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.

Asthma medication is increasingly prescribed for finnish olympic athletes--for a reason?

BACKGROUND: Use of asthma medication is common among athletes. In 2009, the World Anti-Doping Committee (WADA) and the International Olympic Committee removed the need to document asthma by lung function tests before the use of inhaled ß2-agonists. METHODS: We assessed the changes in asthma medication use in Finnish Olympic athletes 8 years apart in 2002 (N = 446) and 2009 (N = 372). The athletes filled out a questionnaire on asthma symptoms, diagnosis, and medication. RESULTS: The use of asthma medication increased from 9.4% in 2002 to 12.6% in 2009 (adjusted odds ratio (OR) = 1.71, 95% confidence interval (CI) 1.08-2.69). Fixed combinations of inhaled long-acting ß2-agonists (LABAs) and inhaled corticosteroids (ICSs) were used three times more in 2009 vs. 2002 (OR = 3.38, 95% CI 1.26-9.12). At the same time, no significant changes were observed in the occurrences of physician-diagnosed asthma (13.9% vs. 15.9%) or wheezing (10.3% vs. 10.2%). In 2002, all athletes on asthma medication also had a physician-diagnosed disease, but in 2009, 11.8% of the athletes on medication were lacking it. CONCLUSIONS: Especially, the use of combination therapy of LABAs and ICSs is increasing among Finnish Olympic athletes. This trend is worrying as it is not based on increasing occurrence of symptoms, asthma diagnoses, or objective lung function measurements. More data, also from other countries, are needed to change recommendations or WADA rules.

Dietary supplementation habits and perceptions of supplement use among elite Finnish athletes.

The aim of this study was to evaluate the frequency of dietary supplement (DS) use among elite Finnish athletes in 2002 and 2009. In 2009, the authors also wanted to examine the reasons for athletes' DS use, whether athletes feel they have experienced benefits from their supplement use, and whether athletes had had an opportunity to consult dietary specialists. Cross-sectional studies were conducted in 2002 and 2009 among Finnish Olympic athletes. Data were collected using semistructured questionnaires, mainly in national team camps. The study population in 2002 was 446 athletes, and in 2009 it was 372. The number of DS users was high in both study years (81% in 2002 and 73% in 2009). Vitamin D consumption was low in both 2002 and 2009 (0.7% and 2.0%, respectively). An increase was found in consumption of omega-3 fatty acids between study years (11% in 2002 and 19% in 2009; p = .002), and their regular use nearly doubled (8% and 15%, p = .002). For vitamin and mineral users, the main reason for DS use was to prevent nutritional deficiencies, and for nutritional supplement users the main reason was recovery from exercise. Only 27% of all athletes and 30% of DS users had an opportunity to consult dietary specialists in 2009. This survey shows that supplementation rates among elite Finnish athletes are high and there may be over- and underuse of some micronutrient supplements. There is a need for professional nutritional counseling among national elite athletes.

Use of dietary supplements in Olympic athletes is decreasing: a follow-up study between 2002 and 2009.

BACKGROUND: The aim of this study was to assess the frequency of use of dietary supplements (DS) among large sample of elite Finnish athletes and to describe possible changes in dietary supplement use between the years 2002 and 2009. METHODS: A prospective follow-up study was conducted on Olympic athletes. The first survey was conducted on Olympic athletes in 2002 (N = 446) and the follow-up study was conducted between May 2008 and June 2009 (N = 372). RESULTS: In 2002, a total of 81% of the athletes used dietary supplements (a mean of 3.37 ± 3.06 DS per user) and in 2009, a total of 73% of the athletes (a mean of 2.60 ± 2.69 per DS user) used them. After adjusting for age-, sex- and sport type, the OR (95% confidence interval, CI) for use of any dietary supplement was significantly less in 2009 as compared with 2002 results (OR, 0.62; 95% CI, 0.43-0.90). Decrease in DS use was observed in all supplement subgroups (vitamins, minerals, nutritional supplements). Athletes in speed and power events and endurance events reported use of any dietary supplement significantly more often than team sport athletes both in 2002 and 2009. In year 2009, the frequency of all dietary supplement use increased when athlete's age increased and the increase was significant in older age groups: of the athletes under 21 years 63%, 21-24 years 83% and over 24 years 90% consumed nutritional supplements. CONCLUSIONS: Based in our study, there seems to be a lowering trend of dietary supplement use among elite Finnish athletes although differences between sport subgroups and age groups are considerable.

Use of prescription drugs in athletes.

Although athletes are young and generally healthy, they use a variety of non-doping 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 beta(2)-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.

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.

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.

Asthma medication in Finnish olympic athletes: no signs of inhaled beta2-agonist overuse.

INTRODUCTION: Occurrence of asthma has been reported to be frequent in endurance athletes and especially high in winter sport athletes. Recently, the International Olympic Committee has restricted the use of inhaled beta2-agonists and requires documentation for their use. However, epidemiologic data comparing the use of antiasthmatic medication in different sport events are mostly missing. METHODS: A cross-sectional questionnaire survey was carried out in 2002. All the athletes (N = 494) financially supported by National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1 504) served as controls. RESULTS: Physician-diagnosed asthma was more common in athletes as compared with controls (13.9% vs 8.4%). Use of any asthma medication was reported by 9.6% of the athletes and by 4.2% of the controls. No difference was observed in the frequency of asthma medication used by winter or summer sport athletes (10.0% vs 9.4%). Inhaled beta2-agonists were used by 7.4% and 3.0% of the athletes and controls, respectively. After adjusting for age, sex, and smoking, odds ratio with 95% confidence interval for use of any asthma medication was 0.69 (0.17-2.92) for motor skills demanding events, 1.87 (0.85-4.11) for speed and power sports, 3.00 (1.68-5.37) for team sports, and 4.16 (2.22-7.78) for endurance events as compared with controls. None of the athletes used antiasthmatic medication without physician diagnosis. CONCLUSIONS: The frequency of antiasthmatic medication is clearly lower than the occurrence of physician-diagnosed asthma in Finnish Olympic athletes. No evidence of overuse of inhaled beta2-agonists is found.