Controlled Drugs And Substances Act Pdf Asthma

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Control medicines for asthma are drugs you take to control your asthma symptoms.

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Asthma - control drugs

Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma.

The reason for the heightened incidence in elite sport remains to be fully established; however, there is now evidence indicating that airways hyper-reactivity can develop over the course of a sporting career for review see Price et al. However, for athletes competing under the constraints of the World Anti-Doping Code Code , the use of SABA and several other commonly prescribed asthma medications puts athletes at risk of returning an adverse analytical finding AAF , potentially leading to an anti-doping rule violation ADRV and a period of ineligibility from sport [ 11 ].

Prior to initiating treatment, it is therefore imperative that athletes and their support personnel e. In keeping with their non-athletic counterparts, elite athletes with asthma are also susceptible to acute illness e. To ensure health protection is afforded for athletes bound by anti-doping rules and regulations, the International Olympic Committee—Medical Commission IOC-MC introduced a policy in the s for permitted use of prohibited substances and methods [ 14 ].

Currently, athletes competing at the elite level are thus typically required to provide objective evidence of asthma before a therapeutic use exemption TUE may be granted to permit use of an otherwise prohibited substance or medication dose. However, the legitimacy and utilisation of asthma medication use in this setting has been questioned for some time and highlighted in recent years following the release of personal medical information of several high-profile athletes by Russian cyber-espionage group Fancy Bears.

For many this has served to reinforce perceptions of wrong-doing within the athlete community [ 16 ] and may prompt the misuse of asthma medication amongst those potentially seeking to gain an advantage.

Whilst instinctively, a decision to comply with the Code may be viewed as straightforward, factors underpinning non-compliance are often complex and have recently been conceptualised in the scope of a model evaluating the multi-faceted dopogenic environment [ 17 ]. In this model, it is proposed that an athlete may be influenced by the surroundings, opportunities and conditions that promote ADRVs. To fully understand the drivers of the misuse of asthma medication in sport, an appraisal of current literature guided by a contemporary and overarching model of behavioural theory the capability, opportunity, motivation—behaviour [COM-B] model [ 18 ] is required.

Drawing upon this model, it is proposed that behaviour B is the result of an interaction between three necessary conditions: capability, opportunity and motivation. For an individual to engage in a specific behaviour B they must have the psychological and physical capability C e.

Motivation covers automatic processes, such as habit and impulses, as well as reflective processes, such as intention and choice [ 18 ]. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance, and employs a theory of behaviour COM-B to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma.

WADA was established in to harmonise global anti-doping policy and practice. Most countries, and almost all sports, are signatories to the Code, with the major exceptions being North American professional sporting bodies e. Major League Baseball. First published in January [ 19 ], the Code provides the framework for anti-doping polices, rules and regulations within sport organisations and among public authorities.

Along with five international standards e. International Standard for Therapeutic Use Exemptions; List of Prohibited Substances and Methods , the Code serves to ensure that anti-doping policies and procedures are the same for all athletes and support personnel. Updated annually, the prohibited list contains substances and methods that if detected in the absence of a TUE, will result in an ADRV. The International Standard for Therapeutic Use Exemptions states that an athlete will only be granted a TUE if the following conditions are met: a the athlete would experience significant health impairment if the prohibited substance or method were to be withheld, b therapeutic use of the prohibited substance or method is unlikely to produce any additional performance enhancement, c there is no reasonable therapeutic alternative to the use of the prohibited substance or method, and d the necessity for the use of the prohibited substance or method is not a consequence of the prior use without a TUE of a substance or method that was prohibited at the time of use [ 15 ].

Permitted limits were introduced for inhaled salbutamol, salmeterol and formoterol between and The requisite to submit a TUE during this period was therefore no longer required for these substances unless an athlete exceeded permitted limits in a medical emergency whereby a retroactive TUE was still required [ 23 ].

An athlete found to exceed the urinary decision limit for a substance may request an individualised pharmacokinetic study. Indeed, following recent high-profile anti-doping investigations concerning asthma medication use in elite athletes, a pharmacokinetic modelling study demonstrated that an AAF for salbutamol has the potential to occur irrespective of adherence to current guidelines i.

