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.
Stack A, Derksen FJ, Sordillo LM, Williams KJ, Stick JA, Brandenberger C, Steibel JP, Robinson NE.To determine the effects of 2 weeks of intense exercise on expression of markers of pulmonary venous remodeling in the caudodorsal and cranioventral regions of the lungs of horses. Methods: 6 horses. Methods: Tissue samples of the caudodorsal and cranioventral regions of lungs were obtained before and after conditioning and 2 weeks of intense exercise. Pulmonary veins were isolated, and a quantitative real-time PCR assay was used to determine mRNA expression of matrix metalloproteinase-2 and -9, tissue inhibitor of metalloproteinase-1 and -2, collagen type I, tenascin-C, endothelin-1, platelet...
Heffron B, Taddei L, Benoit M, Negrusz A.The use of nonsteroidal antiinflammatory drugs in racehorses is allowed under most jurisdictions. Furosemide is administered to treat exercise-induced pulmonary hemorrhage. To help distinguish between therapeutic and illegal uses, racing regulatory bodies have set thresholds in serum for several drugs. The method for the simultaneous detection and quantification of furosemide, flunixin, ketoprofen, phenylbutazone and oxyphenbutazone using 500 µL of serum, and liquid extraction using diethyl ether : hexanes : dichloromethane followed by liquid chromatography tandem mass spectrometry quantitati...
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...
Mason BJ, Riggs CM, Cogger N.The risk of respiratory conditions, such as inflammatory airway disease (IAD) and exercise-induced pulmonary haemorrhage (EIPH), are thought to be higher in racehorses that undergo prosthetic laryngoplasty with ventriculocordectomy (PLVC) surgery to treat left-sided laryngeal hemiplegia (LLH) than in racehorses with normal laryngeal function. However, this has not been investigated formally owing to the difficulty of obtaining reliable follow-up data. Objective: To determine the incidence of respiratory conditions (IAD and EIPH), duration of racing career, number of starts and number of starts...
Costa MF, Ronchi FA, Ivanow A, Carmona AK, Casarini D, Slocombe RF.Exercise-induced pulmonary haemorrhage has an impact on racehorse performance. Although endoscopic diagnosis (with or without the aid of bronchoalveolar lavage) is considered to be the standard diagnostic method for this condition, the use of biomarkers that could aid in quantifying risk and severity of the condition would represent an advance in equine sport medicine. This preliminary research investigated the use of angiotensin-converting enzyme (ACE) activity in plasma of racehorses and demonstrated that ACE activity is increased in horses with higher degrees of haemorrhage and is a promisi...
Michelotto PV, Muehlmann LA, Zanatta AL, Bieberbach EWR, Kryczyk M, Fernandes LC, Nishiyama A.This study investigated the putative roles of inflammation and platelet-activating factor (PAF) in exercise-induced pulmonary haemorrhage (EIPH). Two-year-old Thoroughbred colts (n=37) were exercised on a racetrack for 5months before commencement of the study. Each colt was then exercised at 15-16m/s over 800-1000m and broncho-alveolar lavage fluid (BALF) was collected 24h later. The colts were subsequently divided into two groups on the basis of BALF analysis; an EIPH-positive group (presence of haemosiderophages, n=23) and an EIPH-negative group (absence of haemosiderophages, n=14). BALF fro...
Derksen F, Williams K, Stack A.While airway endoscopy and bronchoalveolar lavage are the methodsof choice for diagnosing exercise-induced pulmonary hemorrhage (EIPH), these techniques do not allow accurate evaluation of the severity of bleeding. EIPH pathology is characterized by occlusive remodeling of pulmonary veins. Affected veins have large collagen deposits in their walls, which reduces their lumens. In the caudodorsal regions, pulmonary vein wall remodeling is associated with hemosiderin accumulation, bronchial circulation angiogenesis, and fibrosis of the alveolar interstitium, bronchovascular bundle, septa, and ple...
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 ...
