Exercise-Induced Pulmonary Hemorrhage (EIPH) is a condition observed in horses, characterized by bleeding from the blood vessels within the lungs during or shortly after intense physical activity. This phenomenon is commonly identified in racing and performance horses. The condition is associated with the rupture of pulmonary capillaries, leading to the presence of blood in the airways. EIPH can affect a horse's respiratory efficiency and overall performance. Diagnosis is typically confirmed through endoscopic examination or detection of blood in the trachea post-exercise. This page compiles peer-reviewed research studies and scholarly articles that explore the pathophysiology, diagnosis, management, and implications of EIPH in equine athletes.
Massie S, Bayly W, Ohmura H, Takahashi Y, Mukai K, Léguillette R.Comparatively little is known regarding the initial cardiorespiratory response of young racehorses to training. The objectives were to compare physiological parameters before and after introductory training and determine whether young Thoroughbreds show endoscopic signs of exercise-induced pulmonary hemorrhage (EIPH). Ten Thoroughbreds (20-23 months) underwent 12-weeks of introductory training, including weekly speed sessions. Two 600 m high-speed exercise tests (HSET) were performed following weeks 4 and 12 while wearing a validated ergospirometry facemask. Peak oxygen consumption (V̇Opk...
Shoemaker S, Wang Y, Sellon D, Gold J, Fisher A, Bagshaw J, Leguillette R, Sanz M, Bayly W.Little has been reported regarding the prevalence and severity of exercise-induced pulmonary hemorrhage (EIPH) in 2-year-old Thoroughbred racehorses. Objective: Evaluate EIPH prevalence and severity and its association with performance, speed index, furosemide administration, race distance, and track surface. Methods: A total of 830 2-year-old Thoroughbreds. Methods: Prospective blinded observational study. Videoendoscopy was performed 30 to 60 minutes postrace at 15 American racetracks. Three blinded observers independently assigned an EIPH grade (0-4) to each video, and prevalence and seve...
Nath LC, Elliott A, La Gerche A, Weir J, Forbes G, Thomas G, Franklin S.Atrial fibrillation (AF) is the most common performance limiting arrhythmia in racehorses. High dose exercise and airway disease promote AF in humans. Few studies have investigated epidemiological factors associated with AF in horses. Objective: Explore variables relating to performance, exercise volume and postrace endoscopic findings in horses with AF. Methods: A total of 164 horses with poor race performance and postrace AF were compared to 321 horses with poor performance without AF (PP) and 314 horses performing to expectation (TE). Methods: Horse-level and race-level variables for horses...
Hansen S, Otten ND, Nissen SD, Carstensen H, Hopster-Iversen C, Fjeldborg J, Staun SH, Fenner M, Hesselkilde EM, Buhl R.Atrial fibrillation (AF) has been proposed as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) due to increased pressure in the left atrium. Objective: To evaluate if AF was associated with EIPH following a standardised exercise test (SET) to fatigue. Methods: Two-arm controlled experiment. Methods: Ten untrained Standardbred mares mean (standard deviation [SD]) age 6 (2) years performed a SET on the treadmill in sinus rhythm (SR) (SET1) and 25-44 days after induction of self-sustained AF (SET2). AF was induced by tachypacing using a pacing device. Endoscopy, including trachea...
Burns JJ, MacMillan KM, John E.Respiratory disease is common in the horse population and is often associated with poor performance in equine athletes. Despite their outstanding strength and aerobic capacity, little regard is given to draft horses and the respiratory disorders they may encounter when performing athletic activity. For this reason, the objectives of this study were: (1) to determine the prevalence of exercise-induced pulmonary hemorrhage (EIPH), tracheal mucus (TM) and recurrent laryngeal hemiplegia (RLH) in a population of competitive draft pulling horses, and (2) to determine if there was an association betw...
Lo Feudo CM, Stucchi L, Conturba B, Stancari G, Zucca E, Ferrucci F.Poor performance is a multifactorial syndrome of racehorses, commonly associated with subclinical disorders, which can be diagnosed by exercise testing. Objective: Describe the prevalence of medical causes of poor performance in Standardbreds unassociated with lameness, and evaluate their relationships with fitness variables measured by exercise treadmill test. Methods: Hospital population of 259 nonlame Standardbred trotters referred for poor performance. Methods: The horses' medical records were retrospectively reviewed. Horses underwent a diagnostic protocol including resting examination, p...