Similarly, although differences in urinary concentrations between oral and inhaled terbutaline have been demonstrated, a threshold has yet to be established [ 30 ]. However, in the context of elite sport, athletes typically complete multiple exercise bouts or training sessions per day.

To avoid overuse and potential adverse effects, or reduced tolerance and efficacy of reliever medication [ 31 ], it is recommended that daily inhaled corticosteroid maintenance therapy is initiated to target underlying airway inflammation and optimise asthma management [ 9 ].

Inhaled corticosteroids remain permitted in and out of competition without a TUE [ 12 ]. However, the systemic administration of corticosteroids i. It is important to acknowledge that any responsible clinician should ensure that the care afforded to an athlete with asthma is always prioritised.

In the event a prohibited substance is administered to treat an asthma exacerbation, the athlete is required to apply for a retroactive TUE [ 15 ]. The impact of asthma and associated treatment on athletic performance has been extensively investigated for review see Price et al. Yet, despite several proposed physiological mechanisms indicating asthma may impair sporting performance, there remains limited experimental evidence to support or refute this concept.

Indeed, elite-level athletes with asthma are consistently reported to match and indeed in some cases out-perform their non-asthmatic rivals [ 1 ], fuelling widespread speculation concerning the performance-enhancing properties of asthma therapy [ 33 ].

Similarly, aerobic exercise performance appears to remain unchanged following the administration of inhaled LABA [ 38 , 39 ]. To date, studies investigating inhaled corticosteroids at therapeutic doses have failed to show any improvement in exercise performance [ 43 ].

Furthermore, daily terbutaline administration has been shown to elicit a significant increase in skeletal muscle growth in healthy males irrespective of a concurrent resistance exercise programme [ 47 ]. On the contrary, chronic use of terbutaline has been reported to impair skeletal muscle adaption following high-intensity training [ 48 ].

Despite this, establishing a urine threshold for athletes who acquire a TUE for terbutaline has been proposed to reduce supra-therapeutic dosing and the potential for performance enhancement [ 49 ]. Furthermore, oral salbutamol has recently been shown to increase protein turnover rates in skeletal muscle following resistance exercise [ 53 ]. The acute administration of an oral corticosteroid has been previously shown to improve prolonged sub-maximal exercise performance in trained cyclists [ 54 , 55 ].

It has been proposed that oral corticosteroids may improve exercise performance from both a psychological and physiological perspective by inducing the perception of euphoria [ 59 ] and increasing fat oxidation to meet energy requirements during exercise [ 60 ].

Oral corticosteroids have also been associated with increased lipolysis [ 61 ], resulting in changes to body composition; the latter being considered desirable for endurance-based athletes i. Finally, a blunted pro-inflammatory response post-exercise has also been observed following oral corticosteroid administration [ 55 ], which in turn may translate to enhanced recovery between repeated exercise bouts e. Although there was no suggestion of wrong-doing on the part of the athletes whose data was leaked, the omnipresent use of asthma medication by high-profile athletes questions the legitimacy of the anti-doping system in this setting [ 33 ].

Fundamentally, the purpose of the Code is not to restrict the use of required medication in athletes with asthma and prevent them from becoming elite competitors, however abuse of this system is both undesirable and certainly unethical. Taken together, these behaviours may be detrimental to the overall health and well-being of athletes or individuals partaking in sport across all levels. Understanding athlete and associated support personnel capability, opportunity and motivation with regards the current TUE system and use of asthma medication is a necessary first step to facilitate interventions and modifications to ensure global anti-doping policy and practice can be reviewed and effectively delivered in a supportive and progressive manner.

Therefore, athletes need to be knowledgeable and comply with all applicable anti-doping rules and regulations [ 11 ]. However, recent studies have exposed partial knowledge and understanding of the policies and rules that govern participation in sport [ 64 ], rendering athletes at increased risk of committing ADRVs.

Compounding this situation further, stigma attached to anti-doping information seeking within elite sporting organisations has previously been reported [ 66 ]. Athletes reporting breathing difficulty most often seek medical guidance from non-specialist i.

