Topic:Bronchoalveolar Lavage
Bronchoalveolar lavage (BAL) is a diagnostic procedure used to collect samples from the lower respiratory tract of horses. The technique involves the introduction of a sterile fluid into the bronchi and alveoli, which is then retrieved for analysis. BAL is utilized to assess the cellular and microbiological composition of the lower airways, aiding in the diagnosis of respiratory conditions such as inflammatory airway disease, recurrent airway obstruction, and infections. The procedure provides valuable insights into the type and extent of inflammation or infection present in the respiratory system. This page compiles peer-reviewed research studies and scholarly articles that explore the methodology, applications, and clinical relevance of bronchoalveolar lavage in equine respiratory health.
Tracheal wash culture is not associated with bronchial infection, remodelling or inflammation in horses with asthma. Antimicrobials are commonly prescribed for the treatment of equine asthma, despite limited evidence supporting their use. Tracheal wash (TW) bacterial culture results are known to influence antimicrobial prescription decisions. Objective: To determine whether a positive TW bacterial culture in horses with asthma is associated with bronchial infection or colonisation, increased bronchial remodelling and airway inflammation by evaluating the presence of bacteria and airway remodelling in endobronchial biopsies, as well as bronchoalveolar lavage fluid (BALF) cytology and tracheal mucus scores. Me...
A randomized, masked, crossover, clinical trial of the efficacy and safety of nebulized albuterol sulfate and dexamethasone sodium phosphate in asthmatic horses. Nebulization of injectable dexamethasone sodium phosphate (DSP; 0.01 mg/kg) to horses with severe equine asthma (SEA) was previously found to be ineffective. Horses with SEA have marked bronchoconstriction that decreases peripheral lung deposition of nebulized drugs. Administration of a bronchodilator immediately before nebulizing dexamethasone may improve efficacy. Objective: Evaluate the therapeutic effects and optimal dose of nebulized DSP after nebulized albuterol in horses with SEA. Methods: Seven horses with SEA from a research herd. Methods: In this masked randomized crossover trial, h...
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...
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, ...
Genomic Epidemiology of Fungi Identified in Bronchoalveolar Lavage Fluid from Asthmatic Horses in the US. Fungal exposure is strongly implicated in the pathogenesis of asthma in horses, but the importance of specific fungi is unknown. Geographic variation in equine asthmatic endotypes is suspected and might be related to different fungal exposures due to different climatological and geographical conditions. This study had two objectives: evaluate the effect of the ecoregion upon BALF inflammatory cells and fungal community composition in horses with asthma and evaluate the effect of BALF fungal community composition upon the likelihood of neutrophilic, mastocytic and eosinophilic inflammation in t...
The trajectories of relative concentrations of antirhodococcal immunoglobulin A differ from those of immunoglobulin G subisotypes in bronchoalveolar lavage fluid but not serum of foals. To characterize age-related trajectories of the relative concentrations of anti-virulence-associated protein A (VapA) immunoglobulin (Ig)-G1, IgG3/5, IgG4/7, and IgA in serum and bronchoalveolar lavage fluid (BALF) as indicators of systemic and intrapulmonary immune responses in foals naturally exposed to Rhodococcus equi. Unassigned: Blood and BALF samples were collected at ages 4, 14, 28, and 56 days from healthy Quarter Horse foals (n = 19) naturally exposed to R equi. Samples were tested via ELISA for relative concentration of IgG1, IgG3/5, IgG4/7, and IgA recognizing the VapA of R equi. D...
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...
Multi-pathogen lower respiratory tract infection including a fungal agent in a yearling mustang filly. This report describes the diagnosis and successful management of a yearling filly with Coombs-positive anemia, thrombocytopenia, and fungal pneumonia. Diagnostic procedures, including thoracic ultrasonography and radiography, respiratory pathogen PCR testing, and evaluation of tracheal wash and bronchoalveolar lavage samples established multi-pathogen lower respiratory tract infection including a fungal agent. Orally administered voriconazole was a key component of treatment in this case to successfully eliminate fungal infection, alongside therapies for managing hematologic disease. This case...
Equine Asthma Is Characterised by Severity-Dependent Correlations Between Blood Neutrophil Cholesterol Content and NET Formation. Equine asthma (EA) is the most prevalent chronic lung disease in horses. Neutrophils are the main effector cells in severe EA. Neutrophil extracellular traps (NETs) have been described as contributors to severity in human asthma and chronic obstructive pulmonary disease. Thus, we aimed to investigate if NET-related factors in equine neutrophils, blood and bronchoalveolar lavage fluid (BALF) allow us to differentiate EA severities and to identify NET-related mechanistic insights in EA. We quantified NETs and NET-related factors in the blood and BALF of eight healthy horses and 18 horses with di...
