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.
Validation of a Rapid Bronchoalveolar Lavage Fluid Colorimetric Evaluation for Assessing the Severity of Exercise-Induced Pulmonary Hemorrhage in Horses in Field Conditions. Diagnosis and assessment of severity of exercise-induced pulmonary hemorrhage (EIPH) relies on postexercise visualization of fresh blood in the airways via tracheobronchoscopic examination (TBE) and/or counting erythrocytes in bronchoalveolar lavage fluid (BALFRBC). Determining the BALFRBC is more sensitive than TBE but its usefulness is hampered by the need to have BALFRBC counted at a laboratory. We explored the feasibility of evaluating the severity of EIPH by using a color chart comprised of five shades of red and matching those colors with the color of BALF immediately following collectio...
Metabolomics analysis of bronchoalveolar lavage fluid samples in horses with naturally-occurring asthma and experimentally-induced airway inflammation. The present work characterized the metabolomic profile of bronchoalveolar lavage fluid (BALF) in healthy horses, experimentally-induced airway inflammation by lipopolysaccharide (LPS) nebulization, and naturally-occurring asthma (n = 3 in each group). All animals underwent clinical and upper airway endoscopic examinations, and bronchoalveolar lavage. BALF supernatant samples were subjected to metabolic analysis based on gas chromatography-mass spectrometry (GC-MS). Overall, 67 peaks were obtained from BALF GC-MS analysis, corresponding to 53 metabolites which were categorized according to ch...
Clinical Feasibility and Airway Deposition of Nebulized Voriconazole in Healthy Horses. Voriconazole (VRC) is a potential treatment for pneumomycosis in horses. The objectives of this study were to determine if the delivery of Vfend using a Flexineb nebulizer produced clinically significant [VRC] in lower airways. The hypothesis was that [VRC] after delivery by nebulization would be greater in the pulmonary epithelial lining fluid than plasma. A secondary objective was to determine [VRC] in upper airways through the collection of nasopharyngeal wash (NPW) samples. Voriconazole solution [Vfend-6.25 mg/mL, 100 (n = 2), 200 (n = 3), 500 (n = 1) mg] was nebulized once in 6 health...
Deep Learning-Based Quantification of Pulmonary Hemosiderophages in Cytology Slides. Exercise-induced pulmonary hemorrhage (EIPH) is a common condition in sport horses with negative impact on performance. Cytology of bronchoalveolar lavage fluid by use of a scoring system is considered the most sensitive diagnostic method. Macrophages are classified depending on the degree of cytoplasmic hemosiderin content. The current gold standard is manual grading, which is however monotonous and time-consuming. We evaluated state-of-the-art deep learning-based methods for single cell macrophage classification and compared them against the performance of nine cytology experts and evaluated...
The Relationship between Lung Inflammation and Aerobic Threshold in Standardbred Racehorses with Mild-Moderate Equine Asthma. Mild-moderate equine asthma (MEA) is a common disease of young racehorses characterized by inflammation of the lower airways diagnosed by cytological examination of bronchoalveolar lavage fluid (BALF), and it is considered an important cause of poor performance. The most common parameter of athletic capacity associated with horse performance is the speed at 4 mmol/L of lactate (VLA4). The aim of the present work was to evaluate the relation between the different BALF inflammatory cells and VLA4 in racehorses affected by MEA. A population of Standardbred racehorses that underwent an accurate pr...
A retrospective study of bronchoalveolar lavage fluid analysis in barrel racing horses with exercise-induced pulmonary hemorrhage and asthma in Texas from 2016 to 2018. Exercise-induced pulmonary hemorrhage (EIPH) and asthma in barrel racing horses is a common disease across the United States. Limited information is available on non-infectious respiratory diseases in this population, the interaction between these two diseases, and the occurrence of both EIPH and asthma in the horse. The purpose of this study was to evaluate the bronchoalveolar lavage (BAL) fluid cytological results of barrel racing horses with EIPH, asthma, or both. A retrospective study was conducted using the medical records of horses that presented with cough and decreased athletic perform...
