Ulissi - Provisionally Suspended - Salbutamol

Mad_Malx

bigcgilmour wrote:

Can it be used as a masking agent???

I doubt it, and since it's easily detectable not a lot of point anyway.

bigcgilmour wrote:

I'm mildly asthmatic, couldn't say my performance was ever enhanced..then again I'm no athlete.

You need to take much, much, more -this is not a recommendation - and even then it's not been shown to be very effective in any trials.

Someone's now going to tell me how they take it and it turns them into superman.

Mad_Malx

FF - who's the new Avatar ?

frenchfighter

Not sure but here is the full photo. Not sure it is someone known as it doesn't show on any google searches.



If you want a new avatar lmk.

Pokerface

So if the substance provides no performance-enhancement (at lower does), why is it banned at such a low dose?

If it CAN be used to mask something else, would this explain why so many riders (legally) take it? Yes it is detectable, but that's sorta the point isn't it? They are 'allowed' to use it, therefore no one thinks twice as to what it might be masking.

Or is it simply not used to mask anything else?

Mad_Malx

Pokerface wrote:

So if the substance provides no performance-enhancement (at lower does), why is it banned at such a low dose?

But it's not banned at a low dose - at maximum clinically recommended levels the plasma and urine levels would still be ok for competition. More than that and there is a significant risks of adverse effects and small performance gains.

Doubtless some competitors think they get an advantage (possibly the reason why there are so many asthmatics in the peleton), and that will give them a psychological edge, but in proper trials it doesn't improve performance in any measurable way (at even high therapeutic levels).

joelsim

There once was a rider who swallowed a fly, I don't know why he swallowed a fly (repeat until it gets to cow with asthma).

Crozza

looks like Cheryl Cole to me

I know far more about hot girls than I do about cycling

The_Boy

Not to cast any aspersions against Ulissi, but is it wrong that I'm totally unsurprised that it should be a lampre rider to get pinged?

awavey

Mad_Malx wrote:

no TUE required for ordinary inhaled use, and therapeutic doses VERY unlikely to be of any benefit to non-asthmatic in or out competition. Non-asthmatic airways are pretty much fully dilated, so no benefit there.

Standard inhaled dose is 100micrograms

standard actuation is 100 micrograms on an inhaler, how much you actually inhale is down to technique, and its trickier than it sounds to combine the right length of actuation, inhaling properly to get a maximum dosage, its not like the movies where its just a quick 1 second puff and thats it, thats why you might well often just go for 2 doses at a time.

ddraver

It's going to be a case of trying to prove that he wasnt trying to use it illegally (as it were) what with strict liability and all.

Ironically all the twaliban holwing about Froome is going to make this a lot more difficult for him (if it is a genuine mistake)

Mad_Malx

https://www.youtube.com/watch?v=7X4CoXIdlCA&feature=kp

Mad_Malx

awavey wrote:

standard actuation is 100 micrograms on an inhaler, how much you actually inhale is down to technique, and its trickier than it sounds to combine the right length of actuation, inhaling properly to get a maximum dosage, its not like the movies where its just a quick 1 second puff and thats it, thats why you might well often just go for 2 doses at a time.

Yes - the actual dose absorbed into the patient is very variable, and much lower than the 100micrograms per puff. Delivery depends on the device type, shaking properly (for many devices) and co-ordinating inhalation and pressing the button - neither of which will be easy while riding.

joelsim

Apparently the amount of salbutamol in his urine was almost impossible to have. There is no way that can come from an inhaler. Shame as I like Ulissi.

philbar72

me too. seems odd. if a drug isn't obviously performance enhancing by itself could it be combined to make him the best uphill finisher and one of the strongest time triallers at the Giro?

thought his talent was natural... seems rather odd.

graeme_s-2

Mad_Malx wrote:

https://www.youtube.com/watch?v=7X4CoXIdlCA&feature=kp

My wife's a physiotherapist and her or her colleagues occasionally demonstrate inhaler technique to patients. The favourite story is the little old lady who'd been given an inhaler to treat an allergy she had to her cat. She came back in because it wasn't helping her symptoms and it turned out she'd been spraying the inhaler at the cat!

frenchfighter

"Salbutamol concentrations following inhalation were commonly (99%) below 1000 ng/ml whereas values after oral administration frequently (48%) exceeded this threshold."

http://www.ncbi.nlm.nih.gov/pubmed/22081503

dsoutar

From french cycling site:

Brent Copeland has expressed its support for Diego Ulissi, accused of taking salbutamol (product found especially in Ventolin) during the last Giro d'Italia, where he won two stages. The manager of the Lampre Merida team explains: "We are all behind our rider and we believe in his innocence 100 percent What we found in his urine is very small as I have been told the doctors." .

