Sports Medicine

, Volume 38, Issue 6, pp 449–463 | Cite as

Use of Prescription Drugs in Athletes

  • Antti AlarantaEmail author
  • Hannu Alaranta
  • Ilkka Helenius
Leading Article


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 Heterotopic Ossification Montelukast Formoterol Eccentric Exercise 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this article. The authors have no conflicts of interest that are directly relevant to the content of this article.


  1. 1.
    Alaranta A, Alaranta H, Heliövaara M, et al. Allergy and pharmacological management in elite athletes. Med Sci Sports Exerc 2005; 37: 707–11PubMedCrossRefGoogle Scholar
  2. 2.
    Alaranta A, Alaranta H, Palmu P, et al. Asthma medication in Finnish Olympic athletes: no signs of overuse of inhaled β2—agonists. Med Sci Sports Exerc 2004; 36: 919–24PubMedCrossRefGoogle Scholar
  3. 3.
    Helenius IJ, Tikkanen HO, Haahtela T. Association between type of training and risk of asthma in elite athletes. Thorax 1997; 52: 157–60PubMedCrossRefGoogle Scholar
  4. 4.
    Helenius IJ, Tikkanen HO, Sarna S, et al. Asthma and increased bronchial responsiveness in elite athletes: atopy and sport event as risk factors. J Allergy Clin Immunol 1998a; 101: 646–52PubMedCrossRefGoogle Scholar
  5. 5.
    Nystad W, Harris J, Sundgot Borgen J. Asthma and wheezing among Norwegian elite athletes. Med Sci Sports Exerc 2000; 32: 266–70PubMedCrossRefGoogle Scholar
  6. 6.
    Kujala UM, Taimela S, Antti-Poika I, et al. Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data. BMJ 1995; 311: 1465–8PubMedCrossRefGoogle Scholar
  7. 7.
    Kujala UM, Nylund T, Taimela S. Acute injuries in orienteers. Int J Sports Med 1995; 16: 122–5PubMedCrossRefGoogle Scholar
  8. 8.
    Alaranta A, Alaranta H, Heliövaara M, et al. Ample use of medications in elite athletes. Int J Sports Med 2006; 27: 919–25PubMedCrossRefGoogle Scholar
  9. 9.
    Helenius I, Rytilä P, Sarna S, et al. Effect of continuing or finishing high—level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5−year prospective followup study of 42 highly trained swimmers. J Allergy Clin Immunol 2002; 109: 962–8PubMedGoogle Scholar
  10. 10.
    Berglund B, Sundgot-Borgen J. Sports medicine update. Scand J Med Sci Sports 2001; 11: 369–71PubMedCrossRefGoogle Scholar
  11. 11.
    Corrigan B, Kazlauskas R. Medication use in athletes selected for doping control at the Sydney Olympics (2000). Clin J Sports Med 2003; 13: 33–40CrossRefGoogle Scholar
  12. 12.
    Lewis SC, Langman MJS, Laporte JR, et al. Dose—response relationships between individual nonaspirin nonsteroidal anti inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta—analysis based on individual patient data. Br J Clin Pharmacol 2002; 54: 320–6PubMedCrossRefGoogle Scholar
  13. 13.
    Bents RT, Tokish JM, Goldberg L. Ephedrine, pseudoephedrine, and amphetamine prevalence in college hockey players. Phys Sportsmed 2004; 32: 30–4PubMedGoogle Scholar
  14. 14.
    Alaranta A, Alaranta H, Holmila J, et al. Self—reported attitudes of elite athletes towards doping: differences between type of sport. Int J Sports Med 2006; 27: 842–6PubMedCrossRefGoogle Scholar
  15. 15.
    Huang S-H, Johnson K, Pipe AL. The use of dietary supplements and medications by Canadian athletes at the Atlanta and Sydney Olympic games. Clin J Sport Med 2006; 16: 27–33PubMedCrossRefGoogle Scholar
  16. 16.
    Weiler JM. Medical modifiers of sport injury: the use of non—steroidal anti—inflammatory drugs (NSAIDs) in sports soft tissue injury. Clin Sports Med 1992; 11: 625–44PubMedGoogle Scholar
  17. 17.