Colahan PT, Jackson CA, Rice B, Szabo N, Jones JH.Sildenafil, a phosphodiesterase-5 inhibitor vasodilator, increases cGMP concentrations by inhibiting enzymatic degradation. Marketed to treat erectile dysfunction in men, it also reduces pulmonary arterial pressure (PAP). Because it reduces PAP, sildenafil may enhance performance and/or prevent exercise induced-pulmonary haemorrhage (EIPH). Objective: To determine if sildenafil citrate administration altered commonly measured indices of performance or reduced EIPH in exercised horses. Methods: Thirteen athletically conditioned Thoroughbred horses (2 mares and 11 geldings, age 3-12 years) were ...
Buchholz BM, Murdock A, Bayly WM, Sides RH.The antifibrinolytic, 6-aminohexanoic acid, also named aminocaproic acid (ACA), has been used empirically as a treatment for exercise-induced pulmonary haemorrhage (EIPH) on the unsubstantiated basis that transient coagulation dysfunction may contribute to its development. Objective: To assess the effect of ACA on bronchoalveolar lavage fluid (BALF) erythrocyte counts in horses performing treadmill exercise at an intensity greater than that needed to reach maximal oxygen consumption. Methods: Eight Thoroughbreds were exercised to fatigue 3 times on a 10% inclined treadmill at a speed for which...
McKane SA, Slocombe RF.Histological studies of exercise-induced pulmonary haemorrhage (EIPH) reveals inflammatory infiltrates within areas of lung that contain haemorrhage. This has resulted in the hypothesis that pulmonary inflammation could cause EIPH or contribute to an increased risk or severity of EIPH. Objective: To determine whether experimentally-induced pulmonary inflammation predisposes the lung to haemorrhage during exercise, by evaluating the bronchoalveolar lavage (BAL) cytology of normal and inflamed regions of lung following high speed treadmill exercise. Methods: Transendoscopic airway inoculations o...
Williams KJ, Derksen FJ, Defeijter-Rupp HL, Robinson NE.Exercise-induced pulmonary haemorrhage (EIPH) occurs in nearly all strenuously exercising horses. Recent studies have attempted to identify the role of free blood within the airspaces, in the lung fibrosis that develops within the lungs of EIPH horses. Objective: Repeated exposure of the equine lung to autologous blood results in lung fibrosis similar to that observed in spontaneous EIPH. Methods: Forty ml of autologous blood from the jugular vein was instilled into preselected lung regions of 6 horses one, 2, 3, 4 or 5 times at 2 week intervals, with 40 ml of saline instilled into the contral...
Giordano A, Meazza C, Salvadori M, Paltrinieri S.Exercise-induced pulmonary hemorrhage (EIPH) commonly occurs in race horses. Thromboelastometry (TEM) investigates the whole hemostatic process by evaluating the viscoelastic properties of the blood clot from its formation to fibrinolysis. The aim of this study was to assess whether horses with EIPH have abnormal thromboelastometric profiles. Intrinsic and extrinsic pathways, fibrinogen activity and fibrinolysis were investigated by TEM before and after the race in negative controls and in horses on which EIPH was confirmed by bronchoscopy. Compared with controls, horses with EIPH had an incre...
Vengust M, Kerr C, Staempfli HR, Pringle J, Heigenhauser GJ, Viel L.Frusemide (Fru) is widely prescribed for management of racehorses experiencing EIPH. The effect of Fru in the lung appears to be a reduction in transcapillary pressures and inhibition of the erythrocyte anion exchange, which may lead to attenuation of transpulmonary fluid fluxes during exercise. Objective: Treatment with Fru will attenuate transpulmonary fluid fluxes in horses during high intensity exercise. Methods: In a crossover study, 6 race-fit Standardbred horses were treated with 250 mg of Fru i.v. (FruTr) or placebo (Con) 4 h before exercise on a high speed treadmill until fatigue. Art...
Saulez MN, Godfroid J, Bosman A, Stiltner JL, Breathnach CC, Horohov DW.To determine concentrations of cytokine mRNA in horses with exercise-induced pulmonary hemorrhage (EIPH) after racing. Methods: 97 Thoroughbreds. Methods: Following tracheobronchoscopy, the severity of EIPH was graded (scale of 0 to 4), and venous blood samples were collected from 10 horses in each grade. After RNA isolation and cDNA synthesis, real-time PCR assay was conducted to detect cytokinespecific mRNA for interleukin (IL)-1, IL-6, and IL-10; interferon (INF)-gamma; and tumor necrosis factor (TNF)-alpha. Results: Neither location nor grade of EIPH affected the expression of IL-1 and INF...