Maxwell L, McCarrel TM, Hay S, Cole C.The antifibrinolytic agent aminocaproic acid (ACA) is occasionally used prior to episodes of intense training in racehorses suffering from exercise-induced pulmonary hemorrhage. Although a previous study indicated that the drug is cleared rapidly in horses, some racetrack practitioners claim that recent adverse analytical findings for ACA in postrace samples were from ACA administrations 5-7 days before the race. The purpose of this study was to re-examine the pharmacokinetics of ACA in horses to address this apparent conundrum. Eight exercise-conditioned thoroughbred horses were administere...
Mahalingam-Dhingra A, Bedenice D, Mazan MR.Hemosiderophages in bronchoalveolar lavage fluid (BALF) are commonly ascribed to exercise-induced pulmonary hemorrhage (EIPH). Little information exists regarding the presence of these cells in horses that perform light or no work and that are referred for respiratory problems. Objective: Evaluate the presence of hemosiderophages in BALF of horses suspected of respiratory disease without history of or risk factors for EIPH and determine predictors of hemosiderophages in BALF in this population. Methods: Observational retrospective cross-sectional study using STROBE (Strengthening the Reporting...
Vinardell T, David F, Galezowski AM, Ali M, Qasim M, Massie SL, McCrae P, Filho S, Leguillette R.Swimming is used for rehabilitation of musculoskeletal injuries and for conditioning to improve equine fitness. However, there are anecdotal reports that suggest that tethered swimming can induce epistaxis, likely secondary to exercise-induced pulmonary hemorrhage (EIPH). The objective of this observational, prospective study was to investigate if EIPH occurs during intensive free-swimming training sessions (5 × 70m) using 15 endurance horses. On tracheo-bronchoscopic evaluations following swimming, low grade mucus scores were observed, but no tracheal blood was observed. Bronchoalveolar la...
Bertram CA, Marzahl C, Bartel A, Stayt J, Bonsembiante F, Beeler-Marfisi J, Barton AK, Brocca G, Gelain ME, Gläsel A, Preez KD, Weiler K....Exercise-induced pulmonary hemorrhage (EIPH) is a relevant respiratory disease in sport horses, which can be diagnosed by examination of bronchoalveolar lavage fluid (BALF) cells using the total hemosiderin score (THS). The aim of this study was to evaluate the diagnostic accuracy and reproducibility of annotators and to validate a deep learning-based algorithm for the THS. Digitized cytological specimens stained for iron were prepared from 52 equine BALF samples. Ten annotators produced a THS for each slide according to published methods. The reference methods for comparing annotator's and al...
Cascardo B, Bernardes C, de Souza GN, Silva KM, Pires NR, de Alencar NX, Lessa DAB.Lower airway cytology has been proposed as a complementary diagnostic method to confirm the presence and quantifying the severity of exercise-induced pulmonary hemorrhage (EIPH). Bronchoalveolar lavage is usually preferred over tracheal wash (TW), yet the need for sedation imposes as a limitation for active sport horses in addition to be a highly invasive technique. This study aims to evaluate the diagnostic value of TW with Total Hemosiderin Score (THS) for monitoring EIPH in active Thoroughbred racehorses. A sampling of 47 randomly selected Thoroughbreds were endoscopically examined for EIPH...
Rocchigiani G, Verin R, Uzal FA, Singer ER, Pregel P, Ressel L, Ricci E.Exercise-induced pulmonary hemorrhage (EIPH) is a common condition of Thoroughbred racehorses that is usually responsible for reduced performance, while exercise-associated fatal pulmonary hemorrhage (EAFPH) is characterized by severe pulmonary bleeding of unknown pathogenesis resulting in sudden death during strenuous exercise. The aim of the study was to characterize and compare anamnestic data together with pulmonary gross, histologic, and ultrastructural findings in racehorses with EIPH (n = 10), EAFPH (n = 10), and control horses (n = 5). No differences in anamnesis were identified betwee...
