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Topic:Exercise-Induced Pulmonary Hemorrhage

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.
Functional and compositional changes in pulmonary surfactant in response to exercise.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 62-66 doi: 10.1111/j.2042-3306.1999.tb05190.x
Morrison KE, Slocombe RF, McKane SA, Dargaville PA.Pulmonary surfactant from bronchoalveolar lavages was obtained from 2 groups of horses. A control group consisting of 6 healthy racehorses that were paddock-rested and lavaged weekly for 6 consecutive weeks were compared with an experimental group of 10 healthy racehorses, lavaged weekly the same period, consisting of a 5 week incremental-intensity treadmill training programme and one week post training paddock rest. Phospholipid content of lavage fluid was determined indirectly by phosphorus assay, and surfactant functional activity was determined by bubble surfactometry. Total cell counts an...
Sequential changes in bronchoalveolar cytology after autologous blood inoculation.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 126-130 doi: 10.1111/j.2042-3306.1999.tb05202.x
McKane SA, Slocombe RF.Six horses, free of recent exercise-induced pulmonary haemorrhage (EIPH), each had 8 bronchial segments inoculated with 40 ml of autologous blood lavaged on Days 3, 5, 7, 10, 14 and 21 after inoculation. The bronchoalveolar lavage (BAL) fluid samples were analysed, and total leucocyte counts and differential cell percentages determined. Statistical analysis of the differences between the 8 post inoculation and 1 pre-inoculation (control) lavage sites demonstrated an early neutrophilic response, rising from < 5% of alveolar leucocytes to 10% by 24-48 h post inoculation. As this response wane...
Modelling impact-initiated wave transmission through lung parenchyma in relation to the aetiology of exercise-induced pulmonary haemorrhage.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 34-38 doi: 10.1111/j.2042-3306.1999.tb05184.x
Schroter RC, Leeming A, Denny E, Bharath A, Marlin DJ.Recently we proposed that exercise-induced pulmonary haemorrhage (EIPH) results from locomotory-impact-induced trauma by impact of the scapula on the chest wall during footfall and the consequent transmission of waves through the lung. A computational model has been developed to demonstrate that wave amplification and focusing occur in the dorsocaudal tip of the lung for waves originating on the anterior subscapular surface. The propagation of an acoustic wave was investigated in a simplified 2-dimensional representation of a vertical anterio-dorsal section of horse lung. It was demonstrated t...
Blood gas, plasma lactate and bronchoalveolar lavage cytology analyses in racehorses with respiratory disease.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 77-82 doi: 10.1111/j.2042-3306.1999.tb05193.x
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...
Feasibility of scintigraphy in exercise-induced pulmonary haemorrhage detection and quantification: preliminary studies.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 137-142 doi: 10.1111/j.2042-3306.1999.tb05204.x
Votion DM, Roberts CA, Marlin DJ, Lekeux PM.We hypothesised that scintigraphic imaging of the lungs following injection of 99mTc labelled red blood cells (99mTc-RBC) in the exercising horse might enable exercise-induced pulmonary haemorrhage (EIPH) quantification. Ideally, to favour detection of bleeding, circulating 99mTc-RBC not involved in the haemorrhage should be removed from the circulation quickly. Altering RBC during labelling to stimulate splenic uptake of 99mTc-RBC may encourage this. In order to investigate this hypothesis, 99mTc-RBC distribution was followed for 1 h in 2 groups of horses. Group 1 was injected i.v., at rest, ...
Repeated administration of frusemide does not offer an advantage over single dosing in attenuating exercise-induced pulmonary hypertension in thoroughbred horses.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 539-545 doi: 10.1111/j.2042-3306.1999.tb05280.x
Goetz TE, Manohar M, Magid JH.The objective of the present study was to ascertain whether administration of a second dose of frusemide would attenuate exercise-induced pulmonary hypertension more than a single dose. Right atrial, right ventricular and pulmonary vascular pressures were determined in 7 healthy, sound, exercise-trained Thoroughbred horses at rest and during exercise (14.2 m/s + a 3.5% uphill grade) performed at maximal heart rate (217 +/- 3 beats/min [mean +/- s.e.]). Horses were studied during the following 3 treatments in random order 7 days apart: control (no medication), frusemide single dose (250 mg i.v....
Plasma adrenocorticotropin, cortisol and catecholamines response to various exercises.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 570-574 doi: 10.1111/j.2042-3306.1999.tb05286.x
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...
Equine respiratory pharmacology.