    Shoor S. Athletes, nonsteroidal anti—inflammatory drugs, coxibs, and the gastrointestinal tract. Curr Sports Med Reports 2002; 1: 107–15Google Scholar
  18. 18.
    Thorsson O, Rantanen J, Hurme T, et al. Effects of nonsteroidal antiinflammatory medication on satellite cell proliferation during muscle regeneration. Am J Sports Med 1998; 26: 172–6PubMedGoogle Scholar
  19. 19.
    Almekinders LC. Anti—inflammatory treatment of muscular injuries in sport: an update of recent studies. Sports Med 1999; 28: 383–8PubMedCrossRefGoogle Scholar
  20. 20.
    Vane JR. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin—like drugs. Nat New Biol 1971; 231: 232–5PubMedGoogle Scholar
  21. 21.
    Rankin JA. Biological mediators of acute inflammation. AACN Clin Issues 2004; 15: 3–17PubMedCrossRefGoogle Scholar
  22. 22.
    Gilroy DW, Colville-Nash PR, Willis D, et al. Inducible cyclooxygenase may have anti—inflammatory properties. Nat Med 1999; 5: 698–701PubMedCrossRefGoogle Scholar
  23. 23.
    Singh P, Roberts MS. Skin permeability and local tissue concentration of nonsteroidal anti—inflammatory drugs after topical application. J Pharmacol Exp Ther 1994; 268: 144–51PubMedGoogle Scholar
  24. 24.
    Moore RA, Tramer MR, Carroll D, et al. Quantitative systemic review of topically applied non—steroidal anti—inflammtory drugs. BMJ 1998; 316: 333–8PubMedCrossRefGoogle Scholar
  25. 25.
    Åkermark C, Forsskåhl B. Topical Indomethacin in overuse injuries in athletes: a randomized double blind comparing elmetacin with oral indomethacin and placebo. Int J Sports Med 1990; 11: 393–6PubMedCrossRefGoogle Scholar
  26. 26.
    Galer BS, Rowbotham M, Perander J. Topical diclofenac patch relieves minor sport injury pain: results of a multicenter controlled clinical trial. J Pain Symptom Manage 2000; 19: 287–94PubMedCrossRefGoogle Scholar
  27. 27.
    Mazieres B, Rouanet S, Velicy J, et al. Topical ketoprofen patch (100mg) for the treatment of ankle sprain. Am J Sports Med 2005; 33: 515–22PubMedCrossRefGoogle Scholar
  28. 28.
    Predel HG, Koll R, Pabst H, et al. Diclofenac patch for topical treatment of acute impact injuries: a randomized, double blind, placebo controlled, multicentre study. Br J Sports Med 2004; 38: 318–23PubMedCrossRefGoogle Scholar
  29. 29.
    Esparza F, Cobian C, Jimenez JF, et al. Topical ketoprofen TDS patch versus diclofenac gel: efficacy and tolerability in benign sport related soft—tissue injuries. Br J Sports Med 2007; 41: 134–9PubMedCrossRefGoogle Scholar
  30. 30.
    Almekinders LC, Gilbert JA. Healing of experimental muscles strains and the effects of nonsteroidal anti-inflammatory medication. Am J Sports Med 1986; 14: 303–8PubMedCrossRefGoogle Scholar
  31. 31.
    Reynolds JF, Noakes T, Schwellnus MP. Nonsteroidal anti inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy. S Afr Med J 1995; 85: 517–22PubMedGoogle Scholar
  32. 32.
    Bondesen BA, Mills ST, Kegley KM, et al. The COX−2 pathway is essential during early stages of skeletal muscle regeneration. Am J Physiol Cell Physiol 2004; 287: C475–83CrossRefGoogle Scholar
  33. 33.
    Rahusen FT, Weinhold PS, Almekinders LC. Nonsteroidal anti—inflammatory drugs and acetaminophen in the treatment of an acute muscle injury. Am J Sports Med 2004; 32: 1856–9PubMedCrossRefGoogle Scholar
  34. 34.