Perez-Moreno CI, Couëtil LL, Pratt SM, Ochoa-Acuña HG, Raskin RE, Russell MA.The objective was to quantify the effect of furosemide and carbazochrome on exercise-induced pulmonary hemorrhage (EIPH) in Standardbred horses using red blood cell count and hemoglobin concentration in bronchoalveolar lavage (BAL) fluid. Six healthy Standardbred horses with prior evidence of EIPH performed a standardized treadmill test 4 h after administration of placebo, furosemide, or furosemide-carbazochrome combination. Red blood cell (RBC) counts and hemoglobin concentrations were determined on the BAL fluid. The RBC count in BAL ranges were (2903-26,025 cells/microL), (45-24,060 cells/m...
Derksen FJ, Williams KJ, Pannirselvam RR, de Feijter-Rupp H, Steel CM, Robinson NE.Regional veno-occlusive remodelling of pulmonary veins in EIPH-affected horses, suggests that pulmonary veins may be central to pathogenesis. The current study quantified site-specific changes in vein walls, collagen and haemosiderin accumulation, and pleural vascular profiles in the lungs of horses suffering EIPH. Objective: In the caudodorsal lung regions of EIPH-affected horses, there is veno-occlusive remodelling with haemosiderosis, angiogenesis and fibrosis of the interstitium, interlobular septa and pleura. Methods: Morphometric methods were used to analyse the distribution and accumula...
Hinchcliff KW, Morley PS, Guthrie AJ.To evaluate the efficacy of furosemide for prevention of exercise-induced pulmonary hemorrhage (EIPH) in Thoroughbred racehorses under typical racing conditions. Methods: Randomized, placebo-controlled, blinded, crossover field trial. Methods: 167 Thoroughbred racehorses. Methods: Horses were allocated to race fields of 9 to 16 horses each and raced twice, 1 week apart, with each of the 2 races consisting of the same race field and distance. Each horse received furosemide (500 mg, IV) before one race and a placebo (saline solution) before the other, with the order of treatments randomly determ...
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...
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...
Catalani G, Dottavio ME, Rasia M.During acute exercise several significant cardiovascular alterations take place, along with possible physiopathological consequences, such as Exercise Inducted Pulmonary Haemorrhage (EIPH). Given the relevance of blood rheology in the determination of flow resistance and its supposed participation in the stated events, the present paper focuses on the analysis of modifications in haematocrit, blood viscosity and erythrocyte deformability in Thoroughbred horses caused by two different levels of effort (6 to 9 m/s and 13 to 16 m/s), in the same track they train in and with their own jockeys. The...
Derksen FJ, Williams KJ, Uhal BD, Slocombe RF, de Feijter-Rupp H, Eberhart S, Berney C, Robinson NE.Exercise-induced pulmonary haemorrhage (EIPH) occurs in the majority of horses performing strenuous exercise. Associated pulmonary lesions include alveolar and airway wall fibrosis, which may enhance the severity of EIPH. Further work is required to understand the pulmonary response to blood in the equine airways. Objective: To confirm that a single instillation of autologous blood into horse airways is associated with alveolar wall fibrosis, and to determine if blood in the airways is also associated with peribronchiolar fibrosis. Methods: Paired regions of each lung were inoculated with bloo...
Williamson KK, Davis MS.It is clear from a review of the current scientific literature that an evidence-based approach to medical treatment of equine respiratory disease can be applied, at least in the instance of common lower respiratory diseases. In particular, there is clear evidence for efficacious treatments for recurrent airway obstruction and exercise-induced pulmonary hemorrhage, and with the recognition of this evidence, these treatments should be the first to be considered by a practitioner when treating these conditions. The purpose of this article is not only to identify the existence of relevant high-qua...
