Topic:Airway Disease
Airway disease in horses is defined as a respiratory condition marked by inflammation and narrowing of the lower airways, leading to symptoms like coughing, increased mucus production, and reduced performance. This condition, which includes forms such as inflammatory airway disease (IAD) and recurrent airway obstruction (RAO), can significantly impact a horse’s respiratory efficiency and overall health.
This page compiles peer-reviewed research studies and clinical insights that explore the pathophysiology, diagnostic techniques, and effective treatment protocols to manage and improve equine respiratory health.
An in-hospital clinical trial assessing nebulized lidocaine compared to saline for treatment of asthma in horses. Corticosteroids are the main pharmacologic treatment for equine asthma (EA) but may have adverse effects in metabolically unstable horses. Recent pilot studies support the use of nebulized lidocaine as an alternative treatment option. Objective: Nebulized lidocaine will improve EA-associated clinical variables and airway inflammation. Methods: Twenty client-owned horses diagnosed with EA. Methods: Randomized, blinded, in-hospital study comparing 1 mg/kg preservative-free 4% lidocaine (n = 10) nebulized via Flexineb (twice daily for 7 doses) to 0.9% saline control (n = 10). Clinical examin...
Multi-Kingdom Fecal Microbiota Alterations in Horses with Severe Equine Asthma. Severe equine asthma (SEA) is a chronic inflammation of airways affecting ~14-20% of adult horses in the Northern Hemisphere. SEA is characterized by a mixed phenotype of T helper cell responses with marked neutrophilia in the bronchoalveolar lavage fluid (BALF) of affected horses. Human studies have demonstrated the impact of gut microbiota in many diseases, including asthma susceptibility and severity. However, the potential role of the gut-lung axis in the development and persistence of SEA remains to be determined. This study aimed to identify key bacterial, archaeal, and fungal microbiota...
[Equine laryngeal dysplasia – overview of variable clinical presentation based on 6 cases]. Equine laryngeal dysplasia (ELD) is the umbrella term for various malformations of laryngeal structures that arise from the 4th and 6th branchial arches during embryogenesis. The disease is rare and may be subclinical. In symptomatic patients with clinical signs, the clinical presentation is highly variable and is the result of functional limitations of the larynx as well as of the esophageal sphincter. The spectrum of signs may range from respiratory changes such as abnormal respiratory noise, coughing, and at times dyspnea all the way to poor performance, dysphagia, aerophagia, and colic. Th...
Proteomic profiling of equine airway mucus reveals compositional changes in asthmatic phenotypes. Mucus hypersecretion and accumulation are hallmark features of equine asthma (EA), a meaningful respiratory disorder in horses occurring in mild to moderate (MEA) and severe (SEA) forms. Changes of the proteomic composition of airway mucus in EA are poorly understood. Using label-free quantitative liquid chromatography-mass spectrometry, we analyzed airway mucus from SEA (n = 10), MEA (n = 6), and healthy (n = 8) horses. We identified and quantified 2,275 proteins including gel-forming mucins MUC5AC and MUC5B and membrane-bound mucins MUC1 and MUC4. Compared with healthy controls, ...
RNA-seq evaluation of equine alveolar macrophages and monocyte-derived macrophages exposed to an inflammatory stimulus (short communication). Macrophage populations in the lung, including resident alveolar macrophages (AMs) and recruited monocyte-derived macrophages (MDMs), recognize the inhaled particulates in barn dust that cause severe equine asthma and orchestrate an immune response though the cytokines they produce. Despite their importance, the specific contributions of these macrophage subsets to lower airway inflammation remain poorly understood. This exploratory in vitro study investigated the likely contributions of AMs and MDMs from healthy horses to the early inflammatory response using RNA-seq. If biologically importan...
