary thing is that approximately 50 percent of the general population (that is the non-professional athlete population) admits to having used performance-enhancing substances. In fact, it’s big business. In the United States, it is an $11.8 billion annual industry.
Most ergogenic aids work by enhancing energy production, energy use or energy recovery processes. Their use provides athletes with a competitive advantage, because metabolically the sports arena heroes can perform at a higher functional level.
Respiratory therapists might all question why beta agonists fall into this category. Most of us would say it is because they improve ventilation, and we all know they do. But Beta 2 agonists also increase lean muscle mass and have some interesting additional metabolic responses as well. Some studies suggest their action may potentially be similar to anabolic steroids.
Call Out the Body Patrol
This is precisely the reason the U.S. Anti-Doping Agency and the International Olympic Committee have banned the systemic use of Beta 2 Agonists. Their inhaled use for asthma is not banned, however.
The biggest problem is the existing testing programs designed to catch the athletes who use ergogenic supplements can’t tell the difference between inhaled medications taken for airway disease and systemic medications taken to improve performance. The tests show only that the drug is present in the urine. They can’t tell how it got there or why.
We don’t know how or why beta 2 agonists alter metabolism and increase lean muscle mass. A 2004 study by van Baak et al. tested the effect of high doses (800 microg) of salbutamol in 16 non-asthmatic athletes before and after exercise.
It was a blinded, crossover trial, so each athlete spent 30 minutes on a cycle ergometer going as fast as he could to complete a given distance 30 minutes after inhalation of 800 microg albuterol and also after a placebo.
Researchers measured pre- and post-peak expiratory flow (PEF), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Researchers obtained ABGs before, during and after the exercise trials. The researchers found cyclist performance times were better after inhaling the albuterol. Their average time was 3927.6 +/- 231.3s. The same cyclists covered the same distance in 4010.2 +/- 327.7s, 30 minutes after inhaling the placebo.
Significance of Studies
Albuterol inhalation also altered their blood chemistry. After inhalation, the athletes showed an increase in plasma-free fatty acids, glycerol and lactate concentrations. From a performance perspective, the researchers noted these changes but didn’t feel they were significant enough to explain the improvement in performance times.
From a pulmonary perspective, the athletes’ pre-exercise PEF and FEV1 values were increased after salbutamol inhalation, a finding we would expect. But after exercise, there was little difference in the ventialtory capacities of the two groups.
As a result, the studies are inconclusive as to why the overall performance was improved. Other studies of oral albuterol formula showed the drug had little or no effect on performance in athletes.
Animal studies using clenbuterol, another beta 2 agonist, suggest the medication contributes to selective hypertrophy of skeletal muscles. But that occurs only when the medication is taken over a period of time. Most of these studies used oral administration. The cyclists above received a single aerosol dose.
Other studies show that clenbuterol increases muscle mass in some rodents and decreases endurance running in other rodents. They can’t explain why. We do know clenbuterol in people is possibly a bad thing. Two European body builders died suddenly while taking the medication. Physicians who conducted autopsies were not able to determine whether the medication contributed to their deaths or not. Both were taking the medication orally and over a lengthy period of time.
What we do know is that beta agonists are banned. As it stands right now, medically we don’t know why or how they impact performance. The interesting thing about the studies in athletes is that they seem to be primarily conducted with cyclists and body builders.
One of the questions we have to ask is whether or not the type of exercise in which an athlete engages makes a difference. We also need to examine inhaled vs. oral routes of administrations, variances, short-term vs. long-term use and dosing levels.
Few of us in clinical practice provide care for Olympic athletes. But a lot of us are taking care of kids with asthma. Some of these children are on both oral and inhaled beta 2 agonists. What is left to determine how it is impacting them?
Margaret Clark is a Georgia Practitioner.