    Dalton JD, Schweinie JE. Randomized controlled noninferiority trial to compare extended release acetaminophen and ibuprofen for the treatment of ankle sprains. Ann Emerg Med 2006; 48: 615–23PubMedCrossRefGoogle Scholar
  35. 35.
    Woo WWK, Man SY, Lam PKW, et al. Randomized doubleblind trial comparing oral paracetamol and oral nonsteroidal antiinflammatory drugs for treating pain after musculoskeletal injury. Ann Emerg Med 2005; 46: 352–61PubMedCrossRefGoogle Scholar
  36. 36.
    Almekinders LC. Nonsteroidal anti—inflammatory drugs and corticosteroids. In: Bahrke MS, Yesalis CE, editors. Performance—enhancing substances in sport and exercise. Champaign (IL): Human Kinetics, 2002: 125–35Google Scholar
  37. 37.
    Peterson JM, Trappe TA, Mylona E, et al. Ibuprofen and acetaminophen: effect on muscle inflammation after eccentric exercise. Med Sci Sports Exerc 2003; 35: 892–6PubMedCrossRefGoogle Scholar
  38. 38.
    Bourgeois J, Macdougal D, Macdonald J, et al. Naproxen does not alter indices of muscle damage in resistance—exercised trained men. Med Sci Sports Exerc 1999; 31: 4–9PubMedCrossRefGoogle Scholar
  39. 39.
    Pizza FX, Cavender D, Stockard A, et al. Anti—inflammatory doses of ibuprofen: effects on neutrophils and exercise—induced muscle injury. Int J Sports Med 1999; 20: 98–102PubMedGoogle Scholar
  40. 40.
    Nosaka K, Sakamoto K, Newton M, et al. How long does the protective effect on eccentric exercise—induced muscle damage last? Med Sci Sports Exerc 2001; 33: 1490–5PubMedCrossRefGoogle Scholar
  41. 41.
    Barnett A. Using recovery modalities between training sessions in elite athletes: does it help? Sport Med 2006; 36: 781–96CrossRefGoogle Scholar
  42. 42.
    Lanier AB. Use of nonsteroidal anti—inflammatory drugs following exercise—induced muscle injury. Sports Med 2003; 33: 177–86CrossRefGoogle Scholar
  43. 43.
    Banovac K, Williams JM, Patrick LD, et al. Prevention of heterotopic ossification after spinal cord injury with COX−2 selective inhibitor (rofecoxib). Spinal Cord 2004; 42: 707–10PubMedCrossRefGoogle Scholar
  44. 44.
    Mehallo CJ, Dezner JA, Bytomski JR. Practical management: nonsteroidal anti—inflammatory drug (NSAID) use in athletic injuries. Clin J Sport Med 2006; 16: 170–4PubMedCrossRefGoogle Scholar
  45. 45.
    Altman RD, Latta LL, Keer R, et al. Effect of nonsteroidal anti inflammatory drugs on fracture healing: a laboratory study in rats. J Orthop Trauma 1995; 9: 392–400PubMedCrossRefGoogle Scholar
  46. 46.
    Burd TA, Lowry KJ, Anglen JO. Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures. J Bone Joint Surg Am 2001; 83: 1783–8PubMedGoogle Scholar
  47. 47.
    Endo K, Sairyo K, Komatsubara S, et al. Cyclooxygenase−2 inhibitor inhibits the fracture healing. J Physiol Anthropol Appl Human Sci 2002; 21: 235–8PubMedCrossRefGoogle Scholar
  48. 48.
    Bergenstock M, Min W, Simon AM, et al. A comparison between the effects of acetaminophen and celecoxib on bone fracture healing in rats. J Orthop Trauma 2005; 19: 717–23PubMedCrossRefGoogle Scholar
  49. 49.
    Simon AM, Manigrasso MB, O’Connor JP. Cyclo—oxygenase 2 function is essential for bone fracture healing. J Bone Miner Res 2002; 17: 963–76PubMedCrossRefGoogle Scholar
  50. 50.