The Veterinary clinics of North America. Equine practice    December 10, 1999   Volume 15, Issue 3 665-x doi: 10.1016/s0749-0739(17)30138-4
Foreman JH.Differentiation of diseases of the equine respiratory tract is based on history, clinical signs, auscultation, endoscopy, imaging, and sampling of airway exudate. Upper respiratory therapies include surgical correction of airway obstructions; flushing of localized abscesses (strangles), guttural pouch disease, or sinusitis; and oral or parenteral antibiotic and anti-inflammatory therapy if deemed necessary. Pneumonia usually is treated with antimicrobials, anti-inflammatories, and bronchodilators. Pleural drainage is indicated if significant pleural effusion is present. The most commonly used ...
Pulmonary vascular pressures of strenuously exercising Thoroughbreds during intravenous infusion of nitroglycerin.
American journal of veterinary research    November 24, 1999   Volume 60, Issue 11 1436-1440 
Manohar M, Goetz TE.To determine whether intravenous infusion of nitroglycerin would modify pulmonary arterial, capillary, or venous hypertension in strenuously exercising Thoroughbreds. Methods: 5 healthy Thoroughbred horses. Methods: Right atrial, right ventricular, and pulmonary vascular pressures were measured. Each horse was used in a control treatment (not medicated) and a nitroglycerin infusion (20 microg/kg of body weight/min) at rest and during exercise on a treadmill. Sequence of treatments was randomized for each horse, and treatments were separated by a 7-day interval. Galloping at 14.2 m/s on a 5% up...
Exercise-induced haemorrhagic lesions in the dorsocaudal extremities of the caudal lobes of the lungs of young thoroughbred horses.
Journal of comparative pathology    November 5, 1999   Volume 121, Issue 4 339-347 doi: 10.1053/jcpa.1999.0331
Oikawa M.The dorsocaudal extremities of the caudal lobes of the lungs of racehorses are vulnerable to exercise-induced pulmonary haemorrhage (EIPH). The morphology of the lungs at these sites was studied in 13 Thoroughbred horses aged 18 to 22 months. These animals, which had been performing low-intensity exercise on a track at maximum running speeds of approximately 5-8.5 metres/second (m/s), were withdrawn from the racehorse training programme for reasons of unsuitability. Lung lesions observed in the dorsocaudal lung extremities in 10 of the 13 horses were not found in the craniodorsal or craniovent...
Effects of furosemide on athletic performance and exercise-induced pulmonary hemorrhage in horses.
Journal of the American Veterinary Medical Association    September 7, 1999   Volume 215, Issue 5 630-635 
Hinchcliff KW.No abstract available
Effects of extrathoracic airway obstruction on intrathoracic pressure and pulmonary artery pressure in exercising horses.
American journal of veterinary research    April 22, 1999   Volume 60, Issue 4 485-494 
Hackett RP, Ducharme NG, Ainsworth DM, Erickson BK, Erb HN, Soderholm LV, Thorson LM.To determine whether dorsal displacement of the soft palate (DDSP) results in pulmonary artery hypertension and leads to increases in transmural pulmonary artery pressure (TPAP); to determine whether pulmonary hypertension can be prevented by prior administration of furosemide; and to determine whether tracheostomy reduces pulmonary hypertension. Methods: 7 healthy horses. Methods: Horses were subjected to 3 conditions (control conditions, conditions after induction of DDSP, and conditions after tracheostomy). Horses were evaluated during exercise after being given saline (0.9% NaCl) solution ...
Cytologic examination of specimens obtained by means of tracheal washes performed before and after high-speed treadmill exercise in horses with a history of poor performance.
Journal of the American Veterinary Medical Association    March 24, 1999   Volume 214, Issue 5 673-677 
Martin BB, Beech J, Parente EJ.To evaluate results of cytologic examination of specimens obtained by means of tracheal washes (TW) in 42 horses with a history of poor performance. Methods: Cross-sectional case series. Methods: 42 horses with a history of poor performance. Methods: A TW was performed via endoscopy before and after horses exercised on a high-speed treadmill, and specimens were evaluated microscopically and graded. Results: Ten (24%) horses were considered to be clinically normal before and after exercise. Pulmonary hemorrhage was diagnosed in 8 (19%) horses. One horse had evidence of exercise-induced pulmonar...
Effect of timing and route of administration of furosemide on pulmonary hemorrhage and pulmonary arterial pressure in exercising thoroughbred racehorses.
American journal of veterinary research    January 26, 1999   Volume 60, Issue 1 22-28 
Lester G, Clark C, Rice B, Steible-Hartless C, Vetro-Widenhouse T.To examine effect of pre-exercise administration of furosemide (FUR) on mean pulmonary arterial pressure (PAP) during work and RBC concentration in bronchoalveolar lavage fluid (BALF) collected 40 minutes after exercise. Methods: 10 adult Thoroughbreds. Methods: A modified 10 X 10 crossover design comprising 10 horses during 10 weeks was used. Each horse received each of 5 treatments twice. Treatment structure included a control plus a 2 X 2 factorial and consisted of the following: A, control; B, FUR, 250 mg, IV, 30 minutes before exercise; C, FUR, 250 mg, IV, 240 minutes before exercise; D, ...
