Asthma medication in athletes: a qualitative investigation of adherence, avoidance and misuse in competitive sport

Abstract

Objectives The purpose of this qualitative study was to utilize the Capability, Opportunity, Motivation - Behavior model (COM-B) to: (1) evaluate athlete knowledge and understanding of current asthma-related anti-doping regulations, (2) explore the impact of environmental and societal influences on athletes with asthma, and (3) examine athlete perception of asthma medication use in competitive sport.Methods: Semi-structured interviews were conducted with ten competitive endurance athletes (five athletes with asthma and five without asthma). Interviews were guided by the COM-B model and transcripts were analyzed inductively and deductively using reflexive thematic analysis.Results: Mapping the experiences and perceptions of athletes against an established behavioral framework identified that: (1) athletes’ possess limited knowledge and understanding of the World Anti-Doping Agency (WADA) Prohibited List and Therapeutic use exemption (TUE) policy with respect to asthma medication; (2) the use of sub-optimal diagnostic methods is commonplace and increases the risk of misdiagnosis and unnecessary inhaler therapy; (3) negative media portrayal of high-profile asthma-related doping allegations impacts public opinion and contributes to the perception of wrongdoing within the sporting community.Conclusion: The novel application of behavioral science highlights several factors that may contribute to asthma medication avoidance and promote misuse in competitive sport. The findings from this study provide a foundation for the development and implementation of targeted education programmes, and it is hoped that employing this approach will ultimately improve overall perceptions of asthma treatment in athletes, which is necessary to maintain respiratory health, optimize performance and protect the integrity of sport.

Keywords:

• Treatment
• education
• exercise induced

Contributors

All authors contributed to design of this study. HA, SB and OP contributed to the data analysis of this study. All authors contributed to writing and reviewing the manuscript.

Ethical approval

This study was approved by the local research ethics committee (application reference: 39303). All participants provided written informed consent to include their responses in the study.

Declaration of interest

JH has a continuing role as a respiratory advisor at the English Institute of Sport and is a TUE committee member for UK Anti-Doping, Union of European Football Associations and the Cycling Anti-Doping Foundation mandated by the Union Cycliste Internationale. JH has received funding from pharmaceutical companies Roche, Teva, AstraZenca and Novartis. OP and JH provide exercise-induced asthma testing for elite athletes. HA and SB have no conflicts of interest.

Data availability statement

All data relevant to the study are included in the article.