    Zhang X, Schwarz EM, Young DA, et al. Cyclooxygenase−2 regulates mesenchymial cell differentiation into the osteoblast lineage and is critically involved in bone repair. J Clin Invest 2002; 109: 1405–15PubMedGoogle Scholar
  51. 51.
    Elder CL, Dahners LE, Weinhold PS. A cyclooxygenase−2 inhibitor impairs ligament healing in the rat. Am J Sports Med 2001; 29: 801–5PubMedGoogle Scholar
  52. 52.
    Khan KM, Bonar F, Harcourt P, et al. Histopathology of common tendinopathies: update and implications for clinical management. Sports Med 1999; 27: 393–408PubMedCrossRefGoogle Scholar
  53. 53.
    Paavola M, Kannus P, Orava S, et al. Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study. Br J Sports Med 2002; 36: 178–82PubMedCrossRefGoogle Scholar
  54. 54.
    Rodemann HP, Goldberg AL. Arachidonic acid, prostaglandin E2 and F influence rates of protein turnover in skeletal and cardiac muscle. J Biol Chem 1982; 257: 1632–8PubMedGoogle Scholar
  55. 55.
    Trappe TA, Fluckey JD, White F, et al. Skeletal muscle PGF2α and PGE2 in response to eccentric exercise: influence of ibuprofen and acetaminophen. J Clin Endocrinol Metab 2001; 86: 5067–70PubMedCrossRefGoogle Scholar
  56. 56.
    Trappe TA, White F, Lambert CP, et al. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 2002; 282: E551–6Google Scholar
  57. 57.
    Soltow QA, Betters JL, Sellman JE, et al. Ibuprofen inhibits skeletal muscle hypertrophy in rats. Med Sci Sports Exerc 2006; 38: 840–6PubMedCrossRefGoogle Scholar
  58. 58.
    Hawke TJ, Garry DJ. Myogenic satellite cells: physiology to molecular biology. J Appl Physiol 2001; 91: 534–51PubMedGoogle Scholar
  59. 59.
    Schultz E, Mc Cormick KM. Skeletal muscle satellite cells. Rev Physiol Biochem Pharmacol 1994; 123: 213–57PubMedCrossRefGoogle Scholar
  60. 60.
    Mackey AL, Kjaer M, Dandanell S, et al. The influence of anti inflammatory medication on exercise—induced myogenic precursor cell responses in humans. J Appl Physiol 2007; 103: 425–31PubMedCrossRefGoogle Scholar
  61. 61.
    Hawkey CJ, Langman MS. Non—steroidal anti—inflammatory drugs: overall risks and management. Complementary roles for COX−2 inhibitors and proton pump inhibitors. Gut 2003; 52: 600–8PubMedCrossRefGoogle Scholar
  62. 62.
    Verrico MM, Weber RJ, Mc Kaveney TP, et al. Adverse drug events involving COX−2 inhibitors. Ann Pharmacother 2003; 37: 1203–13PubMedCrossRefGoogle Scholar
  63. 63.
    Baker J, Cotter JD, Gerrard DF, et al. Effects of indomethacin and celecoxib on renal function in athletes. Med Sci Sports Exerc 2005; 37: 712–7PubMedCrossRefGoogle Scholar
  64. 64.
    Walker RJ, Fawcett JP, Flannery EM, et al. Indomethacin potentiates exercise—induced reduction in renal hemodynamics in athletes. Med Sci Sports Exerc 1994; 26: 1302–6PubMedGoogle Scholar
  65. 65.
    Griffiths ML. End—stage renal failure caused by regular use of anti—inflammatory analgesic medication for minor sports injuries. S Afr Med J 1992; 81: 377–8PubMedGoogle Scholar
  66. 66.
    Rashad S, Hemingway A, Rainsford KD, et al. Effect of non steroidal anti—inflammatory drugs on the course of osteoarthritis. Lancet 1989; II: 519–21CrossRefGoogle Scholar
  67. 67.
    Reijman M, Bierma-Zeinstra SMA, Pols HAP, et al. Is there an association between the use of different types of nonsteroidal anti—inflammatory drugs and radiologic progression of osteoarthritis? Arthritis Rheum 2005; 52: 3137–42PubMedCrossRefGoogle Scholar
  68. 68.