Lampre Merida said Ulissi did not need a Therapeutic Use Exemption (TUE) to get an inhaler Ventolin but when he had to comply with anti-doping controls, it was the reported to the agent. However, the amount of salbutamol found in his urine - 1900 ng / ml - almost twice the legal limit which is 1000 ng / ml. You should also know that for runners using Ventolin with AUT, the limit is raised to 1600 ng / ml. Ulissi is still far from this limit.

"The rider has asked the B sample to be tested and we'll see what it says, but, of course, our first reaction was surprise."

"There had been a problem in the chest for a moment, then he had a small flu that he couldn't recover from," said Copeland. "He had a fever and we decided it was better for him to leave, take a few days off and then start preparing for the national championships, which he was supposed to do this weekend. "

"He's obviously devastated. This is news that any rider who believes in itself does not expect to receive, so he is very surprised. and disappointed. "

Mad_Malx

frenchfighter wrote:

"Salbutamol concentrations following inhalation were commonly (99%) below 1000 ng/ml whereas values after oral administration frequently (48%) exceeded this threshold."

http://www.ncbi.nlm.nih.gov/pubmed/22081503

That's interesting. I can't get the article just now, but I assume they are using the upper end doses.
Poor inhaler technique can result in most of the dose being swallowed, so it's possibly a combination of overdoing it and poor tech - as you might expect if he's using the inhaler while riding.

rick_chasey

Mad_Malx wrote:

frenchfighter wrote:

"Salbutamol concentrations following inhalation were commonly (99%) below 1000 ng/ml whereas values after oral administration frequently (48%) exceeded this threshold."

http://www.ncbi.nlm.nih.gov/pubmed/22081503

That's interesting. I can't get the article just now, but I assume they are using the upper end doses.
Poor inhaler technique can result in most of the dose being swallowed, so it's possibly a combination of overdoing it and poor tech - as you might expect if he's using the inhaler while riding.

Presumably riders use inhalers fairly frequently - frequently enough that if it was easy to OD on the bike it would have come up more often?

Anonymous

@inrng: Diego Ulissi's B sample returns adverse finding. Undergoing medical analysis to check kidneys http://t.co/E71J4hHcrR (Italian)

Lanterne_Rogue

All very odd. The generous part of me wonders (for the first time) how urine tests are conducted to avoid possibility of cross-contamination from fingertips etc causing anomalous results (eg you get some on your fingers, and piss it off into the sample jar). Is there a cross-check against breakdown products, or is it just a case of assuming it doesn't happen?

iainf72

underlayunderlay wrote:

All very odd. The generous part of me wonders (for the first time) how urine tests are conducted to avoid possibility of cross-contamination from fingertips etc causing anomalous results (eg you get some on your fingers, and wee-wee it off into the sample jar). Is there a cross-check against breakdown products, or is it just a case of assuming it doesn't happen?

You mean like how they used to use biological washing powder under their fingernails to beat the urine EPO test?

Lanterne_Rogue

iainf72 wrote:

underlayunderlay wrote:

All very odd. The generous part of me wonders (for the first time) how urine tests are conducted to avoid possibility of cross-contamination from fingertips etc causing anomalous results (eg you get some on your fingers, and wee-wee it off into the sample jar). Is there a cross-check against breakdown products, or is it just a case of assuming it doesn't happen?

You mean like how they used to use biological washing powder under their fingernails to beat the urine EPO test?

Please tell me that it's now possible to test positive in a Daz doorstep challenge?

olake92

Rick Chasey wrote:

Presumably riders use inhalers fairly frequently - frequently enough that if it was easy to OD on the bike it would have come up more often?