Barrel racing horses demonstrate a high incidence of nonclinical postrace airway disorders. To describe the prevalence of postrace airway abnormalities in a population of barrel racing horses competing in Oklahoma. Unassigned: A descriptive field study was conducted at a single event. Horses underwent resting endoscopy within 60 minutes of competition. Recordings were evaluated and numerical and/or binary scores assigned for pharyngeal lymphoid hyperplasia, recurrent laryngeal neuropathy, dorsal displacement of the soft palate, epiglottic entrapment, and exercise-induced pulmonary hemorrhage. Clients completed a questionnaire detailing the horse's medical history and run time. A line...
A Portable Fluorometer Detects Significantly Elevated Cell-Free DNA in Tracheal Wash and Bronchoalveolar Lavage Fluid in Horses with Severe Asthma. Severe equine asthma (sEA) is characterized by increased lower airway neutrophils that contribute to dysregulated inflammation through the release of cytokines, reactive oxygen species and neutrophil extracellular traps (NETs). NETs are composed of cell-free DNA (cfDNA) intercalated with enzymatic proteins and are known to be increased in the lower airway of asthmatic horses. The objectives of this study were two-fold: 1. Determine if cfDNA can be accurately measured in equine bronchoalveolar lavage fluid (BALF) and tracheal wash (TW) with a Qubit 4 fluorometer. 2. Determine whether Qubit-meas...
Field-applicable low-intensity exercise induces bronchodilation in horses with severe asthma. Airway dysfunction in severe equine asthma (SEA) often results in early retirement or euthanasia of affected horses. Exercise-induced bronchodilation occurs in horses with SEA after intense treadmill exercise, but the effects of a lighter, field-applicable, training regimen remain largely unexplored. Objective: To evaluate the impact of submaximal aerobic exercise on airway obstruction during exacerbation of SEA. Methods: The preliminary phase explored the effects of a 25-min standardised exercise on the lung function of eight SEA horses. As notable bronchodilation occurred, the results were c...
Complications of Respiratory Surgery in the Horse. Respiratory surgery and procedures typically focus on conditions of the upper airway that restrict airflow at rest or exercise. This article focuses on respiratory anatomy and common surgeries of the trachea and larynx in horses. The trachea serves as the airway conduit from the larynx to the bronchi. A variety of upper airway disorders can lead to obstruction and in these instances, tracheotomy is typically utilized to bypass these obstructions and maintain airway patency. Emergency and permanent tracheotomy procedures are discussed. Other common upper airway operations, such as laryngotomy, ...
Steamed hay for the prevention of severe equine asthma exacerbations. Steaming hay reduces respirable particles and is commonly used to feed horses with asthma. However, it showed inconsistent benefits in clinical studies. Objective: (1) To assess the effects of steamed hay on lung function and airway inflammation in horses with severe equine asthma (SEA) in remission; (2) To compare these effects with a dry hay diet. Methods: Cross-over in vivo experiment. Methods: Horses were fed steamed and dry hay for 4 weeks in a prospective, cross-over study, with a 4-week washout period. Lung function, bronchoalveolar lavage (BALF) cytology, and a 23-point weighted clin...
Effects of mixed polyphenol supplementation on lower airway inflammation in horses with Equine Asthma Syndrome. Equine Asthma Syndrome (EAS) is a chronic inflammatory respiratory disease of adult horses. While dietary polyphenols have shown anti-inflammatory effects in human asthma, their use in equine asthma has not been studied. Objective: To evaluate the effects of a mixed polyphenol supplement on systemic and pulmonary inflammation, bronchoalveolar lavage (BAL) cytology, and clinical respiratory signs in healthy and asthmatic horses. We hypothesized that polyphenol supplementation would decrease systemic and pulmonary inflammation in both healthy and asthmatic horses and would improve BAL cytology a...
