What is Fluimucil and why would Wiggins need it?

Drug can help breathing but preceded TUE for Kenalog

In Monday's hearing in front of the Culture, Media and Sport Committee, Team Sky principal Dave Brailsford at last revealed the contents of a package that was delivered to the team at the 2011 Criterium du Dauphine.

Brailsford said: "Doctor Freeman told me that it was Fluimucil that was in the package, a product that is for a nebuliser."

According to earlier testimony by Shane Sutton, the package was destined for Bradley Wiggins.

What is Fluimucil?

Fluimucil is a mucolytic, a drug that can help break up thick mucus in the lungs, making it thinner and easier to expel by coughing, making it easier to breathe. It can be used to treat bronchitis. It differs from a cough medicines like guaifenesin (Mucinex), an expectorant that both thins and increases mucus production and help make congestion easier to move out through coughing, decongestants that reduce swelling in the lining of the lungs, or cough suppressants.

The active ingredient in Fluimucil is N-acetylcysteine, but the trade name normally refers to the oral version of the drug. The inhaled version meeting Brailsford's description would more likely be known as Mucomyst, made by Bristol-Myers Squibb Company, in the US.

The drug is not on the WADA list of substances prohibited in or out of competition.

According to the Salisbury NHS Foundation Trust, N-acetylcysteine is not licenced in the UK for use by inhalation, and this kind of application of the drug is not the first line of defence for treating conditions like bronchitis.

The product documentation warns that some patients could be dangerously and unpredictably sensitive to the drug, and cautions against its use by patients with asthma.

Wiggins' history

Wiggins has a long history of severe allergies and breathing issues, and detailed his struggles to The Guardian this summer after hackers published his confidential medical information.

In an interview with The Guardian this year, Wiggins described using over the counter allergy medications and bronchodialators like the asthma drug Salbutamol to help control his symptoms.

The package from Dr. Richard Freeman which, according to Brailsford, contained Fluimucil, was delivered to Team Sky for Wiggins, according to Shane Sutton, on June 12, 2011, the day Wiggins won the 2011 Criterium du Dauphine.

It is not clear whether Wiggins used the Fluimucil. According to the interview in The Guardian, Wiggins went on to see a specialist on June 28, four days before the start of the Tour de France, and was granted a Therapeutic Use Exemption for a 40mg injection of Triamcinolone acetonide (Kenalog).

"I saw the specialist, he did a full examination of me, blood tests, this that and the other, I went home, and he compiled his report for Richard Freeman," Wiggins said to The Guardian this summer. "That's the report he made to Richard Freeman. Upon doing that, the medication he suggested in there would need an application for a TUE.

"I was still unaware at this stage of what was happening because it was the first time I'd seen a specialist. Richard called me and said: 'you've been granted authorisation for a TUE based on seeing Dr Hargreaves' and that was that. He showed me the TUE application; he showed me the TUE certificate, and it was administered."  

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