It's very hard to OD on Salbutamol! I would think (and sincerely hope) that all true sufferers of asthma know how to properly use their inhalers. To give you an idea of how hard it is; my inhaler is a 100microgram actuation. Assuming 100% absorption of each inhalation, you would need 16 doses in a 24 hour period to fail a test. On a really bad day (where I wouldn't even consider racing) I could foresee 2 in the morning, 2 before a hypothetical race, 2 after, 2 in the evening then 2 the next morning. That's still only 1000mg.

I'm guessing Ulissi is either stupid or doping. Most likely both.

frosty99

That would equal 1600micrograms in your whole system (assuming 100% absorbed), that's very different to 1600nanograms/ml in your urine, salbutamol shows up in your urine very quickly, in less than thirty mins in some cases, I've no idea how long it takes you to piss it all out though

olake92

I did wonder that as I wrote it. So presumably you'd need more than 1600 micrograms for it to equal 1600 nanograms in your urine? I just stick to the rules, it's much simpler that way

However, the way I read the WADA rules is that 1600 micrograms is roughly equivalent to 1000 nanograms in your urine. Here's what the WADA prohibited list says...

S3. BETA-2 AGONISTS
All beta-2 agonists, including all optical isomers (e.g. d- and l-) where relevant, are prohibited except inhaled salbutamol (maximum 1600 micrograms over 24 hours), inhaled formoterol (maximum delivered dose 54 micrograms over 24 hours) and salmeterol when taken by inhalation in accordance with the manufacturers’ recommended therapeutic regimen.

The presence in urine of salbutamol in excess of 1000 ng/mL or formoterol in excess of 40 ng/mL is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding unless the Athlete proves, through a controlled pharmacokinetic study, that the abnormal result was the consequence of the use of the therapeutic inhaled dose up to the maximum indicated above.

If anyone can shed some light on that it would be great. Does that just mean you'd have to take 16x100mg actuations in the space of 5 mins?! If so that's just crazy.

frosty99

This study looks like where the cut off may have originated from. http://www.clinchem.org/content/46/9/1365.long
They used 1600mcg inhaler doses so you may be right that' it's roughly he maximum accepted dose. The cut offs were based on urine tests taken 60mins after exercise.

It makes a comment about false positives that means values above the cut off effectively rule out excess inhaler therapy and instead point to oral tablets (illegal ped).

I imagine someone (if not us on TV) would notice ullisi using inhaler 16 times in the last hour of a race whereas a sly salbutamol tablet could go unseen.

darkhairedlord

frosty99 wrote:

This study looks like where the cut off may have originated from. http://www.clinchem.org/content/46/9/1365.long
They used 1600mcg inhaler doses so you may be right that' it's roughly he maximum accepted dose. The cut offs were based on urine tests taken 60mins after exercise.

It makes a comment about false positives that means values above the cut off effectively rule out excess inhaler therapy and instead point to oral tablets (illegal ped).

I imagine someone (if not us on TV) would notice ullisi using inhaler 16 times in the last hour of a race whereas a sly salbutamol tablet could go unseen.

Thing is, if your not used to using an inhaler, the stuff just ends up sprayed over the inside of your mouth and gets swallowed :shock: . So an inhaled dose actually becomes an oral dose....

philbar72

what does it mean though? is it doping or did he have an acute bronchial / asthmatic issue?

olake92

As far as I know, it's not common for people to be prescribed Salbutamol in tablet form, which would be the most obvious way of going over the limit (and Salbutamol taken orally is prohibited anyway) - as pointed out earlier, 10 or more puffs on your inhaler in the last 60 mins of a race might get noticed! If he had acute asthma symptoms, I doubt he'd be winning a stage of the Giro! Certainly, since I started using my preventer, I've never needed anywhere near that dose, and on a particularly bad day you're not going to be winning races.

To me, the size of the dose and his (unhindered) performance suggests he used a Salbutamol tablet with the idea of doping. We'll see though, I could be wrong! I'd be interested to see how much of my standard 200-300mcg dose of inhaled Salbutamol turns up in my urine.