Survey of the large animal diplomates of the American College of Veterinary Internal Medicine regarding percutaneous lung biopsy in the horse.
Journal of veterinary internal medicine    December 19, 1998   Volume 12, Issue 6 456-464 doi: 10.1111/j.1939-1676.1998.tb02150.x
Savage CJ, Traub-Dargatz JL, Mumford EL.A survey designed to obtain information on the indications, contraindications, complications, and methodology of percutaneous lung biopsy in the horse was sent to large animal diplomates of the American College of Veterinary Internal Medicine. Sixty-five of 190 diplomates returned the survey (response rate: 34%) and 59 of these 65 respondents (91%) indicated that they worked with horses. Forty-four diplomates had performed a percutaneous lung biopsy in 1 or more horses (i.e. 75% of those diplomates working with horses and 68% of total respondents). Clinical and radiologic diagnoses that prompt...
Quantification of exercise-induced pulmonary haemorrhage with bronchoalveolar lavage.
Equine veterinary journal    August 15, 1998   Volume 30, Issue 4 284-288 doi: 10.1111/j.2042-3306.1998.tb04098.x
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 ...
Review of furosemide in horse racing: its effects and regulation.
Journal of veterinary pharmacology and therapeutics    July 23, 1998   Volume 21, Issue 3 228-240 doi: 10.1046/j.1365-2885.1998.00132.x
Soma LR, Uboh CE.Furosemide has been used empirically and has been legally approved for many years by the US racing industry for the control of exercise-induced pulmonary haemorrhage (EIPH) or bleeding. Its use in horses for this purpose is highly controversial and has been criticized by organizations outside and inside of the racing industry. This review concentrates on its renal and extra-renal actions and the possible relationship of these actions to the modification of EIPH and changes in performance of horses. The existing literature references suggest that furosemide has the potential of increasing perfo...
Regional distribution of exercise-induced pulmonary haemorrhage: horses and antelopes.
Equine veterinary journal    June 11, 1998   Volume 30, Issue 3 181-182 doi: 10.1111/j.2042-3306.1998.tb04484.x
Robertshaw D.No abstract available
Exercise-induced pulmonary haemorrhage (EIPH) in horses results from locomotory impact induced trauma–a novel, unifying concept.
Equine veterinary journal    June 11, 1998   Volume 30, Issue 3 186-192 doi: 10.1111/j.2042-3306.1998.tb04486.x
Schroter RC, Marlin DJ, Denny E.Exercise-induced pulmonary haemorrhage (EIPH) in horses, although of major welfare and economic importance worldwide, is of uncertain cause. It is accepted that the dorsocaudal region of the lung is particularly prone to the condition, but present theories of causation cannot satisfactorily explain the mechanism or pattern of occurrence. We propose that EIPH results from locomotory impact induced trauma; the mechanism being similar to that producing lung tissue damage following thoracic impact injury. In impact injury, the localised impulsive load on the chest wall is transmitted by pressure w...
Haemorrheological alterations associated with competitive racing activity in horses: implications for exercise-induced pulmonary haemorrhage (EIPH).
Equine veterinary journal    February 12, 1998   Volume 30, Issue 1 7-12 doi: 10.1111/j.2042-3306.1998.tb04082.x
Weiss DJ, Smith CM.No abstract available
Blood viscosity and its role in the haemodynamic responses to intense exertion.
Equine veterinary journal    February 12, 1998   Volume 30, Issue 1 3 doi: 10.1111/j.2042-3306.1998.tb04079.x
McKeever KH.No abstract available
Effects of airway obstruction on transmural pulmonary artery pressure in exercising horses.
American journal of veterinary research    August 1, 1997   Volume 58, Issue 8 897-903 
Jackson JA, Ducharme NG, Hackett RP, Rehder RS, Ainsworth DM, Shannon KJ, Erickson BK, Erb HN, Jansson N, Soderholm LV, Thorson LM.To determine whether laryngeal hemiplegia would increase transmural pulmonary artery pressure (TPAP). Methods: 6 horses. Methods: Horses were studied under 5 conditions: control conditions, after induction of left laryngeal hemiplegia, during obstruction of the left nostril, after placement of an instrumented tracheostomy, and after placement of an open tracheostomy. Horses were evaluated after being given saline solution and after being given furosemide. Methods: Horses were exercised on a high speed treadmill, using a maximum speed of 13 m/s. During each exercise, airway pressures, airflow, ...
Pulmonary vascular pressures of strenuously exercising Thoroughbreds after administration of varying doses of frusemide.
