Norwegian Ski Team Recommended Nebulizer Use by Healthy Athletes, Say Anonymous Skiers

As Norwegian skier Martin Johnsrud Sundby has decided to appeal his doping ban to the Swiss Supreme Court, stories have emerged suggesting that the Norwegian Ski Federation recommended that healthy skiers use salbutamol nebulizers – the same drug and method Sundby was issued a two-month ban for – as preventative therapy to maximize performance.

That suggests that a number of Norwegian athletes might have engaged in the same behavior which got Sundby in trouble in the first place. No other doping cases are known to exist from the Norwegian team. However, the International Ski Federation (FIS) rules mean that if an athlete had been caught with high levels of salbutamol like Sundby, it may have been kept quiet.

After Sundby’s ban, men’s national team coach Tor Arne Hetland told FasterSkier that “we will not do the same mistake again.”

But what of the past? Norway’s TV2 talked with several cross-country skiers who say they were told by the national team to use nebulizers, even though they did not have asthma. A nebulizer delivers beta-2 agonists, drugs which help relax muscles in the airways. Such medications are banned for use by athletes up until a threshold dose.

TV2 would not reveal the identity of the athletes, but reported that one said they were “mildly surprised” to be offered the drugs even though they were not having difficulty breathing.

In the same piece, national team director Vidar Løfshus said that this constituted “preventative care” to make sure that no athletes had airway obstructions.

Evidence suggests that salbutamol cannot help breathing for athletes who are not having an airway constriction, such as that caused by asthma. But beta-2 agonists, as a class of drugs, can also be used as masking agents for other drugs, and can have androgenic effects (like steroids) when used in high doses.

The Norwegian Ski Federation announced on its website that it would be conducting a full review of medication use policies in the wake of the scandal.

Erik Røste, the president of the federation, said that he expected that healthy athletes would not have been prescribed medication, but sought to clarify whether his assumption was true. The investigation will be carried out by people not affiliated with the federation in order to maintain independence. Anti-Doping Norway has been consulted about assisting.

Røste also said that he was concerned that the stories could damage the reputation of the federation.

That seems to be already happening. Swedish national team doctor Per Andersson told Swedish media that prescribing medication to healthy athletes was a “dangerous path”.

Meanwhile, Sundby had been sanctioned for using high concentrations of salbutamol via a nebulizer. FIS had initially not suspended him, but the World Anti-Doping Agency (WADA) appealed the case to the Court of Arbitration for Sport (CAS), which banned him from competition for two months. Because some results were invalidated, Sundby lost his 2015 overall World Cup title as well as the overall Tour de Ski win.

CAS is the highest governing body in sports, and decisions cannot be appealed or overturned. However, Sundby decided to appeal the case to a non-sports body, the Swiss Supreme Court, because he felt that the judgement was unfair. He told Norwegian media that he was “not guilty.”

Based on WADA rules, the maximum amount of salbutamol that is allowed to be inhaled is 1600 micrograms over 24 hours. Sundby’s samples taken Dec. 13, 2014 after the 15-kilometer classic in Davos, Switzerland, and Jan. 8, 2015 after the 25 k freestyle pursuit at the Tour de Ski in Toblach, Italy, and analyzed by a WADA accredited laboratory exceeded those limits.

His case hinges on a few words, as Sundby and the Norwegian medical team believe that the WADA limit applies only to medication taken in an inhaler, while Sundby used a different device, a nebulizer.

As an athlete with a documented history of asthma, Sundby likely could have received a therapeutic use exemption (TUE), which may have allowed the nebulizer use. But he did not apply for one, and such exemptions cannot be obtained retroactively.