Padilla DJ, Epp TS, McDonough P, Marlin DJ, Erickson HH, Poole DC.During high intensity exercise, the very high pulmonary artery pressure (Ppa) experienced by Thoroughbred horses is considered a major factor in the aetiology of exercise-induced pulmonary haemorrhage (EIPH). Recently, endothelin-1 (ET-1), a potent vasoconstrictive hormone, has been found to increase Ppa in horses at rest via binding to its ET-1A receptor subtype. In addition, plasma concentrations of ET-1 are increased in horses during and after high intensity exercise. Objective: If ET-1 increases Ppa during exercise in the horse, administration of a specific ET-1A antagonist would decrease ...
Zawadzkas XA, Sides RH, Bayly WM.Prerace administration of frusemide to horses has been linked with a significant improvement in racing performance, but the basis for this improvement is unclear. Objective: To test whether improved performance with prerace administration of frusemide is due to the drug's diuresis-induced weight loss rather than its apparent alleviation of exercise-induced pulmonary haemorrhage (EIPH). Methods: Eight thoroughbred horses underwent 3 trials in a random order, 2 or 3 weeks apart: control (C), frusemide/unburdened (FU), and frusemide/burdened (FB). None of the horses were known to have exhibited p...
Costa MF, Thomassian A.To our knowledge no studies evaluating risk factors to EIPH have been undertaken with such a population of horses in Brazil, which is one of the few countries in the racing community to accept the use of frusemide (FUR) as a prerace medication for bleeders. We also compared national results with those already in the literature. Objective: To verify the influence of variables such as distance of the race, racetrack surface, going and season of the year in the recurrence and severity of EIPH and its effect on the finishing position of flat racing Thoroughbreds in Brazil. Methods: 2118 post race ...
Deaton CM, Brown-Feltner H, Henley WE, Roberts CA, Lekeux P, Schroter RC, Marlin DJ.Pulmonary capillary stress failure, largely as a result of high pulmonary vascular pressures, has been implicated in the aetiology of EIPH. However, the role of the respiratory system in determining the magnitude of EIPH has received little attention. Objective: Horses breathing a gas of greater density than air will exhibit greater transmural pulmonary arterial pressures (TPAP) and more severe EIPH, and horses breathing a gas of lower density than air will exhibit lower TPAP and less severe EIPH, both compared with horses breathing air. Methods: Following a warm-up, 8 Thoroughbred horses were...
O'Callaghan MW, Goulden BE.This paper describes the distinctive radiographic changes detected in the dorso-caudal lungfields of four racing thoroughbreds recently affected by exercise-induced epistaxis. A diffuse but localized increase in density was seen in all four cases, which demonstrated a variation from a predominantly alveolar density to an interstitial pattern and finally to increased bronchial markings. Evolution of the radiographic pattern of the pulmonary densities appeared to be related to the time that had elapsed since the bleeding incident. The implications of the changing pattern and site of the densitie...
Roberts CA, Marlin DJ, Lekeux P.The effects of training on ventilation and blood gases during exercise were investigated in 6 clinically normal, detrained Thoroughbred horses. They underwent a 16 week training programme similar to the type frequently used for Thoroughbred racehorses in Great Britain. Standardized treadmill exercise tests (2 min canter at 8 and 10 m/s C8 and C10[ and 2 min gallop at 12 m/s [G12], on a level surface) were performed prior to and after 16 weeks of training. Respiratory flow rates were measured using ultrasound flow transducers. Blood samples were drawn from a transverse facial artery and the rig...
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...
Fedde MR, Wood SC.When horses maximally exercise, splenic contraction and fluid movement out of the vascular compartment greatly increase the hematocrit (up to 0.70). We studied the in vitro rheological characteristics of blood from Thoroughbreds and Quarter Horses to determine the interaction of hematocrit and shear rate on apparent viscosity. We also compared the rheological characteristics of the blood before and after horses received furosemide, a drug commonly used to prevent exercise-induced pulmonary hemorrhage. Although the apparent viscosity of blood with a high hematocrit was high at low shear rates, ...
Manohar M, Goetz TE.The present study examined whether Thoroughbred horses performing strenuous exercise exhibit intrapulmonary arteriovenous shunting that may contribute to the observed arterial hypoxemia. Experiments were carried out on seven healthy, exercise-trained Thoroughbreds at rest, maximal exercise (galloping at 14 m/s on a 3.5% uphill grade for 120 s), and submaximal exertion (8 m/s on a 3.5% uphill grade for 150 s). Along with blood gas/hemodynamic parameters, intrapulmonary arteriovenous shunting was studied by injecting 15-microm-diameter microspheres, labeled with different stable isotopes, into t...
