Athlete’s Name: ___________________________

Procedure for Obtaining a Therapeutic Use Exemption

for a Prohibited Substance.
1. Download forms. Please be sure to download the appropriate TUE Application form for your sport
AND the Specific Information for the medication or condition published by The World Anti-Doping
Agency (WADA) and available from both the USADA and WADA website.

The following sporting Federations require the use of a specific application form: Archery(FITA);
Badminton(BWF); Basketball(FIBA); Bobsled and Skeleton (FIBT); Cycling(UCI); Field Hockey (FIH):
Paralympic Athletes(IPC); Rowing(FISA); Tennis(ITF); Track and Field(IAAF); Wrestling(FILA);
Volleyball(FIVB). If you compete in one of these sports, PLEASE make sure you have downloaded the
correct form. If you submit the wrong form your application will be returned to you. For all other sports,
please use the USADA TUE Application Form on the USADA website.

There are additional pages attached to this form for applications for Beta-2 Agonists in the treatment of
Asthma. Please ensure your physician fills out ALL of the relevant forms (Pages 2,3,7,8). If pages 7 and 8
are not filled out by your physician, your application will be returned to you. If you are not applying
for a Beta-2 Agonist then disregard pages 5-8.

2. Bring all relevant documents to your physician. All forms must be filled out completely. Incomplete
applications will NOT be submitted to the Therapeutic Use Exemption Committee for review, and cannot
be approved. The documents detailing the medical information to support decisions of TUECs are very
useful, and will help the physician provide information that will help in the decision process for this TUE
application.

3. Submit the completed application by email, fax, or mail as detailed below. You should receive a
confirmation of receipt within 3 business days. If you do not receive confirmation of receipt, please
notify the TUE Administrator immediately.

By Mail: By Fax: (719) 785-2029

United States Anti-Doping Agency
ATTN: TUE Department By E-mail: tue@usada.org
1330 Quail Lake Loop, Suite 260
Colorado Springs, CO 80906 TUE Administrator (719) 785-2045

4. Review of your Application. If your application is complete, it will be forwarded to the Therapeutic
Use Exemption Committee of USADA or that of the relevant International Federation for your sport. It is
very important that you notify us of your competition status, your membership in a Registered Testing
Pool, and whether you intend to compete in an event sanctioned by your International Sporting
Federation (whether the event takes place in the USA or abroad; You may need to consult the website of
your International Federation to make this determination). Such information will determine who has the
authority to grant your Therapeutic Use Exemption. Failure to provide this information, or the provision
of incorrect information will result in delays in the processing of your Therapeutic Use Exemption.

5. Await Decision. Your application will normally be processed within 21 days of receipt. Until you are
formally granted a Therapeutic Use Exemption, the use of prohibited substances may result in a doping
violation. We will formally notify you of a decision by email, and by postal mail. If your Therapeutic Use
Exemption is granted, you will receive a formal Approval Letter and Certificate.

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 Athlete’s Name: ___________________________

Therapeutic Use Exemption (TUE)

Application Form
For International-Level Athletes, these Federations require their own application form which should be obtained
from the USADA Website: Archery(FITA); Badminton(BWF); Basketball(FIBA); Cycling(UCI); Paralympic
Athletes(IPC); Rowing(FISA); Tennis(ITF); Track and Field(IAAF); Wrestling(FILA); Volleyball(FIVB)

Sections 1, 4, and 6 – Completed By Athlete

Sections 2, 3, 5 – Completed By Prescribing Physician
For Beta-2 Agonists- Physicians Please read pages 5 and 6, and fill out pages 7 and 8.
1. Basic Athlete Information (Please print in BLOCK LETTERS.)

Last Name: ........................................................................... First Name:..........................................................................................

Female  Male  Date of Birth (month/day/year): ............................................................................................................

Mailing Address: .....................................................................................................................................................................................

City: ................................................................................... State: ............................................... Zip Code: ........................................

Work Phone: .......................................... Home Phone: ................................................ Mobile Phone: .......................................

Email: ..................................................................................................... Fax: ........................................................................................