Lo Feudo CM, Stancari G, Collavo F, Stucchi L, Conturba B, Zucca E, Ferrucci F.Dynamic upper airway obstructions (DUAO) are common in racehorses, but their pathogenetic mechanisms have not been completely clarified yet. Multiple studies suggest that alterations of the pharyngo-laryngeal region visible at resting endoscopy may be predictive of the onset of DUAO, and the development of DUAO may be associated with pharyngeal lymphoid hyperplasia (PLH), lower airway inflammation (LAI) and exercise-induced pulmonary hemorrhage (EIPH). The present study aims to investigate the possible relationship between the findings of a complete resting evaluation of the upper and lower ai...
Lo Feudo CM, Stucchi L, Stancari G, Alberti E, Conturba B, Zucca E, Ferrucci F.Exercise-induced pulmonary hemorrhage (EIPH) is a condition affecting up to 95% of racehorses, diagnosed by detecting blood in the trachea after exercise and/or the presence of hemosiderophages in the bronchoalveolar lavage fluid (BALf). Although EIPH is commonly associated with poor performance, scientific evidence is scarce. The athletic capacity of racehorses can be quantified through some parameters obtained during an incremental treadmill test; in particular, the speed at a heart rate of 200 bpm (V200), and the speed (VLa4) and the heart rate (HRLa4) at which the blood lactate concentrati...
Mild-moderate (MEA), severe (SEA) equine asthma and exercise-induced pulmonary hemorrhage (EIPH) are common respiratory disorders in horses. The present retrospective study aims to evaluate the role of ultrasonography and endoscopy in the diagnosis of these conditions. Three hundred and three horses were included and divided into SEA, MEA and MEA + EIPH groups, on the basis of history, clinical examination and bronchoalveolar lavage fluid (BALf) cytology; scores were assigned to lung ultrasonography, pharyngeal lymphoid hyperplasia (PLH), tracheal mucus (TM) and tracheal bifurcation edema (TB)...
McGilvray TA, Cardwell JM.Exercise induced pulmonary haemorrhage (EIPH) is an important condition of horses performing high intensity exercise, with reported prevalence among racehorses of up to 95%, based on the detection of blood on tracheobronchoscopy. Previously identified risk factors include age, sex, season, race type, years spent in racing and lower airway inflammation. Objective: To estimate the prevalence of EIPH in British National Hunt racehorses as indicated by two outcome measures: presence of tracheal blood on tracheobronchoscopy, and presence of moderate-large (significant) proportions of haemosideropha...
McCrae P, Guigand C, Jones KB, Thueson ES, Troudt TA, Warlick LM, Sides RH, Jones JH, Bayly WM, Léguillette R.High pulmonary blood pressure contributes to exercise-induced pulmonary hemorrhage. The objective of this study was to use bioimpedance spectroscopy to assess body fluid compartment volumes under 3 conditions in 6 racehorses: i) Pre- and post-supramaximal treadmill exercise (control); ii) Exercise 4 hours after furosemide (0.5 mg/kg body weight, IV); iii) Exercise, removal of ~14 L of blood and subsequent reinfusion of the blood. Statistical analysis used linear mixed effects models. Body compartment volumes did not change during the control runs. Total body water (TBW) ( = 0.007, = 0.007), e...
Warlick LM, Léguillette R, Kogan C, Gold JR, Bayly WM.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...
Marzahl C, Aubreville M, Bertram CA, Stayt J, Jasensky AK, Bartenschlager F, Fragoso-Garcia M, Barton AK, Elsemann S, Jabari S, Krauth J, Madhu P....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...
Decloedt A, Van Steenkiste G, Vera L, Buhl R, van Loon G.Atrial fibrillation (AF) is the most common clinically relevant arrhythmia in horses, with a reported prevalence up to 2.5%. The pathophysiology has mainly been investigated in experimental animal models and human medicine, with limited studies in horses. Atrial fibrillation results from the interplay between electrical triggers and a susceptible substrate. Triggers consist of atrial premature depolarizations due to altered automaticity or triggered activity, or local (micro)reentry. The arrhythmia is promoted by atrial myocardial ion channel alterations, Ca2+ handling alterations, structural ...
Sundman EA, Chigerwe M, Hunyadi LM.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...
Dahlgren AR, Tablin F, Finno CJ.Genetic bleeding disorders can have a profound impact on a horse's health and athletic career. As such, it is important to understand the mechanisms of these diseases and how they are diagnosed. These diseases include haemophilia A, von Willebrand disease, prekallikrein deficiency, Glanzmann's Thrombasthenia and Atypical Equine Thrombasthenia. Exercise-induced pulmonary haemorrhage also has a proposed genetic component. Genetic mutations have been identified for haemophilia A and Glanzmann's Thrombasthenia in the horse. Mutations are known for von Willebrand disease and prekallikrein deficienc...