Equine veterinary journal    July 1, 1997   Volume 29, Issue 4 298-304 doi: 10.1111/j.2042-3306.1997.tb03127.x
Manohar M, Goetz TE, Sullivan E, Griffin R.The frusemide dose-response for attenuation of exercise-induced pulmonary capillary hypertension was studied in 7 healthy, exercise-conditioned Thoroughbred horses using previously described haemodynamic procedures. Four different doses of frusemide were tested: 250 mg regardless of bodyweight (amounting to 0.56 +/- 0.03 mg/kg bwt), 1.0 mg/kg bwt, 1.5 mg/kg bwt and 2.0 mg/kg bwt. Frusemide was administered i.v., 4 h before exercise. Haemodynamic data were obtained at rest and during treadmill exercise performed at 14.2 m/s on a 3.5% uphill grade; this workload elicited maximal heart rate of ho...
Very high pressures are required to cause stress failure of pulmonary capillaries in thoroughbred racehorses.
Journal of applied physiology (Bethesda, Md. : 1985)    May 1, 1997   Volume 82, Issue 5 1584-1592 doi: 10.1152/jappl.1997.82.5.1584
Birks EK, Mathieu-Costello O, Fu Z, Tyler WS, West JB.Thoroughbred horses develop extremely high pulmonary vascular pressures during galloping, all horses in training develop exercise-induced pulmonary hemorrhage, and we have shown that this is caused by stress failure of pulmonary capillaries. It is known that the capillary transmural pressure (Ptm) necessary for stress failure is higher in dogs than in rabbits. The present study was designed to determine this value in horses. The lungs from 15 Thoroughbred horses were perfused with autologous blood at Ptm values (midlung) of 25, 50, 75, 100 and 150 mmHg, and then perfusion fixed, and samples (d...
Invited editorial on “Nitric oxide and thermoregulation during exercise in the horse”.
Journal of applied physiology (Bethesda, Md. : 1985)    April 1, 1997   Volume 82, Issue 4 1033-1034 doi: 10.1152/jappl.1997.82.4.1033
Joyner MJ.No abstract available
Oxidant injury and nitric oxide: a role in exercise-induced pulmonary haemorrhage?
Veterinary journal (London, England : 1997)    March 1, 1997   Volume 153, Issue 2 119-121 doi: 10.1016/s1090-0233(97)80032-9
Derksen FJ.No abstract available
Oxidant injury, nitric oxide and pulmonary vascular function: implications for the exercising horse.
Veterinary journal (London, England : 1997)    March 1, 1997   Volume 153, Issue 2 125-148 doi: 10.1016/s1090-0233(97)80034-2
Mills PC, Higgins AJ.The athletic ability of the horse is facilitated by vital physiological adaptations to high-intensity exercise, including a thin (but strong) pulmonary blood-gas barrier, a large pulmonary functional reserve capacity and a consequent maximum oxygen uptake (VO2max) far higher than in other species. A high pulmonary artery pressure also serves to enhance pulmonary function, although stress failure of lung capillaries at high pulmonary transmural pressures, and the contribution of other factors which act in the exercising horse to increase pulmonary vascular tone, may lead to pathological or path...
Exercise-induced changes in the lung of Shetland ponies: ultrastructure and morphometry.
Journal of submicroscopic cytology and pathology    January 1, 1997   Volume 29, Issue 1 65-72 
Erickson HH, McAvoy JL, Westfall JA.The ultrastructural changes in pulmonary alveoli produced by running two ponies on a high speed treadmill at 7.6 m/sec, 3-degree incline, for 2 min support the hypothesis of pulmonary capillary stress failure as an explanation for exercise-induced pulmonary hemorrhage (EIPH). Light microscopy combined with scanning and transmission electron microscopy confirmed the presence of red blood cells and proteinaceous material in the alveolar lumina and interstitial swelling in approximately one third of the pulmonary alveoli examined. Morphometric analysis revealed that the blood-gas barrier was 30-7...
Pulmonary vascular pressures of exercising thoroughbred horses with and without endoscopic evidence of EIPH.
Journal of applied physiology (Bethesda, Md. : 1985)    October 1, 1996   Volume 81, Issue 4 1589-1593 doi: 10.1152/jappl.1996.81.4.1589
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...
Pulmonary vascular pressures of strenuously exercising thoroughbreds after administration of phenylbutazone.
American journal of veterinary research    September 1, 1996   Volume 57, Issue 9 1354-1358 
Manohar M, Goetz TE, Griffin R, Sullivan E.To determine the effects of phenylbutazone administration on heart rate and right atrial and pulmonary vascular pressures in Thoroughbreds during rest and during exercise performed at maximal heart rate. Methods: 7 healthy, exercise-conditioned Thoroughbreds. Methods: Horses were studied on 3 occasions: without medication [control], after i.v. administration of phenylbutazone (4.4 mg/kg of body weight) at 12-hour intervals for 2 days and a final dose given 1 hour before exercise, and after i.v. administration of phenylbutazone for 2 days in the same manner, but with the final dose given 24 hou...
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