Intraday and Interday Evaluation of pH and Hydrogen Peroxide in the Exhaled Breath Condensate of Horses Using A Portable Device. The analysis of equine exhaled breath condensate (EBC) lacks standardized methodology, and current collection devices are often adapted for research. This study evaluates a novel horse-specific EBC collector and assesses the variability of EBC pH and hydrogen peroxide (HO) levels, exploring potential correlations with bronchoalveolar lavage (BAL) and tracheal wash (TW) cytology. Eleven healthy mixed-breed mares from a teaching herd, with no evidence of airway abnormalities, were included in this randomized observational study. The collection efficiency of the proposed device was assessed, and ...
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 ...
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...
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...
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 = ...
Pulmonary disposition and pharmacokinetics of a single oral dose of chloramphenicol in healthy fasted adult horses. To describe and compare the pulmonary and plasma pharmacokinetics of different oral formulations of chloramphenicol administered as a single dose to healthy adult horses. Unassigned: A single dose of chloramphenicol was administered to 6 healthy, university-owned fasted adult horses IV (25 mg/kg), orally as commercial tablets (50 mg/kg), or orally or intragastrically as compounded suspension (50 mg/kg), according to a randomized crossover protocol. Plasma was collected 5, 10, 15, 20, and 30 minutes and 1, 1.5, 2, 3, 4, 6, 8, 12, and 24 hours after drug administration. Bronchoalveolar lavage (B...
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 ...
Nebulization of 2% lidocaine has no detectable impact on the healthy equine respiratory microbiota. Glucocorticosteroids remain the most common pharmaceutical approach for the treatment of equine asthma but can be associated with significant side effects, including respiratory microbiome alterations. The goal of the study was to assess the impact of 2% lidocaine nebulization, a projected alternative treatment of equine asthma, on the healthy equine respiratory microbiota. A prospective, randomized, controlled, blinded, 2-way crossover study was performed, to assess the effect of 1 mg/kg 2% lidocaine (7 treatments over 4 days) on the equine respiratory microbiota compared to control horses (s...
Exploring a pico-well based scRNA-seq method (HIVE) for simplified processing of equine bronchoalveolar lavage cells. Single-cell RNA sequencing (scRNA-seq) is a valuable tool for investigating cellular heterogeneity in diseases such as equine asthma (EA). This study evaluates the HIVE™ scRNA-seq method, a pico-well-based technology, for processing bronchoalveolar lavage (BAL) cells from horses with EA. The HIVE method offers practical advantages, including compatibility with both field and clinical settings, as well as a gentle workflow suited for handling sensitive cells. Our results show that the major cell types in equine BAL were successfully identified; however, the proportions of T cells and macropha...
Respiratory extracellular vesicle isolation optimization through proteomic profiling of equine samples and identification of candidates for cell-of-origin studies. Growing evidence supports the importance of extracellular vesicle (EV) as mediators of communication in pathological processes, including those underlying respiratory disease. However, establishing methods for isolating and characterizing EVs remains challenging, particularly for respiratory samples. This study set out to address this challenge by comparing different EV isolation methods and evaluating their impacts on EV yield, markers of purity, and proteomic signatures, utilizing equine/horse bronchoalveolar lavage samples. Horses can serve as effective translational animal models for respi...
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...
Equine Asthma Diagnostics: Review of Influencing Factors and Difficulties in Diagnosing Subclinical Disease. This literature review focuses on diagnostics of equine asthma (EA), possible influencing factors on diagnostic techniques and latest developments in diagnosing horses during EA remission or with subclinical disease. Routine EA diagnostics include a clinical examination of the respiratory system with percussion and auscultation including a rebreathing examination, and clinical pathology including white blood cells and arterial blood gas analysis. Subsequent diagnostics include bronchoscopy to evaluate the amount and viscosity of respiratory secretion, bronchoalveolar lavage, and the cytology o...
The Role of Viral Pathogens in Horse Respiratory Diseases: A Cytological and Molecular Approach Using Next-Generation Sequencing. (1) Background: Respiratory problems may be associated with pathogens among which viruses may play an important role in causing or promoting clinical signs. However, traditional diagnostic methods for equine infectious diseases, such as PCR, are limited to known pathogens and often miss rare or novel viruses. Metagenomic next-generation sequencing is a transformative method that allows the sequencing of all genomes present in a sample. Recent studies have used next-generation sequences to identify viral sequences in horses with unexplained respiratory symptoms, revealing potential links betwee...
The Role of Viral Pathogens in Horse Respiratory Diseases: A Cytological and Molecular Approach Using Next-Generation Sequencing. (1) Background: Respiratory problems may be associated with pathogens among which viruses may play an important role in causing or promoting clinical signs. However, traditional diagnostic methods for equine infectious diseases, such as PCR, are limited to known pathogens and often miss rare or novel viruses. Metagenomic next-generation sequencing is a transformative method that allows the sequencing of all genomes present in a sample. Recent studies have used next-generation sequences to identify viral sequences in horses with unexplained respiratory symptoms, revealing potential links betwee...