Knych HK, Wilson WD, Vale A, Kass PH, Steffey EP, Jones JH, Arthur RM.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...
Lopez Sanchez CM, Kogan C, Gold JR, Sellon DC, Bayly WM.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...
Blott S, Cunningham H, Malkowski L, Brown A, Rauch C.Exercise-induced pulmonary haemorrhage (EIPH) occurs in horses performing high-intensity athletic activity. The application of physics principles to derive a 'physical model', which is coherent with existing physiology and cell biology data, shows that critical parameters for capillary rupture are cell-cell adhesion and cell stiffness (cytoskeleton organisation). Specifically, length of fracture in the capillary is a ratio between the energy involved in cell-cell adhesion and the stiffness of cells suggesting that if the adhesion diminishes and/or that the stiffness of cells increases EIPH is ...
Jones S, Franklin S, Martin C, Steel C.There is limited knowledge of the breathing strategy and impact on the patency of the upper respiratory tract (URT) in swimming horses. Objective: To describe the respiratory responses and endoscopic appearance of the URT during tethered swimming in horses. Methods: Prospective descriptive study. Methods: Ten race-fit horses, with no history of URT obstruction, were examined during tethered swimming. Endoscopic examination, heart rate, sound recordings and above and below water video recordings were obtained. Plasma lactate concentration was measured before and 5 min after swimming and trache...
Pritchard A, Spooner H, Hoffman R.Furosemide is used to reduce the incidence of exercise-induced pulmonary hemorrhage in racehorses. Previous research suggests furosemide negatively impacts calcium balance, which may have long-term implications for bone health. Eleven healthy horses, either control (CON, n = 5) or treatment (FUR, n = 6), were used to test furosemide's effects on bone mineral content (BMC), bone metabolism biomarkers, and weight loss after administration. Treatment horses received IV furosemide at 1 mg⋅kg BW once weekly for seven weeks, and blood was collected before and at 24 hours after administration f...
Tarancón I, Armengou L, Melendez-Lazo A, Pastor J, Ríos J, Jose-Cunilleras E.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...
Bayly W, Lopez C, Sides R, Bergsma G, Bergsma J, Gold J, Sellon D.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...
Crispe EJ, Lester GD.Exercise-induced pulmonary hemorrhage (EIPH) occurs commonly in horses undergoing strenuous exercise. Reported risk factors include racing in cold temperatures and wearing of bar shoes. In horses with documented moderate to severe EIPH, increasing the interval between races and adopting a negative race pace strategy may reduce the severity of EIPH in subsequent races. EIPH seems to have an impact on performance only when moderate to severe. This occurs in a small number of starters, approximately 6%. EIPH often is erratic in severity from race to race, although across a population it is weakly...
West JB, Mathieu-Costello O, Jones JH, Birks EK, Logemann RB, Pascoe JR, Tyler WS.Bleeding into the lungs in thoroughbreds is extremely common; there is evidence that it occurs in essentially all horses in training. However, the mechanism is unknown. We tested the hypothesis that exercise-induced pulmonary hemorrhage (EIPH) is caused by stress failure of pulmonary capillaries. Three thoroughbreds with known EIPH were galloped on a treadmill, and after the horses were killed with intravenous barbiturate the lungs were removed, inflated, and fixed for electron microscopy. Ultrastructural studies showed evidence of stress failure of pulmonary capillaries, including disruptions...
Hinchcliff KW, Couetil LL, Knight PK, Morley PS, Robinson NE, Sweeney CR, van Erck E.Published studies of exercise-induced pulmonary hemorrhage (EIPH), when assessed individually, often provide equivocal or conflicting results. Systematic reviews aggregate evidence from individual studies to provide a global assessment of the quality of evidence and to inform recommendations. Objective: Evaluate evidence to determine: if EIPH adversely affects the health, welfare or both of horses; if EIPH affects the athletic capacity of horses; the efficacy of prophylactic interventions for EIPH; and if furosemide affects the athletic capacity of horses. Methods: None. Methods: Systematic re...
