3 Less Obvious Angles About Amanda Kendall’s Doping Suspension

Editorial content is the opinion of its author and does not necessarily reflect the views of SwimSwam.

Earlier today, SwimSwam reported on the 3-month doping suspension of U.S. National Team swimmer Amanda Kendall. Kendall, her attorney, and USADA all acknowledged her personal fault for the issue, if unintentional, but there are 3 key points to this case that I want to focus on separate from that, which I think are going to be largely overlooked in the typically (and appropriately) ravenous response to any doping case:

1. She didn’t actually fail a test

A percentage of you who are going to comment are going to read this headline, and not this sentence, and perceive this to be excusing her test. This is not that.

The reason this is crucial is that Kendall, who was taking a banned substance, was only caught and punished because she confessed when asked. This story is going to provide incentives for people to lie on their declarations, hoping they won’t get caught, even if scientifically that’s unlikely. She was taking a banned substance 7 days before she was tested, and the test came back clean.

That’s bad news for the integrity of the testing system, if the biggest loophole is “just don’t tell the tester that you’re taking any medicines,” although her confession probably saved her time on her suspension.

2. Inhaler abuse is real in sports

Kendall was prescribed her inhaler by a doctor, for acute, temporary symptoms that it sounds like would benefit from inhaler use.

But, this is a gateway into a broader conversation about inhaler use in swimming.

I got my first taste of this phenomenon when I was in high school and print newspapers were still a thing. The Houston Chronicle ran an investigative story on inhaler in Houston club swim teams, including looking at The Woodlands Swim Team – one of the most successful clubs in the state. The story was done by Richard Justice – now a national baseball writer, but also the parent of a daughter who swam collegiately at the University of Houston. The story involved doctor shopping to find one who would prescribe asthma medicine.

Since then, the problem doesn’t seem to have improved. A recent study by Popular Science found that athletes with asthma are more likely to win medals at the Winter Olympics than athletes without asthma – a counter-intuitive statistic. The study cites a professor at the University of Kent who says that “up to 70 percent” of swimmers have asthma.

The results are inconclusive, but inhaler use is being looked at as a potential culprit for the disparity. According to the CDC, about 8% of Americans have asthma. One could imagine forces of selection bias acting in both directions on the swimming population – asthmatics avoiding the sport because of chlorine’s ability to inflame the condition, or in the opposite direction doctors who recommend swimming as a treatment for asthma in order to help force the lungs to expand.

Full disclosure: I had moderate asthma as a child that at least once required hospitalization, was prescribed swimming as a treatment, along with an inhaler, by a doctor, who was not my mother, who was also a doctor. I don’t remember when I stopped using my inhaler, but it was sometime around age 12 or 13. I still occasionally have mild bouts of exercise or allergy-induced asthma, but have more-or-less outgrown it.

But in either case – the math on numbers of elite athletes diagnosed with asthma just don’t add up, and needs more investigation. Every time this subject is broached, parents come to the comments, saying that anybody who claims inhaler abuse is belittling their child’s condition of “real asthma.” But that’s not what’s actually happening. We’re trying to make sure that healthy individuals aren’t using the condition as an excuse to gain an edge.

3. Comparing the suspension to the last similar TUE violation

The last TUE violation that feels similar to this (the athletes were open about taking a medication, under a doctor’s direction, but failed to take the proper administrative steps) was the case of Brazil’s World Record holder Etiene Medeiros. In 2016, she failed an anti-doping test for asthma medication that she was prescribed by a doctor.

Medeiros did file a TUE, but according to reports, her doctor failed to list this specific medicine among the others she was taking. She was consistent in filing appropriate TUEs throughout the year, but at some point hit an administrative lapse.

Medeiros received just a warning, whereas Kendall received a 3-month suspension.

  • The similarities: both were taking prescribed asthma medications, both of which would have been cleared with proper TUE paperwork.
  • The differences: One case was adjudicated by the USADA, one by the Brazilian Anti-Doping Authority. In Medeiros’ case, she was regularly filing a TUE, while in Kendall’s case, she was not. Kendall’s was prescribed for treatment of bronchitis, an acute condition, while Medeiros’ was for treating an ongoing condition, asthma.

Both stories carry an equal level of credibility, given the respective circumstances, and there are some nuanced differences that can explain the different suspensions. Overall, I would deem these suspensions ‘consistent with each other’ based on the facts presented.

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Dan D.
2 years ago

My sister and I were at a championship meet a few years ago, and my sister saw an egregious example of inhaler abuse. She went into the locker room, and there was a swim parent from another team in there letting girls take puffs on her inhaler before their races. One of the girls was nervous about taking the inhaler, and the parent told her, “It’s OK. It just opens up your lungs.” The head coach for that team was suspiciously standing outside the locker room door, and there’s no way he didn’t know what was going on. What an embarrasing lack of integrity.

