Revista de Medicina Desportiva (English) November 2018 | Page 14

Rev. Medicina Desportiva informa, 2018; 9(6):12-13.
An Athlete with a Positive
Doping Control After Taking
a “Cough Syrup”
Dr. André Amaral 1 , Dra. Telma Miragaia 2
1
Resident of General Medical Pratitioner at the Health Unit of Faial Island; 2 General Medical Practitioner
Specialist; Post-graduation on Sports Medicine at The Oporto Medical School. Azores, Portugal.
RESUMO / ABSTRACT
We report the case of a 22-year-old high-ranking athlete who addressed to a health care center with
a respiratory infection of the upper airways and to whom, among other drugs, was prescribed with
a "cough syrup". Subsequently, the athlete was subjected to an anti-doping control test in a national
event, that proved to be positive for clenbuterol. As the athlete had not reported being a high
competition athlete, a Therapeutic Use Exemption (TUE) was not requested at the time of prescrip-
tion. Although it was a case of "involuntary doping", the athlete was suspended preventively and
suffered invalidation of the results obtained in the competition, as foreseen in article 50 of the law nº
38/2012 related to anti-doping in sport.
PALAVRAS-CHAVE / KEYWORDS
Doping, anti-doping control, clenbuterol
Introduction
Doping is the use of forbitten
substances or methods that can
promote physical and / or mental
changes that artificially increase
sports performance. The List of
forbitten substances or methods
was first published in 1963 and since
2004 that the World Anti-Doping
Agency (WADA) is responsible for its
actualization and publication. This
List is a fundamental element of
the World Anti-doping Code and it
aims to harmonize the fight against
doping in sports in all countries to
guarantee that all the athletes are
tested in the same way and that the
analytical tests are performed in the
same way as well. This List is revised
every year and a new version comes
into force on January, the 1 st of each
new year. 1
If an athlete gets sick, he has the
right to access any medication,
regardless if it is included in the List
of doping substances. Whenever
an athlete needs to take a forbitten
medication he must apply to the
Portuguese Anti-Doping Authority
(ADoP) the authorization for such
utilization. This Therapeutic Use
Exemption (TUE) must be asked
before the beginning of the non-
emergent treatment ant it will be
12 november 2018 www.revdesportiva.pt
only approved if there isn’t a good
alternative treatment, this is, only
after the non-forbitten treatments
have been excluded. 2
According to the 5 th article of the
law number 38/2018 related to the
anti-doping in sports, the athlete
is the only one responsible for not
introducing in his body any forbit-
ten substance or that any forbitten
method is used. 3 However, some
forbitten substances can be found in
regular medications of regular use
and studies have shown that there
are supplements contaminated,
whereby much care has to be taken
when an athlete needs to be medi-
cated or when he decides to take
nutritional supplements. No know-
ing these facts, either by the doc-
tors, or by the athletes, can lead to
involuntary doping, as it is described
in the present case.
last six days. On that medical visit
he didn’t have any other respiratory
symptomatology. He didn’t refer any
past disease and he was not doing
any chronic medication. He denied
any allergy to medications.
On physical examination he had
no fever (aural temperature equal
to 36,0°C, had pink mucous mem-
branes but dehydrated, and there
wasn’t any respiratory distress. On
chest auscultation, the heart beat
was rhythmic, normal first and
second heart sounds, the vesicular
murmur was present and symmetric
in the lungs and without any extra
sounds. In the oropharynx there was
hypertrophic tonsils but without any
exudates. The rest physical exam
didn’t revealed any significant find-
ing.
Taking into consideration the
anamnesis and the physical exam
and in the absence of complemen-
tary diagnostic tests, the diagnosis of
upper airway respiratory infection of
probable atypical bacterial infection,
and to the athlete it was prescribed
ibuprofen 600mg every 12 hours for
three days, azithromycin 500mg,
one pill per day, also for three days,
paracetamol 1gr for pain and fever ,
and, finally, ambroxol + clenbuterol
3 mg/ml + 0,002 mg/ml with the
posology of 5ml every 12 hours.
Later, the athlete was submitted
to a doping control test during a
national championship event of
his sport, where he informed the
recently prescribed medication,
including the cough syrup, whose
name he couldn’t recall. Because
he hadn’t informed the prescribing
doctor that he is a sportsman, no
TUE was made on that moment or
the prescription of another forbit-
ten medication to take in sports was
considered.
Clinical Case
It was a 22 years old male athlete
that visited a doctor at a health
unity because he was suffering of
sore throat for three days, fever with
spikes every eight hours (the highest
recorded value was 38° C). He had
also dry cough, mostly during the
night and in the morning for the
Discussion
There are several campaigns of
information and education that
promote a clean sport, like “Together