Comparison Between Tracheal Wash and Bronchoalveolar Lavage Cytology for the Assessment of Airway Inflammation in Racehorses Affected by Exercise-Induced Pulmonary Hemorrhage. Exercise-Induced Pulmonary Hemorrhage (EIPH) results from alveolar capillary stress failure after strenuous exercise, leading to bleeding and pulmonary inflammation. Bronchoalveolar lavage fluid (BALF) cytology is considered the gold standard for the assessment of airway inflammation; however, it is often considered more invasive compared to tracheal wash (TW). It has been demonstrated that TW is a reliable diagnostic tool that may substitute BALF to diagnose and grade the severity of EIPH in racehorses; however, no information about airway inflammation in EIPH-affected horses has been reporte...
Influence of a Standardized Lunging Exercise Test on BALF Cytology in Horses Suffering from Mild-Moderate Equine Asthma. Mild-moderate equine asthma (MEA) is a very common but underdiagnosed pulmonary disease in horses, with mild cases not showing clinical respiratory signs. This study evaluates the influence of a standardized lunging exercise test (SLET) on bronchoalveolar lavage fluid (BALF) cytology in MEA horses. We hypothesized that SLET would increase the total nucleated cell count (TNCC) and/or percentages of inflammatory cells associated with EA. In a prospective, randomized, non-blinded, between-subjects study design of two independent groups, 39 horses (17 mild and 22 moderate) were included. They were...
Endoscopically assessed mucus parameters in equine asthma: Relationship to clinical history and cytological findings data. Mucus parameters are hallmark diagnostic features of equine asthma (EA). Objective: To investigate the relationship between mucus quantity score and mucus viscosity score with signalment, history, clinical findings and cytological parameters. Methods: Retrospective cross-sectional study. Methods: Mucus quantity and viscosity scores, signalment, history and clinical findings recorded for diagnostic purposes from up to 1599 samples, and cytological values of the corresponding bronchoalveolar lavage fluid (BALF) and tracheobronchial secretions were analysed. The cut-off value of a mucus quantity ...
Inspiratory and expiratory tracheal pressures during high-intensity exercise in harness racehorses. Exercise-related upper respiratory tract (URT) disorders are common in racehorses. Objective assessment of URT mechanics is essential to quantify degrees of obstruction caused by URT disorders identified upon dynamic endoscopy. Objective: To establish reference values for inspiratory and expiratory tracheal pressures (cmHO) during high-speed treadmill endoscopy in harness racehorses with clinically normal URTs. Methods: Prospective observational study. Methods: Tracheal pressures were measured in harness racehorses (Standardbreds and Norwegian-Swedish coldblooded trotters) in which no URT abno...
Artificial intelligence in smartphone video analysis for equine asthma diagnostic support. Equine asthma is a prevalent respiratory disease that negatively impacts horses' health and athletic performance. Traditional diagnostic methods are invasive and require specialised equipment. There is a need for a non-invasive, cost-effective screening tool that can be used by veterinarians and horse handlers in ambulatory settings. Objective: To assess the willingness of veterinarians and horse handlers to adopt such a tool (Questionnaire 1) and the challenges associated with visually recognising equine asthma (Questionnaire 2) and to develop EquiBreathe, an artificial intelligence (AI)-powe...
Objective diagnosis of alar fold collapse in active Standardbred trotting racehorses using nasopharyngeal airway pressure measurements. Clinical evaluation of alar fold (AF) collapse is presently based upon subjective evaluation of improvement in breathing and respiratory noise after suturing the AFs dorsally. Objective: To evaluate use of nasopharyngeal airway pressure (NAP) as an objective method of assessing for the presence of AF collapse during exercise. NAPs should also potentially provide a precise means to grade the degree of airway obstruction present and response to surgical treatment. Methods: Prospective clinical study of actively racing Standardbred horses. Methods: Standardbreds undergoing this test were outfitte...
The presence of acylated homoserine lactones and diffusible signal factor in bronchoalveolar lavage fluid from horses with clinical exacerbation of severe equine asthma. Several bacteria associated with chronic lung pathology use quorum sensing (QS) signaling molecules to regulate their virulence in pure cultures and poly-microbial communities. Their excessive growth and biofilm formation in the respiratory tract increase the morbidity and mortality of inflammatory airway diseases in humans, such as chronic obstructive pulmonary disease (COPD), asthma and cystic fibrosis (CF). In horses, severe equine asthma (SEA) has many parallels to these human diseases. We hypothesized that QS molecules associated with the most common biofilm-forming lung pathogens in huma...