Adam
Reply to  Dan D.
2 years ago

That’s heavy

ERVINFORTHEWIN
Reply to  Adam
2 years ago

serious manipulation methods

Anonymous
Reply to  Dan D.
2 years ago

Whoa! I wonder how often this is going on. I know I am naive. All drugs have side effects. I would never risk the lifelong health of my kids for a temporary edge. Even overused protein powder could damage kidneys. We don’t know how large the effects of any of these things would be in children.

GRUBBY_1
Reply to  Anonymous
2 years ago

Inhaler abuse is real. It can and should be controlled in club swimming simply by the LSA’s demanding that the swimmers have their inhalers in the stands with parents or friends with whom they got to the meet. Inhalers are jet propulsion for swimmers with no allergies. It is a stimulant but indeed helps more oxygen into the body as the lungs are more receptive. In well conditioned bodies this is a huge boost for performance. The tinkering or experimenting starts around 13 years and the feeling of performance is euphoric. It is real and it needs parental control. Much of the temptation stems from dedicated club swimmers not getting rested more than twice a year. The boot on the… Read more »

Parent
Reply to  Dan D.
2 years ago

Was at an indoor meet this winter (California team only training in outdoor pools) and a few of the California kids “struggled” to breath after their races. A mom was giving her inhaler to the kids to help “open up their lungs”. She thought she was helping them breath. Ironically, the kids all got best times and made junior national cuts even with their breathing struggles. Ludicrous!

Coachmommy
Reply to  Parent
2 years ago

I grew up swimming in the north east and the air quality at my training pool was horrible. I would have a hacking cough most of the winter season. The pool had a wall of windows that could be opened which was a moderate improvement, but the entire pool would fill with fog. We had a handful of swimmers with inhalers but most of us probably needed them. The pool I coach at now has recently taken many steps to improve air quality, but beforehand the air was terrible. We had one swimmer that never had an issue with breathing in the 10 years he trained in the pool, but when he came back for his first thanksgiving break after… Read more »

Maverick
Reply to  Parent
2 years ago

I doubt a quick inhaler puff caused 3-4 kids to all go best times. However, it does give you an edge!

Ummmm
Reply to  Parent
2 years ago

Medically speaking…apuff off an inhaler when in distress from poor air wuality Does NOT grt you junior cuts…benefit is completely over used throughout the comments. Secondly for anyone with exercise induced issues would not be able to seim without opening the airways…a violation of ADA principals under current guidelines.

Observer
2 years ago

You forgot to mention Sam Tierney. He appealed and won, which had Kendall chose to do so also likely would have. https://swimswam.com/u-s-swimmer-sam-tierney-given-warning-wada-rule-violation/

Assuming she chose not to appeal given the proximity to Nationals and her suspension basically already being over.

Another thing worth noting is that physicians and prescribing asthma inhalers for bronchitis (I was years ago). Kendall did not claim to have asthma at any point and the length of inhaler treatment was 1 week not long term like Medeiros.

MasterSwim
2 years ago

When it comes to inhalers that are prescribed for a asthmatic condition, my questions is how exactly does an inhaler do to enhance an athletes performance other than help provide clear lungs for a full breath of air…which would be equivalent to an athlete who doesn’t have asthmatic conditions and gets a full breath of air naturally? I understand that the majority of performance enhancement drugs provide athletes with better strength, stamina, recovery, etc…, but I don’t understand how inhaler drugs enhance athlete performance other than opening up lungs?

Because they are stimulants
Reply to  MasterSwim
2 years ago
Ummmm
Reply to  Because they are stimulants
2 years ago

Not all inhalers and i really worry about the stigma that these comments gives to those using maintenance inhalers as prescribed.

Fresh air
Reply to  MasterSwim
2 years ago

Hard to trust google searches without doing the back up verification but howstuffworks.com said this ‘In a review article published in a 2007 issue of Sports Medicine, the authors found that, in 17 of 19 clinical trials involving non-asthmatic competitive athletes, the performance-enhancing effects of inhaled beta2-agonists could not be proved.’ Sounded different is ingested or injected but that was their conclusion.

(G)olden Bear
Reply to  Braden Keith
2 years ago

For anyone who doubts the negative effect of the toxic air in indoor pools on athletes, you need only look at what has happened at meets recently hosted in Greensboro, Iowa, Minnesota, etc. Now imagine that you’re a kid who has some allergies, mild exercise-induced asthma, etc, and you have to train in a pool like that 3-5 hours per day, 6 days a week. I’m sure that there are lots of swimmers using albuterol and other inhalers as a (psychological) performance enhancer, but there are also many who need them just to be able to breathe after the first day of a four-day meet… YMMV.