    Seibert K, Zhang Y, Leahy K, et al. Distribution of COX−1 and COX−2 in normal and inflamed tissues. Adv Exp Med Biol 1997; 400A: 167–70PubMedCrossRefGoogle Scholar
  69. 69.
    Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX−2 inhibitors. JAMA 2001; 286: 954–9PubMedCrossRefGoogle Scholar
  70. 70.
    Ray WA, Stein M, Daugherty JR, et al. COX−2 selective non steroidal anti—inflammatory drugs and risk if serious coronary heart disease. Lancet 2002; 360: 1071–3PubMedCrossRefGoogle Scholar
  71. 71.
    Gilroy DW, Tomlinson A, Willoughby DA. Differential effects of inhibition of isoforms of cyclooxygenase (COX−1, COX−2) in chronic inflammation. Inflamm Res 1998; 47: 79–85PubMedCrossRefGoogle Scholar
  72. 72.
    Gretzer B, Knorth H, Chantrain M, et al. Effects of diclofenac and L−745,337, a selective cyclooxygenase−2 inhibitor, on prostaglandin E2 formation in tissue from human colonic mucosa and chronic bursitis. Gastroenterology 1998; 114: A139CrossRefGoogle Scholar
  73. 73.
    Wallace JL, Chapman K, Mc Knight W. Limited anti—inflammatory efficacy of cyclo—oxygenase−2 inhibition in carrageenanairpouch inflammation. Br J Pharmacol 1999; 126: 1200–4PubMedCrossRefGoogle Scholar
  74. 74.
    Gierer P, Mittlmeier T, Bordel R, et al. Selective cyclooxygenase−2 inhibition reverses microcirculatory and inflammatory sequelae of closed soft—tissue trauma in an animal model. J Bone Joint Surg Am 2005; 87: 153–60PubMedCrossRefGoogle Scholar
  75. 75.
    Anderson SD, Fitch K, Perry CP, et al. Responses to bronchial challenge submitted for approval to use inhaled β2—agonists before an event at the 2002 winter Olympics. J Allergy Clin Immunol 2003; 111: 45–50PubMedCrossRefGoogle Scholar
  76. 76.
    Lacroix VJ. Exercise—induced asthma. Phys Sportsmed 1999; 27: 75–92PubMedCrossRefGoogle Scholar
  77. 77.
    Kerrebijn KF, van Essen-Zandvliet EEM, Neijens HJ. Effects of long—term treatment with inhaled corticosteroids and betaagonists on the bronchial responsiveness in children with asthma. J Allergy Clin Immunol 1987; 79: 653–9PubMedCrossRefGoogle Scholar
  78. 78.
    Vathenen AS, Knox AJ, Higgins BG, et al. Rebound increase in bronchial responsiveness after treatment with inhaled terbutaline. Lancet 1988; I: 554–8CrossRefGoogle Scholar
  79. 79.
    Cockcroft DW, Mc Parland CP, Britto SA, et al. Regular inhaled albuterol and airway responsiveness to allergen. Lancet 1993; 342: 833–7PubMedCrossRefGoogle Scholar
  80. 80.
    Cockcroft DW, O’Byrne PM, Swystun VA, et al. Regular use of inhaled albuterol and the allergen—induced late asthmatic response. J Allergy Clin Immunol 1995; 96: 44–9PubMedCrossRefGoogle Scholar
  81. 81.
    Gauvreau GM, Jordana M, Watson RM, et al. Effect of regular inhaled albuterol on allergen—induced late responses and sputum eosinophils in asthmatic subjects. Am J Respir Care Med 1997; 156: 1738–45Google Scholar
  82. 82.
    Nelson JA, Strauss L, Skowronski M, et al. Effect of long—term salmeterol treatment on exercise—induced asthma. N Engl J Med 1998; 339: 141–6PubMedCrossRefGoogle Scholar
  83. 83.
