The founding of the World Anti-Doping Agency (WADA) and of the National Anti-Doping Agency Germany (NADA) at national level has lead to a standardization of the Anti-Doping guidelines. In accordance with the World Anti-Doping Code 2003 the WADA has developed the 2004 list of prohibited substances as an international standard with a number of changes in contrast to the list of prohibited substances of the International Olympic Committee. These changes has consequences for the medical therapy of elite athletes. Caffeine has been removed from the prohibited list. Beta-2-agonists are allowed outside of competition except clenbuterol, salbutamol (concentrations in urine greater than 1000 ng/ml are prohibited), and zeranol. In competition beta-2-agonists are prohibited except formoterol, salbutamol, salmeterol, and terbutalin by inhalation. Athletes need an abbreviated therapeutic use exemption for these substances. The application for this exemption requires a statement and a signature of the athlete's physician. Glucocorticosteroids are prohibited when administered sytemically. All other administration routes require a medical notification in accordance with the inhalative ingestion of beta-2-agonists. The therapy of chronic diseases, for example systemic therapy using insulin or cortison, requires a standard therapeutic use exemption. In this case a detailed statement from a physician including medical history, sufficient medical information to substantiate the diagnosis and the necessity to use the prohibited substance is absolutely necessary.
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