Pascoe JR, Ferraro GL, Cannon JH, Arthur RM, Wheat JD.Of 235 Thoroughbred racehorses examined with a flexible fiberoptic endoscope within 2 hours of racing to determine the frequency of exercise-induced pulmonary hemorrhage (EIPH), 103 (43.8%) had various degrees of hemorrhage in the tracheal lumen. Two of these horses (0.8%) subsequently had blood flow from the nostrils. Blood seemed to originate from the lung. Statistical analysis of frequency data for 191 horses which finished in 1st, 2nd, and 3rd places did not show any relationship between EIPH and horse's age, sex, or finishing position. However, a trend toward an increased frequency of EIP...
Couëtil LL, Denicola DB.The purpose of this study was to evaluate the relationship between bronchoalveolar lavage (BAL) cytology, arterial blood gases and plasma lactate concentration during a standardised treadmill test (STT) in racehorses with small-airway inflammation (SAI), or exercise-induced pulmonary haemorrhage (EIPH). Sixteen Thoroughbred and 20 Standardbred actively racing racehorses, were divided into a control group (n = 10), EIPH group (n = 13) and SAI group (n = 13). Each STT consisted of a 2 min trot at 4 m/s followed by 5 x 1 min, incremental speed steps (6, 8, 10, 11 and 12 m/s) at 10% incline for Th...
Sánchez A, Couëtil LL, Ward MP, Clark SP.Inflammatory Airway Disease (IAD), exercise-induced pulmonary hemorrhage (EIPH), and upper airway obstruction (UAO) are common respiratory tract diseases that can decrease performance. The purpose of this retrospective study was to compare bronchoalveolar lavage fluid cytology and arterial blood gas analysis during a treadmill test by poorly performing racehorses presented to Purdue University. One hundred thirty-two horses with a history of poor performance were included in this study. Ten horses with no history or diagnosis of EIPH, IAD, or UAO served as controls. Horses were evaluated by rh...
MacNamara B, Bauer S, Iafe J.Endoscopic examinations were performed on 965 Standardbred racehorses competing at Yonkers Raceway between June 16 and Aug 3, 1988, to demonstrate an association between exercise-induced pulmonary hemorrhage or chronic obstructive pulmonary disease and poor racing performance. Findings suggested that both exercise-induced pulmonary hemorrhage and chronic obstructive pulmonary disease adversely affect performance, whereas a combination of the 2 conditions more severely affects racing performance than do either of the conditions individually.
Hinchcliff KW, Jackson MA, Brown JA, Dredge AF, O'Callaghan PA, McCaffrey JP, Morley PS, Slocombe RE, Clarke AF.To determine the interobserver variability of assessment of exercise-induced pulmonary hemorrhage (EIPH) during tracheobronchoscopic examination in horses. Methods: 747 Thoroughbred racehorses. Procedures-850 tracheobronchoscopic examinations were performed within 2 hours of racing for the horses. Examinations were recorded on videotape, and EIPH and its severity were assessed independently by 3 veterinarians. Concordance was determined by calculation of the Cohen weighted kappa statistic and tabulation of scores assigned by each observer. Results: Weighted kappa statistics ranged from 0.75 to...
Burrell MH.A group of racehorses in training was examined on several occasions with a fibreoptic endoscope and monitored for viral infection. Only equine herpes virus-2 (EHV-2) infection was detected. Pharyngeal lymphoid hyperplasia (PLH) was present in all horses and decreased in severity with age. There was no association between PLH severity and antibody titres to EHV-1, or with the isolation of EHV-2. Finishing position in races was not affected by PLH severity. Exercise induced pulmonary haemorrhage (EIPH) was evident on 23 out of 49 (47 per cent) examinations after maximal speed training exercise. ...
Lapointe JM, Vrins A, McCarvill E.Sixty Standardbred horses, aged 3 to 10 years, were examined endoscopically for exercise-induced pulmonary haemorrhage (EIPH) 1 h after racing, on at least 3 occasions. Racing time, finishing position and post exercise venous lactate concentrations were also recorded. Horses positive for tracheal blood on endoscopy were classified as having either grade 1 EIPH (one or a few spots of blood in the trachea), or grade 2 (stream of blood). Air temperature, relative humidity and air pollutant levels were recorded on each examination day. Of the 60 horses, 52 (87%) were EIPH-positive on at least one ...