MasterSwim
Reply to  (G)olden Bear
2 years ago

Yeah, I do see both sides of the argument. However as a lifelong sufferer of asthma, and having been hospitalized numerous times for this terrible condition, there is no way that I could have played competitive sports without some sort of inhaler. As a child, and prior to one of the very first inhaler drugs being approved called Ventolin, my parents had to simply take me out of training and competition due to my inability to breathe…and there are several documented cases whereas young sports competitors have died from severe asthmatic attacks in the early years prior to emergency inhalers…many causes of death due to heart attacks. When ventolin came along I thought my life had changed as it opened… Read more »

science geek
Reply to  (G)olden Bear
2 years ago

Yup. My swimming career was ruined by swimming in a bubble during winters and the need to use albuterol just to breathe. I’m sure a breathe of albuterol every six months can be performance enhancing. But multiple puffs a day for years ruins you. Today’s meds are much better thank goodness.

Paco
Reply to  Braden Keith
2 years ago

Braden, not super certain on all of the USADA/WADA rules, but if I’m correct then I believe that Albuterol does not actually require a TUE as it is only conditionally banned after exceeding a certain dosage – a dosage much higher than any doctor would ever prescribe.

So although you need a prescription to use albuterol, in sports anyone is allowed to use it. This could definitely be a reason why people “doctor shop” to find a way to get an asthma diagnosis so that they have access to drugs like albuterol if it really does help performance.

Swimdaddoc
Reply to  Braden Keith
2 years ago

I am a pulmonologist and have 4 kids who are competitive swimmers – two have asthma clearly aggravated by especially indoor pool air quality. This topic needs to be stressed more as most community doctors have no idea which medications are legal, illegal, safe to use in or out of competion, etc. It is also unfair for some to lump all taking inhalers into the abuse category as some truly cannot perform with airway constriction. It is a fallacy that a normal lung taking a bronchodilator will make their lungs super expanded and thus subsequently offering an advantage. It is a stimulant which may offer minimal benefit. Remember the placebo effect as well and if I gave you a sugar… Read more »

Ummmm
Reply to  Swimdaddoc
2 years ago

Agree completely

Alae
Reply to  Swimdaddoc
1 year ago

What about the tachycardia Beta-2-agonists can induce and which can help a well trained competitor to reach a higher level of heart stimulation that can give them an advantage for short and middle length events. I’m talking about athletes with no asthma condition and who I’ve seen using inhalers as performance enhancing drugs.

Ol' Longhorn
Reply to  Braden Keith
2 years ago

You’d get the same effect from a couple cups of strong coffee or a pre-workout supplement. Can’t get more jacked up from albuterol inhalers than Dressel said he was after he took too much pre-workout supplement at NCAAs.

Ummmm
Reply to  Braden Keith
2 years ago

They were asthmatic so it should improve for them, however this doesnt address exercise induced asthma…which affects many swimmers.

Rachel
Reply to  MasterSwim
2 years ago

I think the issue is more along the lines of is there a performance benefit when non asthmatics use inhalers? Such as, when a non asthmatic individual uses an inhaler, is there increased lung capacity to take in much needed oxygen while swimming thereby allowing the muscles and the rest of the body to perform better than had the non asthmatic individual not used the inhaler?

I don’t see the issue being with swimmers who have a real asthma diagnosis. The issue is more when a healthy swimmer gets an asthmatic diagnosis for the purposes of using an inhaler to enhance performance. Unfortunately, it really isn’t hard to find a doctor to get a prescription for an inhaler.

JimSwim
Reply to  MasterSwim
2 years ago

Even for an asthma suffered it could be that inhaler use is unfair. If the inhaler allows the athlete to get larger volumes of air than is possible for them when healthy. Testosterone level manipulation is used in that way. If someone has naturally low testosterone levels they can get away with raising their level and they are in fact still cheating.

B1G parent
Reply to  JimSwim
2 years ago

For children with asthma that require inhalers, they don’t actually get larger volumes of air after using the inhaler. There are tests run (at least for my kid) at the doctor’s office that demonstrate lung capacity prior to use of the inhaler/breathing treatment and after. For my kid, her capacity after a breathing treatment just skimmed the bottom of normal. This was just sitting in the office, not under the demand of a tough workout in an indoor pool with horrible air quality. Please also note that few folks with asthma only use inhalers. My kid takes 3 medications daily, with one med to “support control” of her asthma. I would be a bit suspicious of a doctor who only… Read more »

meeeeee
Reply to  B1G parent
2 years ago

Asthma (and COPD) are obstructive lung disorders. Ability to take in air is normal. It is exhalation that is the issue where lung structures collapse and air remains trapped behind the obstruction.

science geek
Reply to  JimSwim
2 years ago

If you think someone with real asthma is somehow getting an advantage I wish asthma upon you.

About Braden Keith

Braden Keith

Braden Keith is the Editor-in-Chief and a co-founder of SwimSwam.com. He first got his feet wet by building The Swimmers' Circle beginning in January 2010, and now comes to SwimSwam to use that experience and help build a new leader in the sport of swimming. Aside from his life on the InterWet, …

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