By Lisa Rapaport

(Reuters Health) – Sports physicians routinely prescribe corticosteroids to athletes for conditions like inflammation, asthma and allergies, but not all of them know which forms of these drugs are banned under anti-doping rules, a study suggests.

The survey of 603 physicians from 30 countries found that four in five prescribe oral corticosteroids to athletes, one of the forms prohibited during competition by the World Anti-Doping Agency (WADA).

While 73% of physicians knew athletes needed a medical exemption to use oral corticosteroids just before or during competition, far fewer knew exemptions were also required for other forms of these drugs including intravenous injections, ointments, creams and inhaled medicines.

“Where an athlete has a medical condition (for example inflammatory bowel disease or severe asthma) which requires the use of medication which is usually prohibited in sport (for example intravenous or oral glucocorticoid), the health of the athlete should take priority,” said researcher Dr. David Hughes of the Australian Institute of Sport in Bruce.

To keep competitions fair and prevent healthy athletes from using these drugs to improve their performance, sports physicians must be familiar with WADA regulations and ensure their patients get so-called therapeutic-use exemptions to take corticosteroids during competition when it’s medically necessary, Hughes said by email.

“While there is evidence that glucocorticoids may be abused when delivered by certain routes,” such as muscle injection “in very specific sporting scenarios (e.g. long-distance road cycling),” the overwhelming majority of corticosteroid use in sport is for legitimate treatment of injury and illness, Hughes said.

Corticosteroids can reduce inflammation and are widely used to treat a range of medical conditions.

Injections are widely used in sports medicine and for conditions like rheumatoid arthritis, while oral forms are often prescribed for allergies and asthma, the study team notes in the British Journal of Sports Medicine.

In the survey, 93% of sports medicine physicians said they prescribed injected corticosteroids.

Several forms of injections can only be used by athletes with therapeutic use exemptions. Doctors in the survey were aware that exemptions were required for various forms of injections only 30% to 60% of the time.

Practitioners with more experience were more likely to correctly identify which forms of corticosteroids required exemptions.

The results suggest a lack of knowledge in sports medicine about these drugs might lead some athletes to fail anti-doping tests even when it wasn’t their intention to cheat, said Dr. Martine Duclos, a sports medicine specialist at the University Hospital of Clermont-Ferrand in France.

Athletes should make sure they understand anti-doping rules and ask their doctors about any needed exemptions for medicines used during competition, Duclos, who wasn’t involved in the study, said by email.

“Corticosteroids can be used in sport for legitimate therapeutic reasons,” Duclos said. “The value of systemic glucocorticoids is recognized in the treatment of many medical conditions common in athletes such as exacerbations of asthma, sinusitis, musculoskeletal injuries, acute allergic reactions and inflammatory bowel disease.”

SOURCE: British Journal of Sports Medicine, online February 5, 2020.