    Pauwels RA, Löfdahl CG, Postma D, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med 1997; 337: 1405–11PubMedCrossRefGoogle Scholar
  84. 84.
    Ferrari M, Balestreri F, Baratieri S, et al. Evidence of the rapid protective effect of formoterol dry—powder inhalation against exercise—induced bronchospasm in athletes with asthma. Respiration 2000; 67: 510–3PubMedCrossRefGoogle Scholar
  85. 85.
    Kindermann W. Do inhaled β2—agonists have an ergogenic potential in non—asthmatic competitive athletes? Sports Med 2007; 37 (2): 95–102PubMedCrossRefGoogle Scholar
  86. 86.
    Martineau L, Horan MA, Rothwell NJ, et al. Salbutamol a beta 2−adrenoceptor antagonist, increases, skeletal muscle strength in young men. Clin Sci 1992; 83: 616–21Google Scholar
  87. 87.
    Collomp K, Candau R, Lasne F, et al. Effects of short—term oral salbutamol administration on exercise endurance and metabolism. J Appl Physiol 2000; 89: 430–6PubMedGoogle Scholar
  88. 88.
    Haahtela T, Klaukka T, Koskela K, et al. Asthma programme in Finland: a community problem needs community solutions. Thorax 2001; 56: 806–14PubMedCrossRefGoogle Scholar
  89. 89.
    Helenius IJ, Rytilä P, Metso T, et al. Respiratory symptoms, bronchial responsiveness and cellular characteristics of induced sputum in elite swimmers. Allergy 1998c; 53: 346–52PubMedCrossRefGoogle Scholar
  90. 90.
    Lumme A, Haahtela T, Öunap J, et al. Airway inflammation, bronchial hyperresponsiveness, and asthma in elite ice hockey players. Eur Respir J 2003; 22: 113–7PubMedCrossRefGoogle Scholar
  91. 91.
    Barnes PJ. A new approach to the treatment of asthma. N Engl J Med 1989; 321: 1517–27PubMedCrossRefGoogle Scholar
  92. 92.
    Barnes PJ. Inhaled glucocorticosteroids for asthma. N Engl J Med 1995; 332: 868–75PubMedCrossRefGoogle Scholar
  93. 93.
    Haahtela T, Järvinen M, Kava T, et al. Comparison of a beta 2−agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med 1991; 325: 388–92PubMedCrossRefGoogle Scholar
  94. 94.
    Haahtela T, Järvinen M, Kava T, et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994; 331: 700–5PubMedCrossRefGoogle Scholar
  95. 95.
    Barnes PJ. Effect of corticosteroids on airway hyperresponsiveness. Am Rev Respir Dis 1990; 141: S70–6Google Scholar
  96. 96.
    Smith BW, Labotz M. Pharmacologic treatment of exercise induced asthma. Clin J Sports Med 1998; 17: 343–63CrossRefGoogle Scholar
  97. 97.
    Bel EH, Timmers MC, Zwinderman AH, et al. The effect of inhaled corticosteroids on the maximal degree of airway narrowing to methacholine in asthmatic subjects. Am Rev Respir Dis 1991; 143: 109–13PubMedGoogle Scholar
  98. 98.
    Helenius I, Haahtela T. Allergy and asthma in elite summer sport athletes. J Allergy Clin Immunol 2000; 106: 444–52PubMedCrossRefGoogle Scholar
  99. 99.
    Helenius I, Lumme A, Haahtela T. Asthma, airway inflammation and treatment in elite athletes. Sports Med 2005; 35: 565–74PubMedCrossRefGoogle Scholar
  100. 100.
    Bonini S, Brusasco V, Carlsen KH, et al. Diagnosis of asthma and permitted use of inhaled beta2−agonists in athletes. Allergy 2004; 59: 33–6PubMedCrossRefGoogle Scholar
  101. 101.
    Drazen JM, Israel E, O’Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med 1999; 340: 197–206PubMedCrossRefGoogle Scholar
  102. 102.
    Reiss TF, Hill JB, Harman E, et al. Increased urinary excretion of LTE4 after exercise and attenuation of exercise—induced bronchospasm by montelukast, a cysteinyl leukotriene receptor antagonist. Thorax 1997; 52: 1030–5PubMedCrossRefGoogle Scholar
  103. 103.