Respiratory metabolites in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) can differentiate horses affected by severe equine asthma from healthy horses. The use of an untargeted metabolomic approach to investigate biofluids of respiratory origin is of increasing interest in human and veterinary lung research. Considering the high incidence of equine asthma (> 14%) within horse population and the importance of this animal model for human disease, we aimed to investigate the metabolomic profile of bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) in healthy and asthmatic horses. Results: On the basis of clinical, endoscopic and BALF cytology findings, 6 horses with severe asthma (Group A) and 6 healthy horses (Group C) we...
Physiologic effects of furosemide in combination with water restriction when administered at 4 and 24 hours prior to high-intensity treadmill training. Although controversial, due to its reported effectiveness in attenuating bleeding associated with exercise-induced pulmonary hemorrhage (EIPH), furosemide is currently a permitted race day medication in most North American racing jurisdictions. The objective of this study was to assess the efficacy of furosemide in reducing the presence and severity of EIPH when administered 24 hr prior to strenuous treadmill exercise. Eight exercised Thoroughbred horses received saline or 250 mg of furosemide either 4 or 24 hr prior to high-speed treadmill exercise in a balanced 3-way cross-over design. Bl...
Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards. Inflammatory airway disease (IAD) is a commonly diagnosed but variably defined syndrome of equine lower airway inflammation. The most recent American College of Veterinary Internal Medicine (ACVIM) consensus statement, informed by research evidence, recommends a case definition based on clinical signs (poor performance or occasional coughing of at least 3 weeks duration), increased endoscopically-visible tracheal mucus, and bronchoalveolar lavage cytology, and proposes that the condition should be termed 'mild-moderate equine asthma' (mEA). In British Thoroughbred racehorses, research to date ...
Increased Weekly Mean PM2.5, and NO2 Are Associated With Increased Proportions of Lower Airway Granulocytes in Ontario Horses. Ambient pollution is associated with the development and exacerbation of human asthma, but whether air pollution exposure is associated with lower airway inflammation in horses has not been fully evaluated. The Air Quality Health Index (AQHI) is an online tool used by asthmatic Ontarians to modify their outdoor activity when ambient pollution is high. A single AQHI value, falling on a scale from 1 to 10, is calculated from measurements of fine particulate matter (PM), nitrogen dioxide (NO), and ozone (O). Increased AQHI values predict an increased risk for presenting to a health care provider ...
Asymmetrical Pulmonary Cytokine Profiles Are Linked to Bronchoalveolar Lavage Fluid Cytology of Horses With Mild Airway Neutrophilia. Few data on cytokine profiles in bronchoalveolar lavage fluid (BALF) are available for racehorses with mild/moderate equine asthma (EA); cytological diagnosis being most frequently made from only one lung. The purpose of the study was to compare cytokine mRNA expressions and protein concentrations in BALF from both lungs. As part of a larger study, 250 ml saline was randomly instilled in one lung and 500 ml in the contralateral lung of 30 clinically healthy Standardbred racehorses. This procedure was repeated 72 h later, inversing the volume per lung. Cytological cut-off values for diagnosis o...
Airway Diagnostics: Bronchoalveolar Lavage, Tracheal Wash, and Pleural Fluid. Indications for bronchoalveolar lavage, tracheal wash, and thoracocentesis for the diagnosis of respiratory diseases are discussed. Each technique is described in detail and illustrated by videos. Sample handling, preparation and evaluation are reviewed. The advantages and limitations of bronchoalveolar lavage and tracheal wash procedures as well as a critical comparison between the 2 techniques for equine asthma diagnosis are presented. Finally, validated cut-off values for equine asthma diagnosis are reviewed.
