The title of this blog post is obviously a QTWTAIN.

If you’re an athlete taking the WADA allowed 1600 micrograms of salbutamol each day that’s the equivalent of 16 doses from a standard metered dose inhaler. If you’re taking so much that it leads to you failing a drug test, then you have serious problems. Most lay people take two doses at a time to relieve symptoms, such as chest tightness, coughing, wheezing and breathlessness, so that’s still using the stuff 8 times a day.

I wonder though, whether you are an athlete or not, if you need to take that much bronchodilator each day to get relief and a decent peak flow rate, then it’s odd that you got so high up in the world of sport in the first place irrespective of how tenacious you might be. Asthma at that level of reliever need can be quite debilitating regardless of fitness.

Moreover, at that level of dosing, most GPs would’ve prescribed inhaled corticosteroid preventers to preclude the need for taking so much bronchodilator. That, of course, brings with it its own issues with respect to bone density and, of course, the World Anti-Doping Agency’s rules, even though corticosteroids are not muscle-building anabolic steroids.

So, does inhaled salbutamol actually benefit people without asthma? And thence enhance athletic performance. It’s possible. Presumably, everyone has some degree of possible expansion of their airways even if they don’t have the disorder. There was an item in the January 2016 issue of Cycling Weekly that discusses the issues in more detail and suggests that there may well be benefits. However, earlier work suggests that salbutamol does little to enhance the performance of top-level athletes. A research paper from May 2017 studying salbutamol use among professional footballers corroborated that earlier finding; that said it looked at footballers using a single therapeutic dose (2 puffs, 200 micrograms), rather than the big daily dose that represents the upper allowed limit under WADA’s rules.

Salbutamol can have a range of side effects: tremor, anxiety, headache, muscle cramps, dry mouth, heart palpitations, tachycardia, arrhythmia, flushing of the skin, myocardial ischaemia (rare), and insomnia.