It is important that all clinicians are aware and remain up to date with asthma guideline reports [ 9 ] given the global prevalence of the condition, but specifically to ensure diagnosis is robust [ 69 ]. Over the past two decades, a wealth of published research has supported the concept that asthma is frequently misdiagnosed i. Despite recognition of the disconnect between self-report respiratory symptoms and objective evidence of asthma [ 71 ], a study by Hull et al.

Although objective testing is often requested, test selection is typically sub-optimal for the assessment of the breathless athlete e. For clinicians prescribing asthma medication, an appreciation and understanding of evidence-based treatment strategies to optimise management remains a priority.

However, in the same study by Hull et al. The annual updating of the prohibited list only adds to the challenges faced by clinicians when prescribing medications to athletes competing under the Code. The lack of referring for specialist testing and knowledge of the Code is likely attributed to a the challenges of disseminating research to the relevant wider audience e.

Taken together, the capability of athletes and clinicians defined as athlete support personnel under the Code to comply with current rules and regulations appears compromised, increasing the potential to commit an ADRV [ 67 ]. To support athletes and the medical profession, tailored and targeted education programmes for clinicians therefore need to be developed and delivered to help rectify this situation.

To ensure this happens, referral for specialist services must be easily available and promoted widely across the sports medicine community. If specialist services are not accessed, unnecessary inhaler therapy or the illegitimate prescription of asthma medication may be afforded to athletes.

This is concerning given that the adverse health implications of unnecessary chronic SABA administration have been recognised for some time [ 31 ]. In some environments, the physical access to healthcare professionals willing to undermine the system by authorising a TUE for a fictional illness e. Yes, they take therapeutic use exemptions TUEs. They play with the rules. For example, amongst a sample of elite Danish athletes, the perception of over half surveyed was that fellow athletes had been granted a TUE without the clinical requirement, with many using higher doses of prescribed medication than required [ 16 ].

In other sports where doping has received significant attention e. This likelihood can be explained by moral disengagement, a process whereby an athlete justifies unethical behaviours because of perceived extenuating circumstances.

Processes such as moral disengagement offer a coping strategy for reducing cognitive dissonance that occurs from holding conflicting beliefs and values.

Central to the effects of moral disengagement concerning the TUE system is the training and competition environment [ 81 ], most pertinent when applied to groups with high asthma prevalence e. This research brings to the forefront the social opportunity in which asthma medications and the TUE system are perceived to be a legitimised form of doping. In turn, this may provide athletes and support staff with motivation to engage in behaviours that go against the spirit of sport [ 11 ], and that have the potential to compromise athlete health and well-being.

Influential others might also provide the motivation for non-asthmatic athletes to use unnecessary asthma medication through the widespread perception that inhaled SABA improves sports performance. As detailed, this perception is despite the fact that the potentially detrimental impact of asthma on exercise performance has yet to be fully substantiated [ 32 ], with the majority of research supporting the absence of ergogenic benefit for inhaled SABA i.

At the other end of the spectrum, it has been reported that athletes may avoid applying for a TUE despite therapeutic need [ 16 , 80 ]. This is concerning as the continuation of training and competition without appropriate treatment may lead to a deterioration in condition and possibly sporting performance.

In contrast, in recreational athletes, poor asthma control due to the non-adherence to medication may deter physical activity and exercise engagement but may also have more serious consequences, particularly in athletes with severe or uncontrolled asthma i. Increasing the transparency of medication use and the TUE process may be an important intervention to address some of the issues raised. The rights of athletes concerning their personal data and medical information must also be balanced against the effects that public disclosure of all medication use and granted TUEs may have on perceptions of cheating within the athlete community [ 82 ].

This narrative review provides the first theory-informed critical appraisal of anti-doping policy as it applies to asthma management, medication use and sports performance. To date, there remains limited research focusing on athlete knowledge and perceptions of doping and TUEs specific to asthma. Asthma in athletes—a call to action for future research priorities.

