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.
Speirs VC, van Veenendaal JC, Harrison IW, Smyth GB, Anderson GA, Wilson DV, Gilbo B.Endoscopic examinations of the upper respiratory tract were done on 92 of 314 Standardbred horses that raced one or more times at 4 consecutive, weekly race meetings. Although participation was voluntary, the characteristics of the population of horses examined were not statistically different from those of all horses that raced. No horse showed epistaxis, but 34 (32.4%) examinations of the trachea revealed blood that ranged from a trace in the tracheal mucus to large amounts scattered over the tracheal walls. Forty-four horses exhibited minor degrees of pharyngeal lymphoid hyperplasia, 2 had ...
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...
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...
Robinson NE, Sorenson PR.Obstruction of the upper and lower airways is common in horses. In the upper airway, paresis of abductor muscles of the nares and larynx allows inspiratory collapse of soft tissues, which is accentuated by factors increasing upper airway resistance and by high inspiratory flow rates. Intrapulmonary airway obstruction occurs due to accumulation of secretions, release of chemical mediators in response to a variety of stimuli, and parasympathetic stimulation of airways. Obstruction of large airways increases the work of breathing, whereas obstruction of small airways may cause no measurable incre...
Jaggard G.The major problems of racing in the United States at the present time are caused by too much racing. This has led to too few horses and small fields. Consequently many owners and trainers are trying to enter their horses too frequently and to race them when they are not really fit to run. The desire to race horses as frequently as possible has led to constant pressure from horsemen through their organizations for so called "permissive medication". Started in the state of Colorado approximately ten years ago this has grown until finally there are only a few states, notably New York and New Jers...
Pfaff G.In South Africa 2,41% of horses bleed in a race. If all raced until they were 7 years old probably another 2,12% would bleed. Many others bleed after the race or during exercise or at rest. The incidence of epistaxis is significantly greater in geldings than in females and uncastrated males (P less than 0,001). There is an age distribution of bleeding which is highest at 4 years and lowest at 2 years of age (P less than 0,001).
The proposed biological mechanisms for exercise-induced pulmonary haemorrhage (EIPH) are many and varied. Better knowledge of risk factors should lead to achievable measures to reduce the incidence. Objective: To identify risk factors associated with epistaxis following racing in UK Thoroughbreds, to gain possible insights into the pathogenesis of the condition and to investigate the association between epistaxis and race finishing position. Methods: The association of epistaxis occurring on UK racecourses between 1996 and 1998 with a wide range of race-, horse- and start-level variables was e...
Episodic collapse in horses has equine welfare and human safety implications. There are, however, no published case series describing this syndrome. Objective: To characterize the cause and outcomes for horses referred for investigation of episodic collapse. Methods: Twenty-five horses referred for investigation of single or multiple episodes of collapse. Methods: Retrospective study. Clinical records from the Dick Vet Equine Hospital, University of Edinburgh from November 1995 to July 2009 were searched using the following keywords: collapse, collapsing, fall, syncope. Collapse was defined as...
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...
Mazan MR.The airways are the first part of the pathway in the oxygen transport chain that is critical to excellent athletic performance, and the lower airways are considered the final gatekeeper before oxygen enters the blood and carbon dioxide exits. Horses are blessed with large airways and lungs that allow them to be superb athletes, but the down side of this largesse on the part of evolution is that unless they are truly elite athletes they may withstand noninfectious disease of the lower respiratory tract for months to years before the owner or trainer notices. The two conditions of the lower resp...
Bove AA.Myocardial blood flow is the major determinant of oxygen delivery to the myocardium, since oxygen extraction by the myocardium is near maximum in the resting state. Regulation of flow during exercise depends on local metabolic factors and, to a small extent, on autonomic tone. Maximum flow of 5-6 times resting has been measured in reactive hyperemia experiments. In strenuous exercise, myocardial oxygen delivery appears to be adequate and flow reserve seems capable of handling the increased oxygen demand. No evidence of myocardial failure in normal hearts due to excess exercise has been present...
