Knowledge
Asthma medication and anti-doping (TUE).
As a competitive athlete with asthma, your treatment has to do two things at once: it must work, and it must comply with the anti-doping rules. Both start in the same place: with a correct, objectively documented diagnosis.
In brief
Several of the medicines used to treat asthma fall under the anti-doping rules. Most ordinary inhaled treatment (inhaled corticosteroids, and the common inhaled beta2 agonists within set daily limits) does not require an exemption. A smaller number of medicines do require one: a TUE (Therapeutic Use Exemption), granted before they may be used. The rules are updated every year, so it is always the current WADA list and the guidance from Anti Doping Danmark that apply. One substance is worth knowing by name: terbutaline (for example Bricanyl) is not covered by that exemption and requires a TUE, even though it is inhaled like the others. This page otherwise describes the principles — what a TUE is, why the diagnosis is the foundation, and how the clinic can help — without doses or limits; those must always be looked up in the current rules.
The diagnosis is the foundation.
A TUE application stands or falls with its documentation. It is not enough that you were once told you have asthma. Objective documentation of the diagnosis is required, typically a lung-function test and a positive provocation test showing that your airways react as they do in asthma. For elite athletes the IOC recommends an indirect provocation test, and EVH (eucapnic voluntary hyperpnoea) is one of them. The clinic performs the relevant investigations and prepares the medical documentation the application requires.
A thorough work-up also has an important side benefit: it clarifies whether your breathlessness is in fact caused by asthma. Exercise-induced laryngeal obstruction (EILO) is often mistaken for asthma in athletes, and it is managed quite differently, primarily without medication.
Athletes & sport: sport-specific assessment
How exercise-induced asthma is diagnosed
What is a TUE?
TUE stands for Therapeutic Use Exemption, a medical exemption. It allows an athlete with a documented medical need to use a medicine or dose that would otherwise be prohibited. The application is assessed by Anti Doping Danmark and/or the relevant federation. They make the binding decision, not the clinic. Which requirements and procedures apply to you depends on your level of competition and your federation: some athletes must hold an approved TUE in advance, while others follow different procedures. Always clarify your specific obligations with Anti Doping Danmark and your federation, in good time before competition.
How the clinic helps.
The clinic makes no anti-doping decisions, but it can make sure the medical groundwork is in order. That includes:
- An objective diagnosis using the tests the documentation requires: lung-function testing and provocation testing, including EVH.
- Medical documentation and a statement for use in your TUE application.
- Advice on correct use of your inhaled medication in accordance with the current rules.
- Reassessment when the rules or your treatment change.
Always check the current list yourself
The anti-doping rules are updated every year, and what was permitted last season may require an exemption this season. That is why this page deliberately names no doses or limit values, and only one substance (terbutaline), because it is widely used and easily mistaken for the inhalers that need no exemption. The binding answers are found only in the current WADA list and with Anti Doping Danmark and your federation. Ask there before you take the medicine, if you are in doubt.
The documentation needs to be in place.
The clinic assesses asthma and exercise-related breathlessness in athletes with objective testing and prepares medical documentation for TUE applications. The decision rests with Anti Doping Danmark and your federation. A referral from your GP is normally required; you can also be seen as a private or insurance patient. This page is general information and does not replace a medical assessment.