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Comment by Lio | Hacker News Reader

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...

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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.

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