Young LE, Helwegen MM, Rogers K, Kearns L, Schreiber C, Wood JL.Exercise-induced pulmonary haemorrhage (EIPH) and tricuspid (TR) and mitral valve regurgitation (MR) are conditions with high prevalence in conditioned Thoroughbreds. Stress failure of pulmonary capillaries, leading to EIPH, is most likely when pulmonary vascular pressure is increased, and mitral regurgitation can result in pulmonary venous hypertension. Objective: There might be an association between MR and EIPH and the right ventricle (RV) of horses known to suffer repeated episodes of EIPH, as their hearts would be subject to higher pulmonary vascular pressures and cardiac output during tr...
Dirikolu L, Lehner AF, Hughes C, Karpiesiuk W, Camargo FC, Harkins JD, Woods WE, Bosken JM, Boyles J, Troppmann A, Fisher M, Tobin T.Furosemide is a potent loop diuretic used for the prevention of exercise-induced pulmonary hemorrhage in horses. This drug may interfere with the detection of other substances by reducing urinary concentrations, so its use is strictly regulated. The regulation of furosemide in many racing jurisdictions is based on paired limits of urinary SG (100 ng/ml). To validate this regulatory mechanism, a liquid chromatography/mass spectrometry/mass spectrometry method employing a solid-phase extraction procedure and furosemide-d5 as an internal standard was developed. The method was used to determine th...
Thorpe CT, Marlin DJ, Franklin SH, Colborne GR.Changes in shape of the equine thorax during locomotion are not well defined, although it has been shown recently that the transverse hemi-diameter changes its dimension by up to 80mm on the side of the trailing forelimb during gallop, despite minimal change in thoracic circumference. The aim of this project was to analyse transverse and dorso-ventral changes in shape of the thorax simultaneously, and to determine if leading limb, treadmill slope and speed have an effect on these shape changes. Reflective markers were placed on the horse's hemi-thorax and movement of the markers was recorded u...
Kingston JK, Bayly WM, Sides RH.Exercise-induced pulmonary haemorrhage has been associated with reduced performance in racing horses. However, it is unclear what volume of blood loss into the lungs impairs performance. The purpose of the present study was to determine the minimal volume of autologous Horses blood instilled into the airways that significantly affects performance and pulmonary function in exercising horses. Six Thoroughbred horses performed 2 exercise bouts on each of 4 treatment test days. Each exercise bout consisted of a 2 min warm-up at 4 m/s followed by running at a speed equivalent to 115% VO2max, until ...
Schumacher A, Gehlen H.This literature review analyzes the historical development of polo, its organizational structure, the course of the game, as well as the breeding, rearing, and training practices of polo horses. Frequently occurring ailments, such as musculoskeletal injuries, respiratory diseases, and internal illnesses, are highlighted. Lameness is a major problem, with injuries to the superficial digital flexor tendon being the most common cause. Other notable diseases include exercise-induced pulmonary hemorrhage (EIPH), myositis, rhabdomyolysis, and equine infectious anemia (EIA). To ensure the welfare of ...
Shawaf T.Exercise-induced pulmonary hemorrhage (EIPH) is one of the most commonly diagnosed disorders in racehorses. Many EIPH risk factors such as breed, age, high or low environmental temperature, and distance of the race have been studied in racehorses. Unassigned: The aim of this study was to study the relationship between EIPH and the presence of jugular vein thrombose in racehorses. Unassigned: Forty-eight thoroughbred racehorses randomly selected from animals with exercise intolerance due to respiratory disorders were enrolled in the present study. Clinical and tracheobronchoscopy examinations w...
Williams MR, Silverstone A, Burba DJ, McCarrel T, Schoonover MJ, Rudra P.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...
Massie S, Léguillette R, Jones JH, Guigand C, Sides RH, Jones KB, Warlick LM, Thueson EL, Troudt TA, Bayly WM.Maximal intensity exercise in equine athletes induces pulmonary capillary stress failure and exercise-induced pulmonary hemorrhage (EIPH) secondary to excessive transmural pressure (Ptm). Furosemide decreases EIPH severity and pulmonary arterial (PAP) and pulmonary wedge (PAW) pressures. Objective: Assess the effects of furosemide on Ptm and EIPH during supramaximal exercise. Methods: Six fit retired Thoroughbreds with consistent EIPH Grade ≥ 2. Methods: Horses performed a controlled crossover design protocol, completing standardized treadmill tests (120%V̇O2max) before and 4 h after int...
Bozzola C, Sala G, Stancari G, Ferrucci F, Zucca E.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...
