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  • Wily_Quixote

    Intramuscular triamcinolone is not a standard therapy for asthma.

    The standard treatments are inhaled corticosteroids for maintenance. Intramuscular therapy is reserved for refractory acute exacerbations and, in my experience, I have only ever seen this in critical care (ED or ICU). Even then the oral route is preferred.

    This is what the Australian therapeutic guidelines has to say about effective treatment regimes for adult asthmatics:

    “Ongoing treatment aims to use the lowest dose of drugs that maintains asthma symptom control and prevents flare-ups. If inhaled corticosteroids (ICS) are indicated, low-dose regular treatment with ICS (plus short-acting beta2 agonist [SABA] as needed [i.e. ventolin puffer – my clarification]) is more effective than intermittent treatment and more likely to achieve control with a lower total dose of ICS.

    Low-dose regular ICS is more effective than intermittent treatment.”

    I am staggered that an adult asthmatic would be receiving IM corticosteroids for asthma control, particularly without a background in acute and severe exacerbations of asthma manifesting with significant airflow limitation and requiring hospital treatment.

    What kind of respiratory physician is prescibing IM triamcinolone for patients without acute and severe asthma? Has Wiggins been demonstrating severe airflow limitation and bronchoconstriction? Surely someone would have noticed him reaching for his puffer up the Col d’hardass at some stage in his career?

    If Brailsford maintains that this is a reasonable therapeutic approach to his team members than perhaps an objective assessment from a respiratory physician might be required to review the treatment of his team. It is curious that Brailsford is not choosing to listen to the comments from other sports physicians about the efficacy and reasonableness of this treatment.

    British Thoracic Society (BTS), Scottish
    Intercollegiate Guidelines Network (SIGN). British guideline on the
    management of asthma: a national clinical guideline (SIGN 141).
    Edinburgh: SIGN; 2014.

    Australian Electronic Therapeutic Guidelines (2016)

    • dottigirl

      It. Wasn’t. For. Asthma.
      If you’re such an expert, try reading the actual TUE.

      • Wily_Quixote

        They. Were. For. Asthma. And . Pollen. Allergies.

        Triamcinolone for hay fever is even more egregious.

  • Did anyone ask Brailsford if, with such a serious specialist recommendation, Sky considered standing Wiggo down for the sake of his health?

  • David Simons

    Medical need? Absolute rubbish; if I went to my doctor with that ailment, you know what he would prescribe before all else? Rest. The more Sky say, the more tainted they become.

  • Dave

    Sky need to fire their public relations person and seek better advice.

  • Alan Walker

    Not anyone can be a champion cyclist. It requires certain genetically determined factors in physique and physiology. No amount of training nor any diet will compensate, as the genetically endowed athlete can train just as hard, eat just as well then reap a greater benefit.

    We have now found another genetic trait that helps an athlete to reach the top.

  • mick

    The shitty thing about this whole fiasco is that they have played entirely within the current rules. Their ethos of marginal gains shows no mercy in any part of the sport, including the grey areas of TUEs. Even then, they completely dog hump those reg’s and take it to the absolute limit. Big Dave says it himself – “I’m on record for saying, ‘there is a line. You can go up to that line. But you do not go over it. You do not cheat in this team in any way, shape or form.’ So the line is not train hard, rest and eat well. The line for Sky is, where can we exploit what the UCI and WADA have created and turn this into our advantage. Yes, we’ve seen that Wiggins and Brailsford are looking like chumps in trying to justify their actions, but everyone with plain sense can see that they’ve fingered every possible hole to gain their glory. And I guess, for me at least, is where this whole affair leaves a bad taste. Sky have always come across so high and mighty about their attitude and process to cycling, particularly in contrast to the recent and foul history with doping. But these latest revelations have only compounded what Armstrong el al built from the start; a sporting reputation that stinks to high heaven, and we’re all the sadder for it.

    • Wily_Quixote

      It might be able to prove that the conditions of granting the TUE by UK Anti-Doping were not strictly met in this instance.

      4. Conditions for granting TUE

      Article 4.1- UCI Regulations for TUE

      A rider may be granted a TUE if (and only if) he/she can show that each of the following conditions is met:
      a. The prohibited substance or prohibited method in question is needed
      to treat an acute or chronic medical condition, such that the Rider
      would experience a significant impairment to health if the Prohibited
      Substance or Prohibited Method were to be withheld.

      b. The therapeutic use of the prohibited substance or prohibited method
      is highly unlikely to produce any additional enhancement of performance
      beyond what might be anticipated by a return to the rider’s normal state
      of health following the treatment of the acute or chronic medical

      c. There is no reasonable therapeutic alternative to the use of the prohibited substance or prohibited method.

  • Eden Walker

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