Weideman H, Schoeman SJ, Jordaan GF, Kidd M.This study investigated if environmental factors had an effect on the incidence of epistaxis related to exercise-induced pulmonary haemorrhage (EIPH) among racehorses in southern Africa. Data covering the period 1986-2001 and involving 778 532 race runs were analysed. This included the following information: date of race, age, sex, name of breeder, trainer, distance, jockey, state of going, weight carried, racing centre and altitude. Veterinarians employed by the Jockey Club suspended officially entered horses that presented with epistaxis (frank bleeding from the nostrils) after racing. On-co...
Manohar M, Goetz TE.Exercise-induced pulmonary hemorrhage (EIPH) is a common occurrence in racehorses. The objective of this study was to compare pulmonary vascular pressures of healthy Thoroughbred horses with and without postexertion endoscopically detectable fresh blood in the trachea. The nasopharynx, larynx, and trachea (down to the carina) of horses were examined weekly with an endoscope 55-60 min postexertion, and the diagnosis of EIPH was confirmed by the presence of fresh blood in the trachea. Measurements of heart rate and right atrial, pulmonary arterial, and pulmonary arterial wedge pressures were mad...
Langsetmo I, Meyer MR, Erickson HH.Exercise-induced pulmonary haemorrhage (EIPH) is characterised by blood in the airways after strenuous exercise and results from stress failure of the pulmonary capillaries. The purpose of this experiment was to establish a threshold value of transmural pulmonary arterial pressure at which haemorrhage occurs in the exercising horse. Five geldings, age 4-14 years, were run in random order once every 2 weeks at 1 of 4 speeds (9, 11, 13, 15 m/s); one day with no run was used as a control. Heart rate, pulmonary arterial pressure and oesophageal pressure were recorded for the duration of the run. T...
McKane SA, Slocombe RF.Histological studies of exercise-induced pulmonary haemorrhage (EIPH) reveals inflammatory infiltrates within areas of lung that contain haemorrhage. This has resulted in the hypothesis that pulmonary inflammation could cause EIPH or contribute to an increased risk or severity of EIPH. Objective: To determine whether experimentally-induced pulmonary inflammation predisposes the lung to haemorrhage during exercise, by evaluating the bronchoalveolar lavage (BAL) cytology of normal and inflamed regions of lung following high speed treadmill exercise. Methods: Transendoscopic airway inoculations o...
da Silva KM, Otaka JNP, Gonçalves CAP, Silva EGA, de Alencar NX, Lessa DAB.The respiratory system is essential for health and high athletic performance in horses. Respiratory diseases have been recognized as having a major impact on training equine animals and are commonly cited as the second most common cause of wasted training time. Inflammatory airway disease (IAD) is an important cause of poor performance in young racehorses. Exercise-induced pulmonary hemorrhage (EIPH) is considered a major issue for the equine industry because of its high prevalence and association with reduced athletic performance. In Brazil, polo is a growing equestrian sport, but studies on ...
Hinchcliff KW, Muir WW.Furosemide, a diuretic, is frequently administered to horses for the prophylaxis of exercise-induced pulmonary hemorrhage and the treatment of a number of clinical conditions, including acute renal failure and congestive heart failure. Furosemide increases the rate of urinary sodium, chloride, and hydrogen ion excretion. Plasma potassium concentration decreases after furosemide administration but urinary potassium excretion in horses is minimally affected. Renal blood flow increases after furosemide administration. Systemically, furosemide increases venous compliance and decreases right atrial...
Caillaud C, Connes P, Bouix D, Mercier J.Exercise-induced arterial hypoxemia (EIAH), i.e., a significant drop of O2 arterial partial pressure during sea level exercise, has been shown in both aerobically trained athletes and athletic animal species. The mechanisms potentially involved include ventilation/perfusion inequality and/or pulmonary diffusing capacity limitation. In thoroughbred horses, EIAH is going with pulmonary haemorrhage (EIPH). Stress failure of pulmonary capillaries leading to diffusion limitation has been proposed. Indeed, during intense exercise, the increased cardiac output and blood viscosity combine to rise capi...