Equine epiglottitis: Diagnosis, treatment and outcome. Epiglottitis is an uncommon upper airway pathology manifested endoscopically by mucosal oedema, reddening and thickening of the epiglottic mucosa. Literature on epiglottitis in horses is sparse. Objective: To describe the diagnosis, treatment and outcome of Thoroughbred and Standardbred racehorses diagnosed with epiglottitis at a single centre. A secondary objective is to demonstrate the efficacy of inhaled and topical anti-inflammatories for this condition. Methods: Retrospective case series. Methods: Medical records (2009-2023) were reviewed for racehorses treated for epiglottitis. Data coll...
MARCKS protein is a potential target in a naturally occurring equine model of neutrophilic asthma. Asthma is a chronic inflammatory airway disease that affects millions of people worldwide. Horses develop asthma spontaneously and serve as a relevant model for multiple phenotypes and endotypes of human asthma. In horses with equine asthma (EA), environmental organic dust triggers increased inflammatory cytokines, excess airway mucus, reversible bronchoconstriction, and airway inflammation. In horses with severe EA (sEA), lower airway inflammation is invariably neutrophilic, making sEA a potential model for severe neutrophilic asthma in humans. Alveolar macrophages (AM) and airway neutrophils...
Overground endoscopic examination following laryngeal tie-forward in horses with dorsal displacement of the soft palate. To compare overground endoscopy (OGE) findings and racing performance in horses before and after laryngeal tie-forward (LTF) surgery for the treatment of intermittent dorsal displacement of the soft palate (iDDSP). Methods: Retrospective case series with follow up. Methods: A total of 56 horses met the inclusion criteria. Methods: Clinical record review of all horses definitively diagnosed with iDDSP, treated with LTF surgery, and evaluated with a single OGE examination postoperatively. In addition to LTF, some horses underwent bilateral aryepiglottic fold resection (AEFR) and/or soft palate t...
Redox Biomarker Variations With Severity of Asthma in Horses Across Different Sample Types. The contribution of redox imbalance to equine asthma (EA) pathogenesis remains unclear. Objective: (1) validate and measure a panel of redox biomarkers in the tracheal wash (TW) and bronchoalveolar lavage (BAL) samples from horses with neutrophilic and mastocytic mild-moderate EA (MEA) and severe EA. (2) Evaluate the same panel in saliva and serum for comparative purposes. Methods: A total of 117 horses: 37 healthy, 26 mastocytic MEA, 29 neutrophilic MEA, and 25 severe EA. Methods: Cross-sectional study using TW, BAL, and serum and saliva sampling. After assay validation, redox biomarkers-ferr...
Respiratory Rate Recovery After Submaximal Lunging Exercise Is Delayed in Asthmatic Horses with Neutrophilic Airway Inflammation. Equine asthma is a common cause of poor performance, but little is known about its impact on submaximal exercise. The aim of the present study was to evaluate the effects of equine asthma and potential confounding factors on recovery of respiratory rate (RR) and heart rate (HR) after a lunging exercise test. Thirty-seven horses completed a standardized 15 min lunging exercise including HR and RR recording pre- and up to 30 min post-exercise and venous blood lactate measurement. Endoscopy was performed and bronchoalveolar lavage fluid cytology was used to categorize horses as controls or asthma...
Use of inhaled ciclesonide for treatment of moderate asthma in Thoroughbred racehorses. Mild-moderate asthma is common in horses. Inhaled ciclesonide has been approved only for treatment of severe asthma in horses. Objective: We hypothesized that a 10-day treatment course of inhaled ciclesonide (Aservo EquiHaler) would improve clinical signs, endoscopic tracheal mucus scores, and bronchoalveolar lavage fluid (BALF) cytology in racehorses with moderate asthma. Methods: Racehorses with moderate asthma housed at the Emerald Downs Racetrack in Auburn, WA. Methods: Prospective, randomized, double-blinded, placebo-controlled clinical study. Horses received inhaled ciclesonide (n = ...
