Antti Alaranta

Use of Prescription Drugs in Athletes

Although athletes are young and generally healthy, they use a variety of nondoping classified medicines to treat injuries, cure illnesses and obtain a competitive edge. Athletes and sports medicine physicians try to optimize the treatment of symptoms related to extreme training during an elite athlete’s active career. According to several studies, the use of antiasthmatic medication is more frequent among elite athletes than in the general population. The type of training and the kind of sport influence the prevalence of asthma. Asthma is most common among those competing in endurance events, such as cycling, swimming, cross-country skiing and long-distance running. Recent studies show that athletes use also NSAIDs and oral antibacterials more commonly than age-matched controls, especially athletes competing in speed and power sports. Inappropriately high doses and concomitant use of several different NSAIDs has been observed. All medicines have adverse effects that may have deleterious effects on elite athletes’ performance. Thus, any unnecessary medication use should be minimized in elite athletes. Inhaled β2-agonists may cause tachycardia and muscle tremor, which are especially harmful in events requiring accuracy and a steady hand. In experimental animal models of acute injury, especially selective cyclo-oxygenase-2 inhibitors have been shown to be detrimental to tissue-level repair. They have been shown to impair mechanical strength return following acute injury to bone, ligament and tendon. This may have clinical implications for future injury susceptibility. However, it should be noted that the current animal studies have limited translation to the clinical setting. Adverse effects related to the CNS and gastrointestinal adverse reactions are commonly reported in connection with NSAID use also in elite athletes. In addition to the potential for adverse effects, recent studies have shown that NSAID use may negatively regulate muscle growth by inhibiting protein synthesis. Physicians and pharmacists taking care of athletes’ medication need to be aware of the medicines that an athlete is taking and how those medicines interact with performance, exercise, environment and other medicines. Sport associations should repeatedly monitor not only the use of banned substances, but also the trends of use of legal medicines in athletes. Not only physicians and pharmacists, but also athletes and coaches should be better educated with respect to potential benefits and risks, and how each agent may affect an athlete’s performance. The attitudes and beliefs leading to ample use of legal medicines in athletes is an interesting area of future research.

Allergic Rhinitis and Pharmacological Management in Elite Athletes

INTRODUCTION Only a few studies have examined the occurrence of atopy and clinically apparent allergic disease and their pharmacological management in elite athletes. The aim of the study was to assess the frequency of allergic rhinitis and the use of antiallergic medication within the subgroups of elite athletes as compared with a representative sample of young adults of the same age. METHODS A cross-sectional survey was carried out in 2002. All the athletes (N = 494) financially supported by the National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, the use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1504) served as controls. RESULTS The endurance athletes reported physician-diagnosed allergic rhinitis more often (36.1%) than other athletes (23.4%) or control subjects (20.2%). The use of antiallergic medication was reported by 33.3, 15.7, and 15.6% of those, respectively. Among both athletes and controls, females reported the use of antiallergic medication more often than males. Only half of those athletes reporting allergic rhinitis had used antiallergic medication during the past year. After adjusting for age and sex, OR (95% CI) for allergic rhinitis and the use of antiallergic medication were 2.24 (1.48-3.39) and 2.79 (1.82-4.28), respectively, in endurance athletes as compared with the controls. CONCLUSIONS Endurance athletes have physician-diagnosed allergic rhinitis, and they use antiallergic medication more often than athletes in other events or control subjects. Only half of those athletes reporting allergic rhinitis take antiallergic medication. More attention needs to be paid to the optimal management of allergic rhinitis, especially in highly trained endurance athletes.

Effect of deregulation on the prices of nicotine replacement therapy products in Finland

OBJECTIVE The sales of nicotine replacement therapy (NRT) products were deregulated in Finland in February 2006. Previously all medications were sold only in pharmacies, and retail mark-ups and prices were fixed; following deregulation pricing of NRT products has been free. Further more, grocery shops, petrol stations and kiosks are now licensed to sell NRT products. The objective of this study is to evaluate the impact of deregulation on prices of NRT products. METHODS We utilized price data on NRT products (n=2106) from pharmacies, grocery shops, kiosks and petrol stations. Market prices are compared with former regulated prices, as are the prices at different types of outlets. We examined the relationship between competition and prices by regression analysis. RESULTS The average price of NRT products decreased 15% after deregulation. About half of the price decrease was due to exemption of NRT products from the pharmacy fee as part of deregulation, and the other half to increased competition. The least expensive NRT products are obtainable in hypermarkets; however, pharmacies have the largest variety. CONCLUSIONS Deregulation of NRT products in Finland was successful in that the prices of these products have decreased and their availability increased. Based on international experience, however, it is not clear whether these decreased prices and increased availabilities have increased smoking cessation.

Physician-prescribed medication use by the Finnish Paralympic and Olympic athletes.

Objective:Data about medication use by Paralympic athletes (PAs) are limited and no data concerning medication use outside Paralympics exist. The objective of the current study was to compare the use of physician-prescribed medication in PAs and Olympic athletes (OAs). Design:A cross-sectional comparative study. Setting:Finnish PAs and OAs receiving financial support from the Finnish Olympic and Paralympic committee in 2006 and 2009, respectively. Participants:A total of 92 PAs (response rate, 75.0%; 92 of 123) and 372 OAs (response rate, 91.9%; 372 of 405) participated. Assessment of Risk Factors:Age, sex, and type of athlete (PA vs OA) were included as independent covariates in the logistic regression model analysis. Main Outcome Measures:The use of physician-prescribed medication among athletes during the previous 7 days and 12 months. Results:Among the PAs, the use of physician-prescribed medicines (48.9% vs 33.3%; adjusted odds ratio, 1.99; 95% confidence interval, 1.13-3.51), painkillers (2.61; 1.18-5.78), oral antibiotics (4.10; 1.30-12.87), and anti-epileptic medicines (37.09; 5.92-232.31) were more common than among the OAs during the previous 7 days. Paralympic athletes had used significantly less asthma medicines than the OAs during the previous 7 days (4.3% vs 11.0%; adjusted odds ratio, 0.30; 95% confidence interval, 0.10-0.96). Conclusions:The use of any physician-prescribed medicines, especially those to treat chronic diseases, seems to be more common among the PAs than the OAs. Paralympic athletes use significantly less asthma medicines than OAs.