Effects of a propriety oiled mixed hay feeding system on lung function, neutrophilic airway inflammation and oxidative stress in severe asthmatic horses. Hay feeding is considered the main triggering factor for airway obstruction and inflammation in severe equine asthma (SEA). Finding alternate strategies allowing hay feeding while controlling clinical signs of SEA is of importance. The Nutri-Foin Système is believed to decrease inhaled dust by incorporating soybean oil to mechanically processed hay. Objective: We compared airflow obstruction and airway inflammation in horses with SEA fed oiled hay or alfalfa pellet regimen. Methods: Controlled trial in asthmatic research horses. Methods: Twelve horses in exacerbation of SEA from a research he...
Tracheal microbial populations in horses with moderate asthma. There are limited data on potential dysbiosis of the airway microbiota in horses with asthma. Objective: We hypothesized that the respiratory microbiota of horses with moderate asthma is altered. Our objectives were (a) to quantify tracheal bacterial populations using culture and qPCR, (2) to compare aerobic culture and qPCR, and (c) to correlate bacterial populations with bronchoalveolar lavage fluid (BALF) cytology. Methods: Eighteen horses with moderate asthma from a hospital population and 10 controls. Methods: Prospective case-control study. Aerobic culture was performed on tracheal aspir...
Efficacy of dexamethasone, salbutamol, and reduced respirable particulate concentration on aerobic capacity in horses with smoke-induced mild asthma. Mild asthma in horses decreases racing performance and impairs gas exchange. The efficacy of treatment on performance is unknown. Objective: Treatment targeting lung inflammation improves V ˙ O2 peak in horses with mild asthma. Methods: Thoroughbred polo horses (n = 12) with smoke-induced mild asthma. Horses were exposed to increased ambient particulate matter (35.51 μg/m3 [PM2.5 ]; day mean, centrally measured) from day -33 to 0, from bushfire smoke (natural model). Methods: Prospective, randomized, placebo-controlled, double-blinded clinical trial. All horses completed 3 V ˙ O2 peak t...
Relationship between tracheobronchoscopic score and bronchoalveolar lavage red blood cell numbers in the diagnosis of exercise-induced pulmonary hemorrhage in horses. Exercise-induced pulmonary hemorrhage (EIPH) is diagnosed and its severity assessed by post-exercise tracheobronchoscopy, and enumeration of bronchoalveolar lavage fluid red blood cells (BALFRBC). Minimal information is available regarding the relationship of tracheobronchoscopy score to BALFRBC number. Objective: Evaluate the relationship between BALFRBC number and tracheobronchoscopy scores and determine their diagnostic sensitivities. Methods: Nine sedentary horses, 21 fit Thoroughbreds, 129 Barrel Racers. Methods: Normal BALFRBC number and the effect of bronchoalveolar lavage (BAL) on it w...
Prevalence and severity of ultrasonographic pulmonary findings in horses with asthma – a preliminary study. Asthma is one of the most common non-infectious respiratory diseases in horses. Ultrasound examination is a widely available non-invasive additional diagnostic tool. To date, there are no studies focusing on ultrasonographic findings in horses with asthma. The aim of this study was to analyse the prevalence and severity of ultrasound lesions in lung tissue in horses with asthma. Lung ultrasonography was carried out on six healthy horses (controls) and 12 horses with asthma (six with mild and six with severe asthma). The sonographic changes in three lung sections were assessed using a scoring s...
Bronchoalveolar lavage fluid cytokine, cytology and IgE allergen in horses with equine asthma. The pathophysiology of equine asthma (EA) is still not fully described, but the involvement of an allergic reaction is strongly suspected. This theory has led to the use of allergen-specific immunoglobulin (Ig)E tests to support a diagnosis of asthma. The objective of this descriptive study was to evaluate the correlation between four subgroups of EA (mastocytic mild equine asthma [MEA], neutrophilic MEA, mixed MEA, and severe equine asthma [SEA]), allergen specific IgE (measured in both serum and BALF) and mRNA expression of selected genes in bronchoalveolar lavage fluid (BALF). Serum and BAL...