Manohar M, Hutchens E, Coney E.Catheter mounted micro-tip-manometers (the signals from which were matched with fluid-filled pressure signals from same cardiovascular sites and zeroed at the point of the shoulder), were used to study pulmonary haemodynamics in 8 healthy sound horses at rest and during exercise performed at 8, 10, 12 and 14 m/s on a treadmill. Measurements were made without frusemide (control) and 4 h after iv administration of 250 mg frusemide. Post-frusemide data were also obtained on a separate day, and these observations were not significantly different from those made on the same day as controls. Pre-fru...
Johnstone IB, Viel L, Crane S, Whiting T.The purpose of this study was to determine whether a defect in hemostasis might be a factor in the etiology of exercise-induced pulmonary hemorrhage (EIPH). Hemostatic parameters were evaluated in 22 EIPH-positive and ten EIPH-negative racing horses while in a rested state. Nineteen EIPH-positive and ten EIPH-negative horses were further evaluated just before and immediately after a 15 min exercise period on a 260 m oval track. When EIPH-positive and EIPH-negative horses were compared at rest, there was no significant difference in any of the coagulation and fibrinolytic parameters studied. Th...
Pascoe JR, McCabe AE, Franti CE, Arthur RM.The repeatability of endoscopic observations of exercise-induced pulmonary hemorrhage (EIPH) and the efficacy of furosemide as a prophylactic treatment of horses with EIPH were studied in Thoroughbred race horses after consecutive breezes (at or near maximum speed, approx 16 m/s). Of 56 horses examined greater than or equal to 2 times, 21 (38%) had identical EIPH scores, whereas 26 (46%) and 9 (16%) had scores that differed by greater than or equal to 1 grade. In 56 nontreated horses, there was good agreement between 2 consecutive observations (K = 0.59, Z = 4.54, P less than 0.001). Similar c...
Vengust M, Kerr C, Staempfli HR, Pringle J, Heigenhauser GJ, Viel L.Frusemide (Fru) is widely prescribed for management of racehorses experiencing EIPH. The effect of Fru in the lung appears to be a reduction in transcapillary pressures and inhibition of the erythrocyte anion exchange, which may lead to attenuation of transpulmonary fluid fluxes during exercise. Objective: Treatment with Fru will attenuate transpulmonary fluid fluxes in horses during high intensity exercise. Methods: In a crossover study, 6 race-fit Standardbred horses were treated with 250 mg of Fru i.v. (FruTr) or placebo (Con) 4 h before exercise on a high speed treadmill until fatigue. Art...
Sweeney CR, Humber KA, Roby KA.Tracheobronchial aspirates obtained from 66 healthy Thoroughbred racehorses in training at the same track were examined. Twenty-seven percent of the horses had greater than 20% neutrophils in the aspirate. Eosinophils, mast cells, giant cells, and Curschmann's spirals of mucus were observed in 94, 83, 65, and 42% of the horses, respectively. Hemosiderophages were observed in 86% of the horses, half of which had previous confirmation of exercise-induced pulmonary hemorrhage. Although fungal elements were seen in 70% of the horses, bacteria were detected in only 3% of the horses. The authors con...
Goetz TE, Manohar M, Hassan AS, Baker GJ.The present study was carried out to examine whether nasal strip application would improve the exercise-induced arterial hypoxemia and hypercapnia, diminish anaerobic metabolism, and modify the incidence of exercise-induced pulmonary hemorrhage (EIPH) in horses. Two sets of experiments, control and nasal strip experiments, were carried out on seven healthy, sound, exercise-trained Thoroughbred horses in random order, 7 days apart. Simultaneous measurements of core temperature, arterial and mixed venous blood gases/pH, and blood lactate and ammonia concentrations were made at rest, during subma...
Derksen F, Williams K, Stack A.While airway endoscopy and bronchoalveolar lavage are the methodsof choice for diagnosing exercise-induced pulmonary hemorrhage (EIPH), these techniques do not allow accurate evaluation of the severity of bleeding. EIPH pathology is characterized by occlusive remodeling of pulmonary veins. Affected veins have large collagen deposits in their walls, which reduces their lumens. In the caudodorsal regions, pulmonary vein wall remodeling is associated with hemosiderin accumulation, bronchial circulation angiogenesis, and fibrosis of the alveolar interstitium, bronchovascular bundle, septa, and ple...
