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 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