Therefore, the aim of this systematic review and meta-analysis was to assess the effect of beta2-agonists on aerobic performance in healthy, non-asthmatic subjects. 9 10 In a recent meta-analysis, 11 we assessed the effect of beta2-agonists on anaerobic performance in non-asthmatic subjects. Since August 2009, multiple studies have investigated the effect of beta2-agonists on aerobic performance, and controversy with regard to the use of beta2-agonists in sports continuously exists, which has been highlighted in recent beta2-agonist antidoping investigations involving world-class athletes. They did not identify any effect of inhaled beta2-agonists on endurance, strength or sprint performance, but some weak evidence indicating a performance-enhancing effect of systemic beta2-agonists on anaerobic performance. 7 In 2011, Pluim et al 8 published the first systematic review and meta-analysis on the effect of beta2-agonists on physical performance in healthy athletes. The year after, the IOC consensus statement claimed that inhaled beta2-agonists do not enhance endurance performance, 6 and a joint Task Force of European Respiratory Society and European Academy of Allergy and Clinical Immunology concluded that there was no evidence to suggest that asthma drugs can improve physical performance in healthy athletes. In 2007, Kindermann 5 reviewed the effect of beta2-agonists and concluded that inhaled beta2-agonists do not enhance endurance performance, while oral beta2-agonists enhance endurance performance.
![comprehensive meta analysis 3.3 comprehensive meta analysis 3.3](https://venturebeat.com/wp-content/uploads/2020/04/IMG_3014D-e1587504988858.jpeg)
5 Thus, the possible performance-enhancing effect of beta2-agonists has been examined in multiple studies.
![comprehensive meta analysis 3.3 comprehensive meta analysis 3.3](https://documento.mx/img/detail/5c1154bd90969.jpg)
2 There has been some suspicion that non-asthmatic athletes use beta2-agonists with intention to improve their performance. 4Īthletes with a medical history of asthma have consistently outperformed athletes without this condition during the Olympic Games. The prohibited list, effective from 1 January 2020, prohibits all use of beta2-agonists except inhaled salbutamol (maximum of 1600 μg over 24 hours in divided doses, not to exceed 800 μg over 12 hours starting from any dose), inhaled formoterol (maximum delivered dose of 54 μg over 24 hours) and inhaled salmeterol (maximum of 200 μg over 24 hours). 1 WADA annually updates the prohibited list, a list of substances and methods prohibited in elite sports. 3 However, ever since inhaled beta2-agonists became available just before the Olympic Games in 1972, antidoping authorities have regulated the use of beta2-agonists in athletes due to possible performance-enhancing effects.
![comprehensive meta analysis 3.3 comprehensive meta analysis 3.3](https://els-jbs-prod-cdn.jbs.elsevierhealth.com/cms/asset/d272cf44-d241-47b3-ab37-323e54c574a2/gr2.jpg)
2 Asthma is usually associated with airway hyper-responsiveness (AHR), and the recommended therapy for asthma is inhaled glucocorticoids with inhaled beta2-agonists pre-exercise and as a reliever of symptoms. Asthma is the most common chronic disease in elite athletes, 1 and endurance athletes regularly performing heavily increased ventilation are at increased risk of developing asthma.