International or National
Sport :……………………………………………………………………………… Sporting Organization : …………………………………………………………………………..
CONFIRM YOUR COMPETITION STATUS 1 (please check all that apply) :
USADAs Registered Testing Pool International Federation Testing Pool  Neither/unsure
Please list the upcoming National/Internationally Sanctioned Events you intend to participate in: ………………………………

……………………………………………………………………………………………………………………………………………………………………………………………………………………………

2. Medical information –For BETA-2 AGONISTS PLEASE ALSO fill in pages 6 and 7 (Physician
Worksheet). For all other medications you consult the relevant publication in note 2 (below).
Diagnosis. Please attach additional sheets with sufficient medical information to support the diagnosis and
necessity to use the prohibited substance (see below, note 2): ............................................................................................
If a permitted medication can be used to treat the medical condition, provide clinical justification for the requested
use of the prohibited medication (attach additional sheets).
......................................................................................................................................................................................................................
......................................................................................................................................................................................................................
…………………………………………………………………………………………………………………………………………………………………………………………………………………………..

1
Your competition status will determine who has the authority to grant this TUE. You may wish to contact the National
Governing Body or the International Federation for your sport to confirm your competition status.
2 The physician and athlete should consult the relevant publication entitled Medical information to support the decisions

of TUECs for the use of prohibited substance available on the World Anti-Doping Website www.wada-
ama.org/en/exemptions.ch2

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 Athlete’s Name: ___________________________

3. Medication details –(Please use BLOCK LETTERS)

Prohibited substance(s): Dose Route Frequency
Generic name
1.

2.

3.

Intended duration of treatment:  One-Time Only

(Please tick appropriate box.)  Emergency (*If this is an emergency- please write
EMERGENCY in block letters on the top of the
application to expedite processing).

 Long term (note duration: weeks/months): ……………………………………………..

4. TUE Request History (Please type or print in block letters.)

Have you submitted any previous TUE application?: yes  no 

For which substance? …………………………………………………………………………………………………………………

To whom (e.g. USADA, International Federation)?……………………………………………………………….When?……………/………………/……………

Decision: Approved  Not approved 

5. Medical practitioner’s declaration (Please type or print in block letters.)

I certify that the above-mentioned treatment is medically appropriate and that the use of alternative medications
not on the Prohibited List would be unsatisfactory for this condition.
Name: .........................................................................................................................................................................................................

Medical Speciality:...................................................................................................................................................................................

Address: .....................................................................................................................................................................................................

Tel.: .................................................................................................... Fax (optional): ..........................................................................

E-mail (optional): ........................................................................................................................................................................................

Signature of Medical Practitioner: ............................................................................... Date: ......................................................

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 Athlete’s Name: ___________________________

6. Athlete’s declaration

I, ....................................................................................... , certify that the information under section one is accurate and that I am requesting
approval to use a Substance or Method from the World Anti-Doping Agency (WADA) Prohibited List. I authorize the release of
personal medical information to USADA including its Therapeutic Use Exemption Committee (TUEC) as well as to WADA staff, to the
WADA TUEC, and to the appropriate International Federations and their TUEC under the provisions of the WADA Code. I understand
that if I ever wish to revoke the right of the Anti-Doping Organization TUEC or WADA TUEC to obtain my health information on my
behalf, I must notify my medical practitioner in writing of that fact.

I understand that International and National-Level Athletes should submit the Form to USADA and USADA will forward the Form to
the appropriate Governing Body and/or TUEC. I understand that using any prohibited substance is at my own risk of committing a
doping violation until my request has been approved and I receive approval in writing from USADA and/or my IF (if applicable).

Athlete’s signature: .......................................................................................... Date: ............................................................................

Parent’s/Guardian’s signature: ..................................................................... Date: ............................................................................

(If the athlete is a minor or has a disability preventing him/her to sign this form, a parent or guardian shall sign together with or on
behalf of the athlete.)

7. Attention
Diagnosis with sufficient medical information to support the diagnosis
and necessity to use the prohibited substance should be included:
Evidence confirming the diagnosis must be attached and forwarded with this application. The
medical evidence should include a comprehensive medical history and the results of all relevant
examinations, laboratory investigations, and imaging studies. Copies of the original reports or
letters should be included when possible. Evidence should be as objective as possible in the
clinical circumstances, and in the case of non-demonstrable conditions, independent supporting
medical opinion will assist this application.
A statement by an appropriately qualified physician attesting to the necessity of the otherwise
Prohibited Substance or Prohibited Method in the treatment of the athlete and describing why an
alternative, permitted medication cannot, or could not, be used in the treatment of this condition
should also be included.

Incomplete Applications will be returned and will need to be resubmitted.