    Knapp HR. Reduced allergen—induced nasal congestion and leukotriene synthesis with orally active 5−lipoxygenase inhibitor. N Engl J Med 1990; 323: 1745–8PubMedCrossRefGoogle Scholar
  104. 104.
    Donnelly AL, Glass M, Minkwitz MC, et al. The leukotriene D4—receptor antagonist, ICI 204,219, relieves symptoms of acute seasonal allergic rhinitis. Am J Respir Crit Care Med 1995; 151: 1734–9PubMedGoogle Scholar
  105. 105.
    Leff JA, Busse WW, Pearlman D, et al. Montelukast, a leukotriene—receptor antagonist, for the treatment of mild asthma and exercise—induced bronchoconstriction. N Engl J Med 1998; 39: 47–52Google Scholar
  106. 106.
    Villaran C, O’Neill SJ, Helbling A, et al. Montelukast versus salmeterol in patients with asthma and exercise—induced bronchoconstriction. J Allergy Clin Immunol 1999; 104: 547–53PubMedCrossRefGoogle Scholar
  107. 107.
    Melo RE, Sole D, Naspitz CK. Exercise—induced bronchoconstriction in children: montelukast attenuates the immediate phase and late—phase responses. J Allergy Clin Immunol 2003; 111: 301–7PubMedCrossRefGoogle Scholar
  108. 108.
    Peroni DG, Piacentini GL, Ress M, et al. Time efficacy of a single dose of montelukast on exercise—induced asthma in children. Pediatr Allergy Immunol 2002; 13: 434–7PubMedCrossRefGoogle Scholar
  109. 109.
    Rundell KW, Spiering BA, Baumann JM, et al. Effects of montelukast on airway narrowing from eucapnic voluntary hyperventilation and cold air exercise. Br J Sports Med 2005; 39: 232–6PubMedCrossRefGoogle Scholar
  110. 110.
    Helenius I, Lumme A, Öunap J, et al. No effect of montelukast on asthma—like symptoms in ice—hockey players. Allergy 2004; 59: 39–44PubMedCrossRefGoogle Scholar
  111. 111.
    Sandsund M, Sue-Chu M, Reinertsen RE, et al. Treatment with inhaled beta2−agonists or oral leukotriene antagonists do not enhance physical performance in nonasthmatic highly—trained athletes exposed to −15°C. J Thermal Biol 2000; 25: 181–5CrossRefGoogle Scholar
  112. 112.
    Sue-Chu M, Sandsund M, Holand B, et al. Montelukast does not affect exercise performance at subfreezing temperature in highly trained non asthmatic endurance athletes. Int J Sports Med 2000; 21: 424–8PubMedCrossRefGoogle Scholar
  113. 113.
    Mc Kenzie DC, Stewart IB. Asthma medications as ergogenic aids. In: Wilbur R, Lemanske R, Rundell K, editors. Asthma and exercise. Champaign (IL): Human Kinetics, 2002: 237–56Google Scholar
  114. 114.
    Spooner C, Rowe BH, Saunders LD. Nedocromil sodium in the treatment of exercise—induced asthma: a meta—analysis. Eur Respir J 2000; 16: 30–7PubMedCrossRefGoogle Scholar
  115. 115.
    Pope JS, Koenig SM. Pulmonary disorders in the training room. Clin Sports Med 2005; 24: 541–64PubMedCrossRefGoogle Scholar
  116. 116.
    Spooner CH, Spooner GR, Rowe BH. Mast—cell stabilizing agents to prevent exercise—induced bronchoconstriction. Cochrane Database Syst Rev 2003; (4): CD002307Google Scholar
  117. 117.
    Briner Jr WW. Introduction: exercise and allergy. Med Sci Sports Exerc 1992; 24: 843–4PubMedGoogle Scholar
  118. 118.
    Kobayashi RH, Mellion MB. Exercise—induced asthma, anaphylaxis, and urticaria. Prim Care 1991; 18: 809–13PubMedGoogle Scholar
  119. 119.