TUEs therapeutic use exemptions. The reliance on clinicians to provide guidance to athletes presenting with respiratory symptoms is also concerning as there appears to be a disconnect between research-informed evidence and current practice. The challenges clinicians face securing a robust diagnosis only furthers the negative stigma towards the use of inhaler therapy in athletes. To fully understand and recognise the complexity of the dopogenic environment in this setting, it is necessary to qualitatively examine athlete motivation to use asthma medication and perceptions and understanding of asthma TUEs in sport.

Moreover, the true impact of asthma and associated medication on sports performance remains to be fully determined. Until this point, it is likely that the negative stigma associated with inhaler therapy will remain.

Moving forward, developments in policy and practice have potential to change the behaviour of athletes and athlete support personnel, establish trust in the anti-doping system, and in turn, alter the attitudes towards and perceptions of asthma medication use in sport. Fitch KD.

Medications for Chronic Asthma

Chronic asthma is a major health concern for children and adults worldwide. The goal of treatment is to prevent symptoms by reducing airway inflammation and hyperreactivity. Step-up therapy for symptom control involves initiation with low-dose treatment and increasing intensity at subsequent visits if control is not achieved. Step-down therapy starts with a high-dose regimen, reducing intensity as control is achieved. Multiple randomized controlled trials have shown that inhaled corticosteroids are the most effective monotherapy.


corticosteroids (ICS) or other long-term asthma control drugs mitigates the Act on adrenergic receptors causing vasoconstriction in the nasal mucosa, resulting​.


Medications for Chronic Asthma

Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma. The reason for the heightened incidence in elite sport remains to be fully established; however, there is now evidence indicating that airways hyper-reactivity can develop over the course of a sporting career for review see Price et al.

Beta This is a new way of showing guidance - your feedback will help us improve it. It also explains the FOD enforcement policy in this area. Specific guidance on the application of the EMM to chemical risks and health is extremely relevant when considering enforcement action.

Visit the Asthma and Coronavirus page to learn about how coronavirus can affect people with asthma, and how health care providers can better care for them. Asthma is a serious life-long disease of the lungs that is caused by swelling inflammation in the airways. There is no cure for asthma, but it can be prevented and controlled with proper care. People with asthma can live normal, active lives. You can't outgrow asthma, though some people will stop having asthma symptoms as often as in the past.

Coronavirus Disease 2019

The regulations under the Controlled Substances legislation specify the substances that are controlled and the details of the controls. The Controlled Substances Poisons Regulations has been amended. Record keeping and reporting requirements for prescribers and pharmacists have changed. Medicines, poisons and pest control licences are issued by the Controlled Substances Licensing Section of the Department for Health and Ageing. An overview of what you need to know about drugs of dependence, what they are and why and how they are regulated in South Australia. Information about the Virtual Support Network of services and other resources to support the mental health of the South Australian community.

In our efforts to prioritize patient care and make the workers' compensation process go a bit smoother, IWP wants to help injured workers familiarize themselves with the definition of controlled substances and how they're classified. Understanding drug categorization is at times a frustrating and confusing topic for patients, especially when it comes to learning the ins and outs of controlled substances. Do you need a prescription for your medication or can you just purchase it at a local store? Is your medication a controlled substance with certain restrictions on how it can be prescribed or filled? For example, most blood pressure and cholesterol medications, diabetes medications, asthma inhalers, and antibiotics are all non-controlled medications.

Locate a Flu Shot. The statewide toll-free hotline offers counseling information and referrals about pregnancy , infant and toddler issues. WIC provides the following at no cost: healthy foods, nutrition education and counseling, breastfeeding support, and referrals for health care. Influenza or 'flu' is a viral respiratory illness, mainly spread by droplets made when people with flu cough, sneeze or talk.

Gershman has published research on prescription drug abuse, regulatory issues, and drug information in various scholarly journals. She has also presented at pharmacist and physician continuing education programs on topics that include medication errors, prescription drug abuse, and legal and regulatory issues. Gershman can be followed on Twitter jgershman2.

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4 Response
  1. Maurelle C.

    Asthma, medicinal products for the treatment of asthma, asthma in children, do not achieve adequate control with the highest level of medication the Asthma Control Test (ACT) or the Asthma Control Scoring System.

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