10th November 2021

Teddy Atine-Venel case illustrates double standards on salbutamol

France’s 4x400m team, which finished eighth in the 4x400m final at the London 2017 World Athletics championships, is likely to be disqualified after a team member was sanctioned for an anti-doping rule violation (ADRV). Teddy Atine-Venel returned an adverse analytical finding (AAF) for salbutamol at the French Championships on 16 July 2017 – a month before the London 2017 4x400m final. 

The French anti-doping agency (AFLD) has sanctioned Atine-Venel with a five month ban from 16 January 2018, and has asked the French athletics federation (FFA) to cancel his results from 16 July 2017 until 16 June 2018. This is despite his urine sample containing salbutamol at lower concentrations than those displayed by British cyclist Chris Froome, whom the World Anti-Doping Agency (WADA) decided not to sanction in 2017.

Atine-Venel’s case

Atine-Venel wasn’t notified of his AAF until 16 January 2018. He therefore wasn’t provisionally suspended until then and was allowed to compete at London 2017, where he also took part in the 400m. 

The 2017 Prohibited List, published by WADA, permits inhaled salbutamol up to a maximum dose of 1,600 micrograms (mg) over 24 hours, but sets a limit of 1,000 nanograms per millilitre (ng/mL) in urine samples. It clarifies: ‘The presence in urine of salbutamol in excess of 1000 ng/mL […] is presumed not to be an intended therapeutic use of the substance and will be considered as an Adverse Analytical Finding (AAF) unless the Athlete proves, through a controlled pharmacokinetic study [CPKS], that the abnormal result was the consequence of the use of the therapeutic dose (by inhalation) up to the maximum dose indicated above’.   

Atine-Venel’s urine sample contained 1,400ng/mL of the anti-asthma drug. Presumably, he failed to prove through a CPKS that his ‘abnormal result’ was due to therapeutic use of inhaled salbutamol below WADA’s limit of 1,600mg over 24 hours.

Froome comparison

Chris Froome…

Atine-Venel’s urine sample contained less salbutamol than a 7 September 2017 sample given by Chris Froome at the Vuelta a España. WADA outlined that Froome’s sample contained 1,428ng/mL of salbutamol when adjusted for specific gravity, compared to the 2,000ng/mL originally reported by the international cycling union (UCI) and confirmed by Froome and Team Sky. This is double the stated permitted level in urine, although a ‘Decision Limit’ means that findings of salbutamol in urine at concentrations up to 1,200ng/mL are not reported as an AAF.

Froome didn’t perform a CPKS, yet WADA accepted his evidence that the result was due to inhalation of salbutamol within its limits. ‘WADA accepts that a CPKS would not have been practicable as it would not have been possible to adequately recreate the unique circumstances that preceded the 7 September doping control (e.g. illness, use of medication, chronic use of Salbutamol at varying doses over the course of weeks of high intensity competition)’, read a statement. 

WADA guidelines on salbutamol haven’t changed, despite its recognition that individuals excrete it differently (click to open)…

Part of the reason why WADA accepted Froome’s explanation is that individuals process inhaled salbutamol differently, leading to urine excretion variations. This has been acknowledged as being accurate by WADA, yet the 2021 Prohibited List still contains the same guidelines (see right) regarding salbutamol.

In 2014, John Dickinson of Kent University led a Study where athletes inhaled 1,600mg of salbutamol and exercised in a humid environment until a target weight loss of between 2% and 5% was achieved. Twenty of the 22 participants reported salbutamol concentrations in urine at above WADA’s limit of 1,000 ng/mL and above its Decision Limit of 1,200 ng/mL. They would have returned an AAF despite being within WADA’s inhalation limit.

Scientific evidence has found that elite athletes are more prone to asthma than the general population, particularly in sports such as cycling (pollen) and swimming (chlorine). Dickinson also found that 70% of the British Swimming squad suffered from asthma, and that elite athletes suffered from Exercise Induced Asthma (EIA), which is different from the general asthma suffered by between 8% and 10% of the general population. 

Double standards

It is understood that Atine-Venel is considering an appeal against the AFLP’s Decision. “I have been quite shocked by this whole procedure for the past four years”, he told AFP, citing asthma medication as the reason for his AAF. “I have always been transparent”.

There is no indication that either athlete has deliberately cheated. Both Atine-Venel and Froome suffer from asthma, and both reported concentrations of salbutamol in urine that were in excess of WADA’s permissible limits. Yet only one athlete has been sanctioned. Why?

Whilst the AFLD hasn’t released the details of his case, the difference between Atine-Venel and Froome appears to be upon whom the burden of proof is placed. Atine-Venel has apparently been sanctioned for failing to prove that his AAF was due to inhaled salbutamol at below WADA’s permissible limits. Froome escaped sanction because the UCI and WADA couldn’t prove that his AAF was due to inhaling salbutamol at above its permissible limits.

WADA’s statement on Froome revealed that of 41 salbutamol cases from 2013-17, only 21 resulted in a suspension. This suggests that even when salbutamol in urine exceeds WADA’s limit, is is hard to prove that an athlete exceeded the inhaled limit. This is exactly what played out in the Froome case.

Froome had the backing of British Cycling and Team Sky, which issued statements supporting his defence. There is no indication that the FFA is supporting Atine-Venel’s case. It has yet to comment.

One has to feel sympathy for Ludvy Vaillant, Thomas Jordier, and Mamoudou Hanne, Atine-Venel’s teammates in the 4x400m final at London 2017. Although they finished eighth, they face the ignominy of having their results annulled due to an ADRV that not only had nothing to do with them, but arguably shouldn’t have been an ADRV at all.

Until 2010, salbutamol was a prohibited substance, for which a TUE was required. Given the apparent double standards outlined above, perhaps it is time to reinstate that rule.

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