Effect of inclusion or exclusion of epithelial cells in equine respiratory cytology analysis. Published studies vary as to whether epithelial cells are included in differential counts for tracheal wash (TW) and bronchoalveolar lavage (BAL) cytology in horses. The aim of this study was to determine whether inclusion or exclusion of epithelial cells affects interpretation of airway cytology. Using criteria of >20% TW neutrophils, >10% BAL neutrophils and/or >5% BAL mast cells to indicate airway inflammation, there was a change in categorisation from 'normal' to 'abnormal' in 21%, 4% and 8% horses, respectively, when epithelial cells were excluded from differential counts. It is recommend...
Effect of injected dexamethasone on relative cytokine mRNA expression in bronchoalveolar lavage fluid in horses with mild asthma. Mild equine asthma is a common inflammatory airway disease of the horse. The primary treatment of mild equine asthma is corticosteroids. The purpose of this study was to investigate the effects of injected dexamethasone on relative IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p35, IL-17, IL-23, IFN-γ, Eotaxin-2 and TNF-α mRNA expression in bronchoalveolar lavage (BAL) fluid in healthy Thoroughbred horses (n = 6), and those with mild equine asthma (n = 7). Results: Horses with mild equine asthma had a significantly greater bronchoalveolar lavage mast cell percentage than healthy horses...
Prevalence of exercise-induced pulmonary hemorrhage in competing endurance horses. To assess the prevalence of exercise-induced pulmonary hemorrhage (EIPH) among elite endurance horses after competition in a long-distance race. 20 endurance horses and 12 nonexercised or minimally exercised age-, breed-, and trainer-matched horses from the same environment (control horses). Bronchoalveolar lavage fluid samples collected from endurance horses at 3 to 8 days (sample A) and 36 to 38 days (sample B) after the race (100 km in 1 day [n = 3], 70 km/d for 2 days [12], or 100 km/d for 2 days [5]) were cytologically examined for the presence of hemosiderophages. Samples from control ho...
Effect of different protocols on the mitigation of exercise-induced pulmonary hemorrhage in horses when administered 24 hours before strenuous exercise. Public pressure exists in the United States to eliminate race-day furosemide administration despite its efficacy in decreasing the severity of equine exercise pulmonary hemorrhage (EIPH). No effective alternative prophylaxis strategies have been identified. Objective: To investigate alternative protocols to race-day furosemide that might mitigate EIPH. Methods: Seven fit Thoroughbreds with recent EIPH. Methods: Double-blinded placebo-controlled Latin square crossover using a treadmill followed by a blinded placebo-controlled crossover study at a racetrack. First, horses exercised supramaximall...
Effects of general anaesthesia in dorsal recumbency with and without vatinoxan on bronchoalveolar lavage cytology of healthy horses. Pneumonia is one of the potential complications of general anaesthesia in horses. Anaesthesia is known to increase neutrophils in bronchoalveolar lavage fluid (BALF) of horses after lateral recumbency, but studies after dorsal recumbency are lacking. Our primary aim was to determine when lung inflammation reaches its maximum and how rapidly BALF cytology returns to baseline after anaesthesia in dorsal recumbency. A secondary aim was to investigate the possible effect of vatinoxan, a novel drug, on the BALF cytology results. Six healthy experimental horses were enrolled in this observational cr...
Randomised study of the immunomodulatory effects of azithromycin in severely asthmatic horses. Neutrophilic inflammation is believed to contribute to the airway obstruction and remodelling in equine asthma. Azithromycin, an antibiotic with immunomodulatory properties, reduces pulmonary neutrophilia and hyper-responsiveness in human asthmatics and decreases airway remodelling in rodent models of asthma. It was therefore hypothesised that azithromycin would improve lung function, mucus accumulation and central airway remodelling by decreasing luminal neutrophilia in severe equine asthma. The effects of a 10-day treatment with either azithromycin or ceftiofur, an antimicrobial without immu...
