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Open Access 01-12-2023 | Formoterol | Original Research Article

Acute Effects of Single Versus Combined Inhaled β2-Agonists Salbutamol and Formoterol on Time Trial Performance, Lung Function, Metabolic and Endocrine Variables

Authors: Daniel A. Bizjak, Dorle Nussbaumer, Kay Winkert, Gunnar Treff, Kensuke Takabajashi, Lennart Mentz, Franziska Schober, Jasmine-Lèonike Buhl, Lucas John, Jens Dreyhaupt, Luise Steeb, Lukas C. Harps, Maria K. Parr, Patrick Diel, Martina Zügel, Jürgen M. Steinacker

Published in: Sports Medicine - Open | Issue 1/2023

Abstract

Background

High prevalence rates of β2-agonist use among athletes in competitive sports makes it tempting to speculate that illegitimate use of β2-agonists boosts performance. However, data regarding the potential performance-enhancing effects of inhaled β2-agonists and its underlying molecular basis are scarce.

Methods

In total, 24 competitive endurance athletes (12f/12m) participated in a clinical double-blinded balanced four-way block cross-over trial to investigate single versus combined effects of β2-agonists salbutamol (SAL) and formoterol (FOR), to evaluate the potential performance enhancement of SAL (1200 µg, Cyclocaps, Pb Pharma GmbH), FOR (36 µg, Sandoz, HEXAL AG) and SAL + FOR (1200 µg + 36 µg) compared to placebo (PLA, Gelatine capsules containing lactose monohydrate, Pharmacy of the University Hospital Ulm). Measurements included skeletal muscle gene and protein expression, endocrine regulation, urinary/serum β2-agonist concentrations, cardiac markers, cardiopulmonary and lung function testing and the 10-min time trial (TT) performance on a bicycle ergometer as outcome variables. Blood and urine samples were collected pre-, post-, 3 h post- and 24 h post-TT.

Results

Mean power output during TT was not different between study arms. Treatment effects regarding lung function (p < 0.001), echocardiographic (left ventricular end-systolic volume p = 0.037; endocardial global longitudinal strain p < 0.001) and metabolic variables (e.g. NR4A2 and ATF3 pathway) were observed without any influence on performance. In female athletes, total serum β2-agonist concentrations for SAL and FOR were higher. Microarray muscle gene analysis showed a treatment effect for target genes in energy metabolism with strongest effect by SAL + FOR (NR4A2; p = 0.001). Of endocrine variables, follicle-stimulating hormone (3 h Post–Post-TT), luteinizing hormone (3 h Post–Pre-TT) and insulin (Post–Pre-TT) concentrations showed a treatment effect (all p < 0.05).

Conclusions

No endurance performance-enhancing effect for SAL, FOR or SAL + FOR within the permitted dosages compared to PLA was found despite an acute effect on lung and cardiac function as well as endocrine and metabolic variables in healthy participants. The impact of combined β2-agonists on performance and sex-specific thresholds on the molecular and cardiac level and their potential long-term performance enhancing or health effects have still to be determined.

Trial registration: Registered at Eudra CT with the number: 2015-005598-19 (09.12.2015) and DRKS with number DRKS00010574 (16.11.2021, retrospectively registered).

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Title: Acute Effects of Single Versus Combined Inhaled β2-Agonists Salbutamol and Formoterol on Time Trial Performance, Lung Function, Metabolic and Endocrine Variables
Authors: Daniel A. Bizjak
Dorle Nussbaumer
Kay Winkert
Gunnar Treff
Kensuke Takabajashi
Lennart Mentz
Franziska Schober
Jasmine-Lèonike Buhl
Lucas John
Jens Dreyhaupt
Luise Steeb
Lukas C. Harps
Maria K. Parr
Patrick Diel
Martina Zügel
Jürgen M. Steinacker
Publication date: 01-12-2023
Publisher: Springer International Publishing
Keywords: Formoterol
Salbutamol
Published in: Sports Medicine - Open / Issue 1/2023
Print ISSN: 2199-1170
Electronic ISSN: 2198-9761
DOI: https://doi.org/10.1186/s40798-023-00630-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Acute Effects of Single Versus Combined Inhaled β2-Agonists Salbutamol and Formoterol on Time Trial Performance, Lung Function, Metabolic and Endocrine Variables

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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