Abstract
The present study aimed at determining the use of physician-prescribed medication in a large number of elite athletes compared with a representative control sample of the general population. Of all the athletes (N = 494) financially supported by the National Olympic Committee, 446 completed a structured questionnaire (response rate 90.3 %) in 2002. A control group (N = 1503, response rate 80.1 %) comprised an age-matched sample from the population-based study collected by the National Public Health Institute. Any prescribed medication was used by 34.5 % of the athletes and 24.9 % of the controls during the past seven days. The most frequently reported physician-prescribed medications among athletes during the previous seven days were anti-allergic medicines (12.6 % of the respondents), non-steroidal anti-inflammatory drugs (NSAIDs; 8.1 %), anti-asthmatic medicines (7.0 %), and oral antibiotics (2.7 %). The adjusted odds ratios (95 % CI) for the physician-prescribed medications used during the previous seven days was 2.42 (1.69 - 3.46), 3.63 (2.25 - 5.84), 3.42 (2.05 - 5.70), and 2.15 (1.03 - 4.45) for use of anti-allergic medication, NSAIDs, anti-asthmatic medication, and oral antibiotics, respectively, in the athletes compared with controls. Every fifth athlete reported some NSAID-related adverse effect. In conclusion, the athletes used NSAIDs, antibiotics, anti-asthmatic and anti-allergic medication significantly more often than a representative sample of age-matched controls. All these medicines have potential adverse effects that may have a deleterious impact on the maximum exercise performance of elite athletes. Adverse effects were commonly reported in connection with NSAID use.
Key words
Non-steroidal anti-inflammatory drugs - anti-asthmatic medication - anti-allergic medication - antibiotics - adverse effects
References
-
1
Adirim T A, Cheng T L.
Overview of injuries in the young athlete.
Sports Med.
2003;
33
75-81
-
2
Alaranta A, Alaranta H, Heliövaara M, Alha P, Palmu P, Helenius I.
Allergic rhinitis and pharmacological management in elite athletes.
Med Sci Sports Exerc.
2005;
37
707-711
-
3
Alaranta A, Alaranta H, Palmu P, Alha P, Pietilä K, Heliövaara M, Helenius I.
Asthma medication in Finnish Olympic athletes: No signs of inhaled β2-agonist overuse.
Med Sci Sports Exerc.
2004;
36
919-924
-
4
Altman R D, Latta L L, Keer R, Renfree K, Hornicek F J, Banovac K.
Effect of nonsteroidal anti-inflammatory drugs on fracture healing: a laboratory study in rats.
J Orthop Trauma.
1995;
9
392-400
-
5
Baker J, Cotter J D, Gerrard D F, Bell M L, Walker R J.
Effects of indomethacin and celecoxib on renal function in athletes.
Med Sci Sports Exerc.
2005;
37
712-717
-
6 Bennell K, Brukner P. How should you treat a stress fracture?. MacAuley D, Best T Evidence Based Sports Medicine. London; BMI Books 2002: 491-517
-
7
Berglund B, Sundgot-Borgen J.
Sports medicine update.
Scand J Med Sci Sports.
2001;
11
369-371
-
8
Bondesen B A, Mills S T, Kegley K M, Pavlath G K.
The COX‐2 pathway is essential during early stages of skeletal muscle regeneration.
Am J Physiol.
2004;
287
C475-C483
-
9
Buckwalter J A.
Pharmacological treatment of soft-tissue injuries.
J Bone Joint Surg.
1995;
77 A
1902-1914
-
10
Burd T A, Lowry K J, Anglen J O.
Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures.
J Bone Joint Surg.
2001;
83 A
1783-1788
-
11
Corrigan B, Kazlauskas R.
Medication use in athletes selected for doping control at the Sydney Olympics (2000).
Clin J Sports Med.
2003;
13
33-40
-
12
Crofford L J, Wilber R L, Ristimäki A P, Sano H, Remmers E F, Epps H R, Hla T.
Cyclooxygenase-1 and -2 expression in rheumatoid synovial tissues: effects of interleukin-1beta, phorbol ester, and corticosteroids.
J Clin Invest Med.
1994;
93
1095-1101
-
13
Elder C L, Dahners L E, Weinhold P S.
A cyclooxygenase-2 inhibitor impairs ligament healing in the rat.
Am J Sports Med.
2001;
29
801-805
-
14
Endo K, Sairyo K, Komatsubara S, Sasa T, Egawa H, Yonekura D, Adachi K, Ogawa T, Murakami R, Yasui N.
Cyclooxygenase-2 inhibitor inhibits the fracture healing.
J Physiol Anthropol Appl Human Sci.
2002;
21
235-238
-
15
Gierer P, Mittlmeier T, Bordel R, Schaser K D, Gradl G, Vollmar B.
Selective cyclooxygenase-2 inhibition reverses microcirculatory and inflammatory sequelae of closed soft-tissua trauma in an animal model.
J Bone Joint Surg.