No TUE will be in effect until the athlete is notified following review of the documentation after submission.

Please submit the completed request to the U.S. Anti Doping Agency and keep a copy for your records.
You should receive confirmation of receipt of this application within 3 business days.
If you do not receive confirmation, please contact the TUE Administrator immediately.
United States Anti-Doping Agency
ATTN: TUE Department
1330 Quail Lake Loop, Suite 260
Colorado Springs, CO 80906
Fax: (719) 785-2029
Telephone (for TUE Questions): (866) 601-2632 (toll-free); TUE Administrator (719) 785-2045
Drug Reference Online: www.usada.org/dro
Drug Reference Line: (800) 233-0393 or (719) 785-2020 (outside of the U.S.) or drugreference@usada.org
E-mail: tue@usada.org
Web Site: www.usada.org

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 Athlete’s Name: ___________________________

Information for Athletes and Physicians regarding Therapeutic Use

Exemptions for Beta-2 Agonists

Concerned about the increased use of Beta-2 agonists 3 by elite athletes, and the risks of using such
medications long-term, the World Anti-Doping Agency has issued a new International Standard for
Therapeutic Use Exemptions (2009) 4 that requires a medical file justifying the use of Beta-2 agonists.
Information that would support your application includes:

History
• Symptoms suggesting airway obstruction with exercise
• Symptoms at rest and at night
• Allergies or atopic disorders especially seasonal or environmental allergies
• Identified triggering factors
• Childhood asthma
• Previous or current respiratory infection requiring beta-2 agonist treatment
• Previous results of RAST or skin prick testing if pertinent
• IgE
• Total eosinophil count in peripheral blood
• Sputum eosinophils
Physical examination
• Exam findings emphasizing the respiratory system (pathway)
• Past pertinent exam findings (especially as related to initial diagnosis if available)
Spirometry and/or Bronchial Provocation Test Results
• Results of spirometry including forced expiratory volume in 1 second (FEV1) at rest AND in
response to inhaled bronchodilator OR
• Results of bronchial provocation tests (eucapnic voluntary hyperpnea, exercise challenge,
hypertonic saline, mannitol inhalation or methacholine challenge) with response to inhaled
bronchodilator
Diagnosis
• Definitive diagnosis
• Differential diagnoses (hyperventilation syndrome, vocal cord adduction, exercise induced
laryngomalacia, non-reversible airflow obstructive disease, heart failure).
• Associated diagnoses
Treatment
• Details of strategies to manage known contributing factors to asthma/EIB such as rhinitis, nasal
congestion and allergies
• Attempts to manage symptoms with non-prohibited medications such as leukotriene receptor
agonists, anticholinergics, sodium chromoglycate or theophyllines if appropriate

3 For discussion of rationale for change in policy regarding Beta-2 Agonists, see “Asthma and the elite athlete:

Summary of the International Olympic Committee’s Consensus Conference, Lausanne Switzerland, January 22-24
2008” J Allergy Clin Immunol 2008;122:254-60.
4 The World Anti-Doping Agency International Standard for Therapeutic Use Exemptions 2009 (http://www.wada-

ama.org/rtecontent/document/TUE_Standard_2009_Final_031008.pdf)

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 Athlete’s Name: ___________________________

In some instances, in order to produce test results that meet the criteria 5 for the diagnosis of asthma
as adopted by the World Anti-Doping Agency, an athlete may have to cease taking their asthma
medications for a short time preceding the test. Cessation of medication should ONLY be done under
the careful supervision of the attending physician. The athlete may wish to discuss this possibility
with their physician prior to the office visit to determine if this is an appropriate approach. WADA
recommends athletes to stop taking short-acting Beta-2 agonists for 8 hours prior to testing,
and to stop taking long-acting Beta-2 agonists and glucocorticosteroids 24 hours prior to
testing. Further reference should be made to the American Thoracic Society.

In cases where athletes have well controlled asthma and record negative responses to all of the
tests, but still seeking approval for the use of inhaled Beta-2 agonists, substantial medical justification
will be required to demonstrate the absolute necessity for Beta-2 agonists. Such information may
include evidence of emergency room attendance or admission into hospital for acute exacerbation of
asthma, treatment with oral corticosteroids, and a thorough medical file containing ALL of the
information listed above.