The relationship between bronchoalveolar lavage fluid cytology and airway hyper-reactivity in a population of Australian horses presented for poor performance. To investigate the relationship between bronchoalveolar lavage fluid cytology, particularly mast cells, and airway hyper-reactivity in athletic horses presented for poor performance that included a respiratory tract evaluation in two disparate locations in Australia. Methods: Multi-centre, retrospective and prospective cross-sectional study METHODS: Eighty four adult horses underwent both pulmonary function testing and histamine bronchoprovocation with a commercial flowmetric plethysmography system. A bronchoalveolar lavage was performed four to twelve hours later. Bronchoalveolar lavage fluid...
Age-related dynamics of pro-inflammatory cytokines in equine bronchoalveolar lavage (BAL) fluid and peripheral blood from horses managed on pasture. The objectives of this study were to evaluate the natural age-related variation and compare the level of pro-inflammatory cytokines in the peripheral blood and lower airways of horses. The mRNA expression of IL-1β, IL-6, IL-8 TNF-α TLR-4 in bronchoalveolar lavage (BAL) fluid and peripheral blood mononuclear cells (PBMC) were studied by quantitative real time polymerase chain reaction (PCR) and differential cell count cytology from 44 horses of different ages. A significant age-related increase was found for the mRNA expression of IL-6, IL-8, TLR-4 and TNF-α in stimulated BAL cells and for T...
Immunomodulatory asthma therapy in the equine animal model: A dose-response study and evaluation of a long-term effect. Equine asthma represents a naturally occurring animal model for human allergic neutrophilic asthma. Inhalative nanoparticle-bound cytosine-phosphate-guanosine (CpG-GNP) immunotherapy, independent of specific allergens, has already shown promising clinical and immunological results in previous studies and offers the possibility to treat the underlying cause of the disease. This study analyses the relationship between dose and response, and evaluates a possible long-term effect. In the prospective, randomised, double-blind clinical field study, 29 horses suffering from equine asthma received 10 ...
Fatal pulmonary hemorrhage in a horse during bronchoalveolar lavage – single case report. Pulmonary hemorrhage is a rare cause of death in horses. Hemorrhage within the respiratory tract has many causes, including mycosis of the guttural pouch, invasive procedures causing serious trauma to nasal conchae, or lung biopsy. We report on a rare case of a fatal pulmonary hemorrhage in a horse after a severe cough during bronchoalveolar lavage. To the best of our knowledge, this is the first report of spontaneous hemorrhage in a horse during bronchoalveolar lavage. Methods: A 21-year-old mare which belonged to the didactic herd of The Faculty of Veterinary Medicine underwent BAL procedure...
Cytological Findings in Bronchoalveolar Lavage Fluid of Foals With Pneumonia Caused by Rhodococcus equi and Other Bacteria. The distinction between lower respiratory tract infections caused by Rhodococcus equi and those caused by other pathogens is difficult. The aim of this retrospective study was to describe cytological findings in bronchoalveolar lavage fluid (BALF) of foals with pneumonia caused by R. equi or other bacteria. Nineteen foals aged from 3 weeks to 6 months with evidence of respiratory disease between 2015 and 2016 were selected from the database of the Veterinary Teaching Hospital "Mario Modenato" of the University of Pisa. Eight foals of 19 (42.1%) had R. equi pneumonia, whereas 11 of 19 (57.9...
Investigation of blood biomarkers for the diagnosis of mild to moderate asthma in horses. Asthma in horses is associated with nonspecific respiratory clinical signs and may be manifested only as exercise intolerance. Its diagnosis relies on bronchoalveolar lavage fluid (BALF) cytology in the presence of compatible clinical signs. The identification of blood biomarkers for this condition would facilitate diagnosis in the field, because there are regional areas where BAL is not routinely performed in clinical practice. Objective: Identification of blood biomarkers for the diagnosis of asthma in horses. Methods: Fourteen horses with asthma with increased neutrophil numbers in BALF (ne...