Connes P, Bouix D, Durand F, Kippelen P, Mercier J, Prefaut C, Brun JF, Caillaud C.Several studies have suggested that athletes with low hemoglobin saturation during exercise may experience impaired pulmonary blood gas exchange during maximal exercise. Blood viscosity may be implicated in exercise-induced pulmonary hemorrhage in race horses. We hypothesized that blood rheology may contribute to impaired gas exchange and reduced hemoglobin saturation during exercise in humans. A group of 20 highly trained endurance athletes participated in this study, 9 with low hemoglobin saturation during exercise (Low-SpO (2) group) and 11 with normal hemoglobin saturation (High-SpO (2) gr...
Birks EK, Mathieu-Costello O, Fu Z, Tyler WS, West JB.In previous studies of rabbit and dog lung, we demonstrated stress failure of pulmonary capillaries at high transmural pressures (Ptm). The Ptm necessary to elicit stress failure was 40 cmH2O higher in dog than rabbit, and the total blood-gas barrier (BGB) thickness was greater in dog than rabbit. This suggests that stress failure may be related to BGB thickness, and is consistent with the Laplace relationship which states that wall stress is proportional to capillary radius but inversely proportional to wall thickness. In the present studies, we compared BGB thickness and an index of capillar...
West JB, Mathieu-Costello O.The pulmonary blood-gas barrier has a basic physiological dilemma. On the one hand it needs to be extremely thin for efficient gas exchange. On the other hand it also needs to be immensely strong because the stresses on the pulmonary capillary wall become extremely high when the capillary pressure rises on exercise. Maximal hydrostatic pressures in human pulmonary capillaries during exercise are not accurately known but must exceed 30 mmHg. In some animals, for example thoroughbred horses, the capillary pressure rises to about 100 mmHg. These pressures cause stresses in the capillary wall of 5...
Raphel CF, Soma LR.Thoroughbred horses (n = 191) were examined with a flexible fiberoptic endoscope within 2 hours of racing on a dirt track; 147 (75.4%) had evidence of exercise-induced pulmonary hemorrhage (EIPH), and 13 (9.0%) had blood at the nostrils. Of 107 Thoroughbreds examined within the same period after breezing, 41 (38.3%) had evidence of EIPH. One horse (2.4%) of this group had blood at the nostrils. Statistical analysis of frequency data showed that a relationship existed between EIPH and the horse's age or distance raced or breezed. Relationship did not exist between EIPH and sex or finishing posi...
Newton JR, Wood JL.In an epidemiological study of risk factors for exercise-induced pulmonary haemorrhage (EIPH) in young Thoroughbreds in the UK, in which 148 horses contributed 1614 horse-months of data, there were 64 (4%) episodes of endoscopically visible tracheal bleeding and 824 (51%) episodes of increased quantities of haemosiderophages in tracheal washes. There were increases in prevalence and risk of EIPH by both definitions with age from or = 4 years, season of sampling from winter (Nov-Jan) to autumn (Aug-Oct) and several different measures of airway inflammation, including tracheal mucus, neutrophil...
Hinchcliff KW, Jackson MA, Morley PS, Brown JA, Dredge AE, O'Callaghan PA, McCaffrey JP, Slocombe RE, Clarke AE.To determine whether exercise-induced pulmonary hemorrhage (EIPH) was associated with racing performance inThoroughbred horses not medicated with furosemide and not using nasal dilator strips. Methods: Observational cross-sectional study. Methods: 744 two- to 10-year-old Thoroughbred horses racing in Melbourne, Australia. Methods: Horses were enrolled prior to racing, and a tracheobronchoscopic examination was performed after 1 race. Examinations were recorded on videotape, and presence and severity (grade 0 to 4) of EIPH were subsequently determined by 3 observers blinded to the horses' ident...
Meyer TS, Fedde MR, Gaughan EM, Langsetmo I, Erickson HH.Exercise-induced pulmonary haemorrhage (EIPH) causes serious economic losses in the horse racing industry. Endoscopic examination indicates that 40-90% of horses exhibit EIPH following sprint exercise, but the limitations of the endoscope prevent diagnosis in many horses. Bronchoalveolar lavage (BAL) was utilised to detect red blood cells (RBCs) in the terminal airways in 6 horses. Two lavages were performed at weekly intervals prior to exercise, one within 90 min after exercise, and 5 at weekly intervals after exercise. The horses were exercised strenuously at 12.5-14.6 m/s on a treadmill (3 ...