    Montgomery LC, Deuster PA. Effects of antihistamine medications on exercise performance: implications for sportspeople. Sports Med 1993; 15: 179–95PubMedCrossRefGoogle Scholar
  120. 120.
    Mac Knight JM, Mistry DJ. Allergic disorders in the athlete. Clin Sports Med 2005; 24: 507–23CrossRefGoogle Scholar
  121. 121.
    Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systemic review of randomised controlled trials. BMJ 1998; 317: 1624–9PubMedCrossRefGoogle Scholar
  122. 122.
    Carrozzi FM, Katelaris CH, Burke TV, et al. An open study examining the effects of intranasal budesonide on quality of life and performance in elite athletes with allergic rhinoconjunctivitis. J Allergy Clin Immunol 2001; 107: S154–5Google Scholar
  123. 123.
    Walker SM, Pajno GB, Lima MT, et al. Grass pollen immunotherapy for seasonal rhinitis and asthma: a randomized clinical trial. J Allergy Clin Immunol 2001; 107: 87–93PubMedCrossRefGoogle Scholar
  124. 124.
    Katelaris CH, Carrozzi FM, Burke TV, et al. Patterns of allergic reactivity and disease in Olympic athletes. Clin J Sports Med 2006; 16: 401–5CrossRefGoogle Scholar
  125. 125.
    Hodges K, Hancock S, Currell K, et al. Pseudoephedrine enhances performance in 1500−m run. Med Sci Sports Exerc 2006; 38: 329–33PubMedCrossRefGoogle Scholar
  126. 126.
    Gill ND, Shield A, Blazevich AJ, et al. et al. Muscular and cardiorespiratory effects of pseudoephedrine in human athletes. Br J Clin Pharmacol 2000; 50: 205–13PubMedCrossRefGoogle Scholar
  127. 127.
    Nieman DC. Exercise effects on systemic immunity. Immunol Cell Biol 2000; 78: 496–501PubMedCrossRefGoogle Scholar
  128. 128.
    Ciocca M. Medication and supplement use by athletes. Clin Sports Med 2005; 24: 719–38PubMedCrossRefGoogle Scholar
  129. 129.
    Khaliq Y, Zhanel GG. Fluoroquinolone—associated tendinopathy: a critical review of the literature. Clin Infect Dis 2003; 36: 1404–10PubMedCrossRefGoogle Scholar
  130. 130.
    Van der Linden P, Van Puijenbroek EP, Feenstra J, et al. Tendon disorders attributed to fuoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998. Arthritis Care Res 2001; 45: 235–9CrossRefGoogle Scholar
  131. 131.
    Williams RJ, Attia E, Wickiewicz TL, et al. The effect of ciprofloxacin on tendon, paratenon, and capsular fibroblast metabolism. Am J Sports Med 2000; 28: 364–9PubMedGoogle Scholar
  132. 132.
    Vanek D, Saxena A, Boggs JM, et al. Fluoroquinolone therapy and Achilles tendon rupture. J Am Podiatr Med Assoc 2003; 93: 333–5PubMedGoogle Scholar
  133. 133.
    Lapointe BM, Fremont P, Cote CH. Influence of nonsteroidal anti—inflammatory drug treatment duration and time of onset on recovery from exercise induced muscle damage in rats. Arch Phys Med Rehabil 2003; 84: 651–5PubMedGoogle Scholar
  134. 134.
    Järvinen TAH, Järvinen TLN, Kääriäinen M, et al. Muscle injuries: biology and treatment. Am J Sports Med 2005; 33: 745–64PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • Antti Alaranta
    • 1
    • 2
    Email author
  • Hannu Alaranta
    • 3
  • Ilkka Helenius
    • 4
  1. 1.Nutrimed LtdJärvenpääFinland
  2. 2.Division of Social Pharmacy, Department of PharmacyUniversity of HelsinkiFinland
  3. 3.Käpylä Rehabilitation CentreFinland
  4. 4.Hospital for Children and AdolescentsHelsinki University Central HospitalFinland

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