Winn of 2 Giro Stages Ulissi tests positive for Salbutamol

Inquitus

Abnormal Salbutamol levels for Lampre rider

Diego Ulissi has been suspended by his Lampre-Merida team after returning an adverse analytical finding, the team has confirmed.

An anti-doping test completed after the 11th stage of the Giro d’Italia showed Ulissi to have elevated levels of salbutamol in his system. Ulissi was shown to have 1,900 ng/ml in his system, significantly higher than the 1,000 ng/ml allowed by the UCI.

Interesting in light of Froome being in the spotlight for the same Asthma drug recently.

http://www.cyclingnews.com/news/diego-ulissi-returns-adverse-analytical-finding-at-giro-ditalia?ns_campaign=news&ns_mchannel=rss&ns_source=cyclingnews&ns_linkname=0&ns_fee=0

Chips Lovell

Higher than Petacchi when he got popped (1,320 ng/ml).

wirelessdude01

Hmmmmmm. Very suss that this is only coming into the public domain now.

Chips Lovell

Nothing suss about the timing I think. Doping control results often take weeks to come out.

Inquitus

Oscar Gateaux wrote: »

Higher than Petacchi when he got popped (1,320 ng/ml).

Aye it's quite alot of Salbutamol as I understand it, maybe some of our medical folks can confirm.

Chips Lovell

He claims he took two puffs, which would be equivalent of 100 ng/ml. If that's correct, he tested for the equivalent of 38 puffs.

lennymc

how do you reckon 38 puffs? - edit - I re-read the articlle, 2 puffs = 50, so 1900 = 38 puffs.

Wada recommend 1600 ng/ml iirc. I didn't know the UCI had a lower limit.
edit - I re-read the wada and the limit for urine is 1000.

MPFG

Excuse my ignorance but what would be the advantage to a rider in taking 38 buffs

Also how is this not ok when Froome took oral cortisone for asthma and was allowed to race

Surely whatever 'advantage' Ulissi had Froome had more

Very confusing

What is the B sample comes back as per A sample will be his sanction be ??

dermabrasion

Oscar Gateaux wrote: »

He claims he took two puffs, which would be equivalent of 100 ng/ml. If that's correct, he tested for the equivalent of 38 puffs.

Most ventolin (salbutamol) MDI inhalers are 100 microgram / puff, so the reported units reported are wrong by a factor of 1000 (nanogram [ng] vs. microgram [ug]). 2 puffs is the normal dose.
The bio-elimination of salbutamol in the urine of a dehydrated athlete with a huge cardiac output at the end of a stage has likely never been modelled to produce an accurate elimination half life. I am not a pharmacologist, but the values seem to be consistent with his story based on these data: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884284/#b5
Most of us see asthmatics that take an extra puff or two when they need it, or if they perceive the dose was mistimed or not fully delivered. I would suspect he took an extra puff or two if he was feeling chesty. I think he should be given a warning and his doctor needs to be all over any chest infection in terms of notes and medications paper trail next time. I would hope he does not get banned.

p.s. i am not sure from the report / study if it is total amount of drug, or concentration of drug. It depends on how they do the assay.

godtabh

dermabrasion wrote: »

I would suspect he took an extra puff or two if he was feeling chesty.

My wife is asthmatic and the weather plays a big role in how often she uses her inhaler. Damp misty conditions and she will use it a lot more. Plenty of that in this years giro.

She is also very good at predicting the weather. She can tell when a fog is coming depending on how bad her wheeze is

Daroxtar

I'm asthmatic. Cold weather gives me problems. When I was younger and played football I would often take my inhaler even when I didn't need it and I felt it definitely helped me to recover faster after sprints. It may not be medically proven but from my perspective there seemed to be a fairly marked difference in performance so I'm sceptical about its use and not at all surprised it's popping up. Just my 2c worth

Kurtosis

dermabrasion wrote: »

Most ventolin (salbutamol) MDI inhalers are 100 microgram / puff, so the reported units reported are wrong by a factor of 1000 (nanogram [ng] vs. microgram [ug]). 2 puffs is the normal dose.
The bio-elimination of salbutamol in the urine of a dehydrated athlete with a huge cardiac output at the end of a stage has likely never been modelled to produce an accurate elimination half life. I am not a pharmacologist, but the values seem to be consistent with his story based on these data: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884284/#b5

While the dose is 100 microgram per puff, the nanograms per ml refers to the urinary concentration.

There does appear to have been a pharmacokinetic study in athletes: http://www.ncbi.nlm.nih.gov/m/pubmed/22388343/

OBJECTIVE: Data on pharmacokinetics of inhaled and oral salbutamol in elite athletes with asthma are needed to differentiate between therapeutic use and doping in doping control.

DESIGN: An interventional open-label crossover.

SETTING: Respiratory Research Unit, Copenhagen University Hospital, Bispebjerg.

PARTICIPANTS: Eight elite athletes with asthma and 10 nonasthmatic subjects aged 18 to 33 years.

INTERVENTION: Administration of 0.8 mg of inhaled salbutamol and 8 mg of oral salbutamol separated by 14 days.

MAIN OUTCOME MEASURES: Urine concentration of free salbutamol.

RESULTS: Maximum urine concentrations peaked in the period of 0 to 4 hours after the administration of inhaled and oral salbutamol in both groups. Median concentrations after inhaled salbutamol and oral salbutamol were 401.6 and 2108.1 ng/mL in healthy subjects and 334.9 and 2975.2 ng/mL in elite athletes with asthma. There were no significant statistical differences between the groups. One sample exceeded the World Anti-Doping Agency threshold value of 1000 ng/mL with a urinary salbutamol concentration of 1057 ng/mL 4 hours after inhalation, when no correction for urine specific gravity was done. When this sample was corrected for urine specific gravity, the result was 661 ng/mL.

CONCLUSIONS: We found no significant difference in pharmacokinetic profile of inhaled and oral salbutamol between elite athletes with asthma and nonasthmatic subjects. Our results indicate that urine salbutamol concentrations should be corrected for urine specific gravity when evaluating doping cases.

They accounted for urine concentration/dehydration by using urine specific gravity in this study and doing so brought one sample marginally over the limit to well within accepted bounds. Does anyone know if urine specific gravity is adjusted for in doping samples?

dermabrasion

Thanks for this. I was not sure about the assay method and correction as you point out. The paper I looked at quotes values which are absolute (g) not [wt/vol]. So I would defer to chemists. Correcting of SG would make sense, but may not account for increased clearance of the drug which would not be a steady state after a stage.
As much as Boardies are enthralled by analytical chemistry, there is a note of caution: Salbutamol decreases bronchial smooth muscle tone (facilitating air flow), increases cardiac contractility and heart rate are all good things for the heart. All ideal for the cyclist. In toxicity, salbutamol causes / associated with lactic acidosis (frequently seen in status asthmaticus). This would impair performance. So, it would be counter-productive to inhale multiple doses of salbutamol. Don't do it.