Sullivan S, Hinchcliff K.Exercise-induced pulmonary hemorrhage (EIPH) is an important disease of horses that perform high-intensity athletic activity. EIPH is an ongoing concern for the racing industry because of its high prevalence; potential impact on performance; welfare concerns; and use of prophylactic medications, such as furosemide, on race day. During the last 10 years, significant progress has been made in understanding the pathogenesis and risk factors for EIPH and the impact of the disease on performance and career. This article summarizes the most recent advances in EIPH.
Morley PS, Bromberek JL, Saulez MN, Hinchcliff KW, Guthrie AJ.Exercise-induced pulmonary haemorrhage (EIPH) occurs commonly in Thoroughbred racehorses worldwide. While EIPH is believed to be an important cause of impaired performance in these horses, there is limited evidence from sufficiently powered studies to evaluate this association. Objective: To evaluate whether EIPH is associated with finishing position, distance finished behind race winners and differences in race earning among Thoroughbred horses racing in South Africa. Methods: Prospective cross-sectional study. Methods: One thousand Thoroughbred horses racing in South Africa were enrolled pri...
McKane SA, Canfield PJ, Rose RJ.Sixty-two Thoroughbred horses aged between 1 and 7 years in training in Sydney had bronchoalveolar lavage (BAL) samples collected for cytological examination. All horses, except the yearlings and those with a cough, had raced at the time of the examination and the trainers reported satisfactory performance. Free erythrocytes were found in 73% of samples and haemosiderophages in 90% of the samples, indicating immediate or past occurrences of exercise-induced pulmonary haemorrhage (EIPH). Bronchoalveolar fluid from the yearlings contained significantly less (P < 0.05) erythrocytes and haemosi...
Brakenhoff JE, Holcombe SJ, Hauptman JG, Smith HK, Nickels FA, Caron JP.(1) To determine the effect of age, height, weight, breed, sex, and specific use on the prevalence of idiopathic left laryngeal hemiplegia (ILH) in a population of draft performance horses; (2) to determine the association between tracheal mucus and laryngeal dysfunction, and the prevalence of exercise-induced pulmonary hemorrhage (EIPH) in a population of draft performance horses. Methods: Cross-sectional. Methods: Draft horses competing at the 2005 Michigan Great Lakes Draft Horse Show. Methods: Endoscopic examinations were performed on horses competing at the 2005 Michigan Great Lakes Draft...
Marzahl C, Aubreville M, Bertram CA, Stayt J, Jasensky AK, Bartenschlager F, Fragoso-Garcia M, Barton AK, Elsemann S, Jabari S, Krauth J, Madhu P....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...
Hinchcliff KW, Morley PS, Jackson MA, Brown JA, Dredge AF, O'Callaghan PA, McCaffrey JP, Slocombe RF, Clarke AF.Risk factors for occult exercise-induced pulmonary haemorrhage (EIPH) are poorly defined or quantified. Objective: To investigate the importance of putative risk factors for EIPH amongst Thoroughbred racehorses in Australia. Methods: Tracheobronchoscopy was used to determine EIPH status of 744 Thoroughbred racehorses after flat racing in Melbourne, Australia. Horses were identified for study before racing, and over 50% of horses racing during the study period were examined. Statistical analysis included use of bivariate and multivariate logistic regression analysis to account for simultaneous ...
Nagata S, Takeda F, Kurosawa M, Mima K, Hiraga A, Kai M, Taya K.The responses of plasma adrenocorticotropin (ACTH), cortisol, noradrenaline and adrenaline in 5 Thoroughbred horses to an incremental exercise and 2 relative workload exercises, at 105 and 80% maximal oxygen consumption (VO2max), on a treadmill were examined. These hormone concentrations increased (P < 0.05) with each exercise and the maximal plasma concentrations of ACTH, cortisol were observed between 5 and 30 min after the end of the exercise, while maximal catecholamine concentrations occurred just at exhaustion time. The plasma ACTH, noradrenaline and adrenaline responses during exerci...