2005;
87 A
153-160
-
16
Gilroy D W, Tomlinson A, Willoughby D A.
Differential effects of inhibition of isoforms of cyclooxygenase (COX‐1, COX‐2) in chronic inflammation.
Inflamm Res.
1998;
47
79-85
-
17
Gretzer B, Knorth H, Chantrain M, Barbera L, Willburger R E, Wittenberg R H, Peskar B M.
Effects of diclofenac and L‐745, 337, a selective cyclooxigenase-2 inhibitor, on prostaglandin E2 formation in tissue from human colonic mucosa and chronic bursitis.
Gastroenterology.
1998;
114
A139
-
18
Griffiths M L.
End-stage renal failure caused by regular use of anti-inflammatory analgesic medication for minor sports injuries.
S Afr Med J.
1992;
81
377-378
-
19
Hawkey C J, Langman M S.
Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX‐2 inhibitors and proton pump inhibitors.
Gut.
2003;
52
600-608
-
20
Helbling A, Jenoure P, Muller U.
The incidence of hay fever in leading Swiss athletes.
Schweiz Med Wschr.
1990;
120
231-236
-
21
Helenius I, Rytilä P, Sarna S, Lumme A, Helenius M, Remes V, Haahtela T.
Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers.
J Allergy Clin Immunol.
2002;
109
962-968
-
22
Helenius I J, Tikkanen H O, Haahtela T.
Association between type of training and risk of asthma in elite athletes.
Thorax.
1997;
52
157-160
-
23
Irving R A, Noakes T D, Raine R I, Van Zyl Smit R.
Transient oliguria with renal tubular dysfunction after a 90 km running race.
Med Sci Sports Exerc.
1990;
22
756-761
-
24
Kujala U M, Sarna S, Kaprio J.
Use of medications and dietary supplements in later years among male former top-level athletes.
Arch Int Med.
2003;
163
1064-1068
-
25
Kujala U M, Taimela S, Antti-Poika I, Orava S, Tuominen R, Myllynen P.
Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data.
BMJ.
1995;
311
1465-1468
-
26
Maiolo C, Fuso L, Todaro A, Anatra F, Boniello V, Basso S, De Lorenzo A, Pistelli R.
Asthma and atopy in elite athletes.
Int J Sports Med.
2003;
24
139-144
-
27
Nieman D C.
Exercise effects on systemic immunity.
Immunol Cell Biol.
2000;
78
496-501
-
28
Nystad W, Harris J, Sundgot Borgen J.
Asthma and wheezing among Norwegian elite athletes.
Med Sci Sports Exerc.
2000;
32
266-270
-
29
Seibert K, Zhang Y, Leahy K, Hauser S, Masferrer J, Isakson P.
Distribution of COX‐1 and COX‐2 in normal and inflamed tissues.
Adv Exp Med Biol.
1997;
400 A
167-170
-
30
Shoor S.
Athletes, nonsteroidal anti-inflammatory drugs, coxibs, and the gastrointestinal tract.
Curr Sports Med Reports.
2002;
1
107-115
-
31
Simon L S.
Actions and toxicity of non-steroidal anti-inflammatory drugs.
Curr Opin Rheumat.
1996;
5
169-175
-
32
Szczeklik A, Gryglewski R J, Czerniawska-Mysik G, Pieton R.
Asthmatic attacks induced in aspirin-sensitive patients by diclofenac and naxopren.
BMJ.
1977;
2
231-232
-
33
Thorsson O, Rantanen J, Hurme T, Kalimo H.
Effects of nonsteroidal antiinflammatory medication on satellite cell proliferation during muscle regeneration.
Am J Sports Med.
1998;
26
172-176
-
34
Verrico M M, Weber R J, McKaveney T P, Ansani N T, Towers A L.
Adverse drug events involving COX‐2 inhibitors.
Ann Pharmacother.
2003;
37
1203-1213
-
35
Vitting K E, Nichols N J, Seligson G R.
Naproxen and acute renal failure in a runner.
Ann Intern Med.
1986;
105
44
-
36
Walker R J, Fawcett J P, Flannery E M, Gerrard D F.
Indomethacin potentiates exercise-induced reduction in renal hemodynamics in athletes.
Med Sci Sports Exerc.
1994;
26
1302-1306
-
37
Wallace J L, Chapman K, McKnight W.
Limited anti-inflammatory efficacy of cyclo-oxygenase-2 inhibition in carrageenan-airpouch inflammation.
Br J Pharmacol.
1999;
126
1200-1204
-
38
Weiler J M.
Medical modifiers of sport injury. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) in sports soft-tissue injury.
Clin Sports Med.
1992;
11
625-644
M.Sc. (Pharm) Antti Alaranta
Division of Social Pharmacy, Faculty of Pharmacy
University of Helsinki
Tammelankatu 8 B 10
04430 Järvenpää
Finland
Fax: + 35 89 19 15 98 84
Email: antti.alaranta@helsinki.fi.