Association between fungal detection, airways inflammation and diagnosis of moderate to severe asthma in horses. Fungi are ubiquitous in horses' environment. Their contribution to the pathophysiology of severe asthma (SA) is acknowledged, while controversies remain for mild-moderate asthma (MA). Objective: We hypothesised that fungi are a risk factor for asthma. Our objective was to compare different combinations of analytical methods (cytology, culture) and sampling sites (tracheal wash (TW), bronchoalveolar lavage fluid (BALF)) in relation to clinical status (control, MA, SA). Methods: Prospective cross-sectional study. Methods: The study population included asymptomatic racing horses in the field and ...
Chronic Cough and Hyperpnea: Clinical Approach to Equine Asthma. Exercise intolerance, chronic cough, and hyperpnea are the clinical hallmarks of equine asthma. Diagnosis of severe equine asthma in horses is multistep; determination of the phenotype will help guide future recommendations. Management of equine asthma is largely reduction/elimination of triggering agents/conditions. Immunosuppressive therapies and bronchodilators are the mainstay of treatment of equine asthma. Rescue therapy with short-acting bronchodilators is the first goal when managing a horse with hyperpnea. The second goal is to control/reduce inflammation and airway remodeling. Immunos...
Bronchial vessel density is correlated with airway smooth muscle cell proliferation in horses with mild and moderate asthma. In severe equine asthma, structural remodeling of the airways ultimately leads to bronchial wall thickening and airflow obstruction. Increased bronchial vascularization has been described in horses affected by the severe form of the disease, but whether it contributes to bronchial remodeling in milder forms of asthma remains to be determined. In a blinded, retrospective case-control study, we evaluated the presence of bronchial angiogenesis in horses with mild and moderate equine asthma (MEA) and its correlation to airway smooth muscle remodeling. Methods: Endobronchial biopsies from the Equin...
Soft palate angle and basihyoid depth increase with tongue size and with body condition score in horses. Obesity has been associated with human obstructive sleep apnoea and canine brachycephalic obstructive airway syndrome. The effect of body condition score (BCS) on structures of the oropharynx, nasopharynx and upper airway of the horse has not been investigated. Objective: To investigate the effect of BCS on tongue measurements, soft palate angle and basihyoid depth in horses. Methods: Retrospective, analytical, cross-sectional. Methods: Computed tomographic (CT) images of the head of 58 horses were assessed. DICOM viewing software was used to measure head length, basihyoid-skin depth, soft pal...
Clinical efficacy of inhaled corticosteroids in equine asthma: A meta-analysis and number needed to treat. Equine asthma, a prevalent chronic inflammatory condition affecting the equine population, significantly compromises the performance and quality of life in affected horses. Inhaled corticosteroids (ICS) are often the first-line pharmacological intervention due to their potent anti-inflammatory properties. This meta-analysis investigates the clinical efficacy of ICS in treating equine asthma, emphasizing the number needed to treat (NNT) and the likelihood of achieving a clinical response. A comprehensive literature search identified relevant studies comparing ICS with placebo (PCB) controlled t...
Distinct Molecular Profiles Underpin Mild-To-Moderate Equine Asthma Cytological Profiles. A state-of-the-art multi-omics approach was applied to improve our understanding of the aetio-pathogenesis of a highly prevalent, performance-limiting disorder of racehorses: mild-to-moderate equine asthma (MMEA). This is a prerequisite to improving prophylactic, management, and therapeutic options for this condition. Although a number of risk factors have been identified, options for intervention are limited. This study applied a multi-omic approach to reveal key inflammatory pathways involved in inflammatory cell recruitment to the lower airways and highlight distinct MMEA inflammatory profi...