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Comment by denvaar | Hacker News Reader

One other thing about Lael that I don't think the article mentioned is that on top of being an amazing ultra-endurance cyclist, she also has had to deal with lots of respiratory problems. I don't remember if it's Asthma or what, but her lungs literally shut down at times. This makes it even more impressive to me.

EDIT: It's Asthma - https://youtu.be/h0hkoee6sI8?si=NaR4GZjUppQE78xm

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I’ve read about the prevalence of chest infections on other long events (Tour de France). I’ve just been searching and can’t find any supporting evidence.

Breathing very hard for hours at a time for days on end would seem to have consequences

Athletes in most sports report significantly above-average rates of asthma. Athletes with an asthma diagnosis generally outperform their non-asthmatic rivals. Some of that is almost certainly confounded by the fact that many asthma medications - most notably salbutamol - are performance-enhancing drugs; an asthma diagnosis allows an athlete to take drugs under a therapeutic use exemption that would otherwise result in a ban.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4653278/

https://breathe.ersjournals.com/content/12/2/148

Some of that is almost certainly confounded by the fact that many asthma medications - most notably salbutamol - are performance-enhancing drugs; an asthma diagnosis allows an athlete to take drugs under a therapeutic use exemption that would otherwise result in a ban.

That's not true at all.

WADA does not require a therapeutic usage order for normal usage salbutamol. Anyone who needs it can use it at the dosages required to control asthma.

At these dosages it has not been shown to improve performance, as mentioned in the abstract of the first link you cited.

Further I would offer [1],[2] and [3] as evidence for why you are wrong. Salbutamol does not improve performance at normal dosages.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135409/

2. https://thorax.bmj.com/content/56/9/675

3. https://www.wada-ama.org/sites/default/files/resources/files...

They don’t take it at normal dosages.

A test showed that they couldn’t get 12 trained cyclists to have a level above 510ng/ml in their urine, when they took salbutamol at the maximum WADA level of 600ug in an 8 hour period. [1]

The WADA threshold for salbutamol is 1,000ng/ml [2] So this level is about twice the level performance tested in your first link above.

Athletes can get TUEs for levels higher than the 1,000ng/ml limit or to take it using other methods than inhaling. [2]

Cyclists have been banned for having levels at 1,900ng/ml and 1,320ng/ml, and they were banned because the sport considers it a performance enhancing drug.

I imagine (but have no evidence, since they aren't published) that cyclists with a TUE regularly race with levels similar or above that. And without spending hours researching, I imagine this translates to other sports similarly.

[1] https://respiratory-research.biomedcentral.com/articles/10.1...

[2] https://ita.sport/uci-therapeutic-use-exemptions/

1) Even if it doesn't improve performance, athletes might still think it does and try to get the asthma medication. It might surprise you how much lore and voodoo surrounds professional sports. People are willing to try almost anything if it has even a small chance to improve performance by 1%. Also, both of the studies you linked are quite new. Athletes have been obtaining (possibly false) asthma diagnoses for decades.

2) Maybe they don't use normal doses. As long as they get the prescription, they can take however much they want, right?

3) A few studies might not be enough to thoroughly prove that there's no effect under all possible circumstances. Again, as long as there is even a small amount of hope of it helping, many athletes are willing to try it.

> Some of that is almost certainly confounded by the fact that many asthma medications - most notably salbutamol - are performance-enhancing drugs; an asthma diagnosis allows an athlete to take drugs under a therapeutic use exemption that would otherwise result in a ban.

I think all of it might be explained by this. At least to me it was always "common knowledge" that many athletes find a doctor willing to diagnose them with asthma so that they can get the medication.

Also stomach issues are very common, when for periods in the rain, road spray ends up in the mouth.

Drafting someone in the rain is awful. Their wheel makes a nice little geyser for your eyes and mouth.

To add to my comment which I can’t now edit.

On the Netflix series ‘Tour de France: Unchained’ there is mention of the cyclists getting run down, losing weight and getting chest infections.

This seems to be a thing, though upper respiratory tract infections, ‘the cyclists cough’ seem better documented.

https://www.netflix.com/title/81153133

https://www.kheljournal.com/archives/2020/vol7issue6/PartD/7...

That makes sense for tour de France. They spend a lot of time attacking and then conserving energy. The attacks are zone 5 (hr) efforts. High toll on the body and immune system. Endurance athletes ride differently, they avoid higher power zones and focus on max efficiency from which the body can more easily recover.

Key to it, exertion and recovery are non linear. Lael likely can push 300 watts at zone 2. For comparison, a strong amateur cyclist can push 300 watts only for about 15 minutes (and would be in zone 4 - very likely exhausted the following day)

The focus in ultra endurance is extreme efficiency. Extreme aerobic and metabolic fitness.

Bottom line, tour de france riding and ultra endurance are quite different. The athletes from one to the other do not necessarily do well in the other mode of riding.

therapeutic use exemption for salbutamol. same reason the entire norwegian winter olympic team "has asthma". or why the a ton of russian athletes "had ischemia" and needed meldonium. or why many gymnasts "have ADHD"

all your favorite athletes are cheating, especially from rich countries :)

What are you talking about? You don't need a therapeutic use exemption to use salbutamol at the doesages required to control asthma. It does not improve performance.

Breathing cold air does induce asthma, so it's perfectly plausible that everyone on the Norwegian Olympic team could have exercise induced asthma and not be gaining any advantage from it.

Stop casually mixing genuinely asthmatic athletes using, non-controlled, non-performance enhancing medicines with state sponsored dopers.

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