Please note: The US Anti-Doping Agency (in accordance with position statements by the IOC and
WADA) recognizes the inherent risk of undertaking bronchial provocation tests, and the temporary
cessation of medication that may be required to produce positive test results. For this reason, an
advanced Therapeutic Use Exemption for Beta-2 agonists is only mandatory for athletes in the
Registered Testing Pool of USADA or an International Sporting Federation, and for any athlete
intending to compete at an event sanctioned by an International Sporting Federation regardless of
whether they are in a registered testing pool 6.

For athletes not in a registered testing pool, and not wishing to compete at an Internationally
sanctioned event (non-national level athletes), you are only required to notify USADA in advance of
your intention to use Beta-2 agonists through a Website Declaration on the USADA website
(www.usada.org). However, according to WADA guidelines, any athlete may request an advance
Therapeutic Use Exemption if they wish to do so. In the event of testing, you are also required to list
the substance in the “Declaration of Use” section of the Doping Control Official Record at the time of
collection.

5 For further information on WADA standard Therapeutic Use Exemption criteria please see the document entitled
“Medical Information to Support the Decisions of TUECs- Asthma” published by the World Anti-Doping Agency on
www.wada-ama.org
6 Please consult the document “USADA Policy for Therapeutic Use Exemptions and Declarations of Use” published

www.usada.org.

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 Athlete’s Name: ___________________________

**This form MUST accompany a TUE Application for a Beta-2 Agonist**

PHYSICIAN- You must select one of the Objective Tests in the Table below
and report the result. Please take note of the criteria set forth by WADA.

1. Spirometry and/or Bronchial Provocation Test Results (Select all that apply) 7.

Has the patient had been on asthma medication in the days leading up to test(s)?
YES NO (if no, how long has patient been off medications?______________)

Check Test Type WADA criteria Please report test results with
one regard to fall in FEV1
Spirometry: FEV1 12% increase in Please note % change in FEV1:
Pre and Post FEV1 post-
Bronchodilator bronchodilator
20% fall in FEV1; Please note PD20 (µg) and/or PC20
Methacholine PC20<4mg/mL (mg/mL) and % fall in FEV1:
aerosol challenge (tidal breathing
technique- steroid
naive)
Mannitol
Inhalation 15% fall in FEV1 FEV1 decrease of _____% in
______min.

Eucapnic 10% fall in FEV1 FEV1 decrease of _____% in

Voluntary ______min.
Hyperpnea

Hypertonic saline 15% fall in FEV1 FEV1 decrease of _____% in

aerosol challenge ______min.

Exercise challenge 10% fall in FEV1 FEV1 decrease of _____% in

(field or laboratory) ______min
Method of
challenge:__________________
Histamine
Challenge

2. Please attach a complete and comprehensive history of asthma and symptom

management (including the age of onset, severity of symptoms, identified triggering factors, hospital
emergency department attendance for acute exacerbation of symptoms, history of treatment with oral
corticosteroids, past physical exams and spirometry test results, specific information on coughing, wheezing,
chest tightness during or post exercise etc. Attach additional sheets)

3. Please attach physical exam report with a focus on the respiratory system.

7Test result criteria published www.wada-ama.org “Medical Information to Support the Decisions of TUECs-
Asthma”

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 Athlete’s Name: ___________________________

4. Please comment on attempts to manage the asthma by non-prohibited medications (such

as leukotriene receptor antagonists, anticholinergics, sodium chromoglycate, or theophyllines. Please
provide a clear statement why non-prohibited medications have not been effective or are otherwise
inappropriate.)

5. Please note other considerations in the assessment of this patient’s asthma (i.e. other
diagnoses, health concerns expressed by the athlete, parent etc.).

7. According to the Therapeutic Use Exemption International Standard, Section 4,

published Jan 2009 by the World Anti Doping Agency, the criteria for granting a Therapeutic
Use Exemption are as follows:
4.2 The Athlete would experience a significant impairment to health if the prohibited substance were
withheld in the course of treating an acute or chronic medical condition
4.3 The therapeutic use of the prohibited substance would produce no additional enhancement of
performance other than that which might be anticipated by a return to a state of normal health following
the treatment of a legitimate medical condition.
4.4 There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance.
4.5 The necessity for the use of the otherwise prohibited substance cannot be a consequence, wholly or in
part, of prior non-therapeutic use of any substance from the prohibited list.

In your opinion, does the asthma history and present health status of this patient meet the
above criteria? Please Comment.

Signature Date:

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