Sweeney CR, Soma LR, Maxson AD, Thompson JE, Holcombe SJ, Spencer PA.The effects of furosemide on the racing times of 79 horses without exercise-induced pulmonary hemorrhage (EIPH) and 52 horses with EIPH were investigated. Racing times were adjusted to 1-mile equivalent racing times by 2 speed handicapping methods, and analysis of covariance was used to adjust actual racing times by winning time and distance for each race. All 3 methods of determining racing time indicated that geldings without EIPH had significantly faster racing times (P less than 0.05) when given furosemide before racing than when furosemide was not given before racing. Females and colts wi...
Doucet MY, Viel L.The objective of this study was to determine if a quantitative scoring system for evaluation of hemosiderin content of alveolar macrophages obtained by bronchoalevolar lavage provides a more sensitive test for the detection of exercise-induced pulmonary hemorrhage (EIPH) in horses than does endoscopy of the lower airways. A sample population composed of 74 Standardbred racehorses aged 2-5 years was used. Horses were grouped as either control (EIPH-negative) or EIPH-positive based on history and repeated postexertional endoscopic evaluation of the bronchial airways. Bronchoalveolar lavage was p...
Williams KJ, Robinson NE, Defeijter-Rupp H, Millerick-May M, Stack A, Hauptman J, Derksen FJ.Exercise-induced pulmonary hemorrhage (EIPH), which has been reported in humans and a variety of domestic animals following strenuous exercise, is most often documented in racehorses. Remodeling of pulmonary veins (VR) in equine EIPH was recently described, suggesting that it contributes to the pathogenesis of the disease. The cause of VR is unknown. We tested the hypothesis that the development of VR follows pulmonary blood flow distribution, preferentially occurring in the caudodorsal lung region. Furthermore, we hypothesized that VR underpins development of the other lesions of EIPH patholo...
Birks EK, Shuler KM, Soma LR, Martin BB, Marconato L, Del Piero F, Teleis DC, Schar D, Hessinger AE, Uboh CE.The incidence and severity of exercise-induced pulmonary haemorrhage (EIPH) in the 2 most commonly raced horse breeds, Thoroughbreds (TB) and Standardbreds (STD), were studied, with particular interest in the possible influence of frusemide (F) and/or the breed (or running gait) on EIPH. The appearance of blood within the trachea was semi-quantified using a published 5-point system, with zero assigned when no blood was observed, and numbers 1-4 assigned with increasing amounts of blood. Considering each endoscopic examination as a separate event, approximately 75% of the postrace endoscopic ex...
Sullivan SL, Anderson GA, Morley PS, Hinchcliff KW.Exercise-induced pulmonary haemorrhage (EIPH) is associated with impaired short-term race performance but consequences to long-term race performance of Thoroughbred racehorses are unknown. Knowledge of effects of EIPH on performance over a prolonged time would inform the need for management and treatment of this disorder. Objective: To determine the relationship between EIPH detected on a single occasion and long-term athletic performance in Thoroughbred racehorses. Methods: Prospective, longitudinal, observational epidemiological study conducted from 2003 to 2012. Methods: Seven hundred and f...
Erickson BK, Erickson HH, Coffman JR.This study investigated changes in packed cell volume (PCV), pulmonary artery and aortic pressures, and the interaction between oesophageal pressure and pulmonary artery and aortic pressures during strenuous exercise in the horse. It was hypothesised that oesophageal pressure changes summate with pulmonary artery and aortic pressures during exercise and contribute to exercise-induced pulmonary haemorrhage (EIPH). Acute treadmill exercise (10 m/sec, 3 degrees incline) produced increases in heart rate (HR) from 50 to 202 beats/min; mean pulmonary artery pressure (PAP) from 28 to 80 mmHg; mean ao...
Williams KJ, Derksen FJ, de Feijter-Rupp H, Pannirselvam RR, Steel CM, Robinson NE.Exercise-induced pulmonary hemorrhage (EIPH) is common in horses following intense exertion, occurring in up to 75% of racing Thoroughbreds and Standardbreds. In spite of this, the pathogenesis of EIPH is poorly understood. In 7 racing Thoroughbred horses with EIPH, 6 sections were collected from the left and right lung, representing the cranial, middle, and caudal region of the dorsal and ventral lung (84 sites total). Grossly, both right and left lungs had numerous dark brown to blue-black foci along the caudodorsal visceral pleura. Tissue sections were stained with hematoxylin-eosin, Masson...
