Do Inhalers Give Athletes A Boost?
Seattle Times Staff Reporter
Dolan appearance Tom Dolan, a gold medalist and severe asthmatic, will appear from 10 a.m. to 2 p.m. tomorrow at the Asthma and Allergy Fair at the SuperMall in Auburn.
Melvin Stewart, 1992 Olympic gold-medal swimmer, noticed it at the starting block of a U.S. national championship. A competitor grabbed an inhaler hidden inside a towel and "sucked hard" just before the race.
Dick Jochums, coach of the fabled Santa Clara Swim Club in California, has seen it, too.
"You can't even walk on a deck anymore without stepping on one of those things," he said of inhalers that temporarily open the airways for asthmatics.
The scenario suggests two possibilities. More swimmers are plagued by asthma, or, as some claim, swimmers without asthma are using inhalers for a potential performance boost.
Interviews with almost two dozen officials, physicians, coaches and athletes indicate the latter could be true. Although many experts say asthma treatments taken with an inhaler do not enhance performance, a growing number of swimmers and other athletes think they do.
With a high percentage of asthmatics reported on national swim teams such as Great Britain's (almost 30 percent) and Australia's (almost 40 percent), some question whether that many could really be suffering from the disorder. In Australia, for instance, about 10 percent of the general population suffers from asthma.
A U.S. team physician said less than half the American swim team competing in the World Championships in January used inhalers.
Revelations about inhaler use could bring additional scrutiny to a sport whose drug controversies have been noteworthy. Gold medalist Michelle Smith DeBruin of Ireland was suspended this summer after her urine sample from a random test allegedly was altered by alcohol. In January, a Chinese swimmer was arrested for bringing an illegal growth hormone to Australia before the World Championships in Perth.
Medicines used to widen the bronchi to allow a freer flow of air by as much as 15 percent theoretically also enhance breathing for nonasthmatics. Furthermore, legal inhalers could act as a stimulant that might help at the race's start.
And some asthma drugs when ingested by tablet - which is illegal in Olympic sports - have anabolic, or muscle-building, properties, physicians said.
So the question becomes how much of a boost the inhalers provide. Are they merely a placebo effect, giving a psychological edge, or something more?
"For all our preaching, I think we have a problem in American swimming," said Jochums, a one-time University of Washington competitor.
Stewart, a butterflyer who retired after the 1996 U.S. Olympic trials, said he knew 10 U.S. national team members using inhalers who were not suffering from asthma.
Ugur Taner of Bellevue, now training in Tucson, said some elite swimmers use inhalers to offset breathing problems as a result of hard training, not because of asthma. Taner, who won the 200-freestyle national title last month, has seen a dramatic increase in the past five years.
"The only thing I question is that a lot of very good swimmers have started using them," he said. "All of a sudden, everybody turns up with an inhaler in their pocket."
The situation is delicate because of swimming's long association with the disease. For decades, physicians steered asthmatic children such as 1996 Olympic champions Amy Van Dyken and Tom Dolan to pools because humid air helps them breathe and exercise leads to increased lung capacity.
"It's really sick if someone wants to pretend they have this disease," said Van Dyken, who won four Olympic gold medals in Atlanta. "I have to wake up in the middle of the night every night because I can't breathe."
Asthma is a chronic inflammation of the airways characterized by wheezing and shortness of breath. Factors thought to aggravate the lung disorder are pollution, cold dry air, upper respiratory infections and high pollen count.
The Centers for Disease Control in Atlanta reports it is one of the nation's most common and costly conditions, and its incidence is rising worldwide.
Since 1992, the International Olympic Committee has allowed some watered-down medications, including some cortisone-based drugs, as long as they were inhaled. IOC officials recently ruled asthmatics must have written permission by a pulmonologist or team physician to use approved drugs. Many stronger and longer-lasting medications still are banned.
Serious asthmatics take from 12 to 20 puffs a day on inhalers, whereas newer, banned therapies offer up to 12-hour prevention. These medications generally are considered safe, though the Physicians Desk Reference reports potential serious cardiovascular problems from overuse. Other side effects include nausea, headaches and angina.
Since inhalers have been allowed, no swimmer has tested positive at illegal levels, said Taffy Cameron of England, a drug-testing official for FINA, the international swimming federation.
That doesn't mean the sport is clean. "I'm fairly sure there are more using than have bronchial asthma," said Don Catlin, an IOC medical commissioner.
Before the 1994 Winter Olympics in Lillehammer, Norway, the IOC's leading medical officer estimated 60 percent of the Games' athletes were using asthma medications, indicating possible widespread abuse in other sports as well.
Studies finding that about 20 percent of elite athletes suffer from exercise-induced asthma might offer a partial explanation. Colorado allergist William Storms said that particular condition is under-diagnosed and under-reported.
Some in swimming remain skeptical it provides the complete answer.
"I've heard about kids using it to get high and that it could be used for performance enhancing," said Seattle Prep's Patrick Fowler, a world-class breaststroker. "When I use an inhaler, I feel up a little bit."
Fowler, the national high-school swimmer of the year, suffers from exercise-induced asthma, but said he never uses an inhaler just before a race. He usually takes it the night before when necessary.
Rebecca Shapiro of Seattle, who swam for Emory University in Atlanta, never considered the misuse of inhalers for the simple reason asthma sometimes forced her to stop during high-school races.
In retrospect, Shapiro recently wondered if some of the short-term medications were abused by college teammates.
"People would get sick and get a Ventolin (inhaler), and then they would keep using them," said Shapiro, who started classes at Harvard law school this month. "People just think it helps."
Storms found no benefits when testing athletes at the U.S. Olympic Committee Training Center in Colorado Springs.
But no one has a definitive answer, which leads M. Craig Farrell, U.S. Swimming's sports medicine committee chairman, to advocate further studies.
It might be necessary. Stewart, the '92 gold medalist from Tennessee, said his fellow swimmers believe inhalers have real benefits.
"It opens up their lungs," he said. "The gorilla doesn't jump on your back until later in the race."
Tackling asthma medication is difficult for officials, who must be careful when scrutinizing drugs some athletes need for medical purposes. Rick DeMont, a former UW swimmer, still feels victimized in one of the Olympics' most controversial drug cases. DeMont, now a University of Arizona assistant, was stripped of a gold medal in 1972 because his regular asthma medication contained the banned stimulant ephedrine.
And Van Dyken, who regularly uses inhalers before races, said, "I don't want anybody looking at me as if I were trying to get away with something. Asthma is a serious disease.
"The medication makes you sick to your stomach. It's like drinking 10 cups of coffee. It's absolutely disgusting. I can't walk out my door without an inhaler."
Increasingly, neither can others, even if they don't need them. In a world where a hundredth of a second separates an Olympian from an also-ran, there are those who might try anything to gain an edge.
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