Sweeney CR.This article addresses many aspects of exercise-induced pulmonary hemorrhage (EIPH). Reports of the prevalence, effect on performance, and the clinical signs and means of diagnosis of EIPH are included. Radiologic and scintigraphic findings in horses with EIPH are reported. Pathogenesis and treatment are discussed.
Manohar M, Goetz TE, Hassan AS.Strenuously exercising horses exhibit arterial hypoxemia and exercise-induced pulmonary hemorrhage (EIPH), the latter resulting from stress failure of pulmonary capillaries. The present study was carried out to examine whether the structural changes in the blood-gas barrier caused by a prior bout of high-intensity short-term exercise capable of inducing EIPH would affect the arterial hypoxemia induced during a successive bout of exercise performed at the same workload. Two sets of experiments, double- and single-exercise-bout experiments, were carried out on seven healthy, sound Thoroughbred h...
Crispe EJ, Lester GD, Robertson ID, Secombe CJ.Ambient temperature has been identified as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) in racing Thoroughbreds. This warranted a more expansive investigation of climatic conditions on the incidence and severity of EIPH. The impact of other variables such as the type of bit used, tongue ties and nonstandard shoes has not been reported and also warrant investigation. Objective: To examine the effect of various climatic variables as contributing risk factors for EIPH. Other previously uninvestigated variables as well as standard track and population factors will also be examin...
O'Callaghan MW, Pascoe JR, O'Brien TR, Hornof WJ, Mason DK.This study was initiated to determine if the extent and intensity of lung lesions associated with exercise-induced pulmonary haemorrhage (EIPH) in horses could be predicted from thoracic radiographs. Sets of thoracic radiographs from 24 horses with varied histories of EIPH were subjectively coded for radiographic quality, and perceived extent and intensity of diffuse interstitial opacity by three radiologists who had no knowledge of the corresponding autopsy results. Codes assigned from radiographs for the chosen parameters were compared with coded estimates of lung surface staining assigned a...
Derksen FJ, Williams KJ, Uhal BD, Slocombe RF, de Feijter-Rupp H, Eberhart S, Berney C, Robinson NE.Exercise-induced pulmonary haemorrhage (EIPH) occurs in the majority of horses performing strenuous exercise. Associated pulmonary lesions include alveolar and airway wall fibrosis, which may enhance the severity of EIPH. Further work is required to understand the pulmonary response to blood in the equine airways. Objective: To confirm that a single instillation of autologous blood into horse airways is associated with alveolar wall fibrosis, and to determine if blood in the airways is also associated with peribronchiolar fibrosis. Methods: Paired regions of each lung were inoculated with bloo...
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...
Buchholz BM, Murdock A, Bayly WM, Sides RH.The antifibrinolytic, 6-aminohexanoic acid, also named aminocaproic acid (ACA), has been used empirically as a treatment for exercise-induced pulmonary haemorrhage (EIPH) on the unsubstantiated basis that transient coagulation dysfunction may contribute to its development. Objective: To assess the effect of ACA on bronchoalveolar lavage fluid (BALF) erythrocyte counts in horses performing treadmill exercise at an intensity greater than that needed to reach maximal oxygen consumption. Methods: Eight Thoroughbreds were exercised to fatigue 3 times on a 10% inclined treadmill at a speed for which...
Erickson BK, Erickson HH, Coffman JR.Intravenous frusemide (1.0 mg/kg bwt) or phentolamine (0.33 mg/kg bwt) was given to 7 horses 1 h before exercise and their effects on pulmonary artery and aortic pressure changes during strenuous exercise were examined. Short-term near-maximal treadmill exercise (10 m/sec, 3 degrees incline) produced increases in heart rate, mean pulmonary artery pressure (PAP), mean aortic pressure (AP), and packed cell volume (PCV). Frusemide did not affect heart rate, PAP or PCV during exercise. Frusemide significantly decreased mean AP by 10 to 15 mmHg during exercise. Phentolamine produced an increase in ...
