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Topic:Respiratory Health

Respiratory health in horses encompasses the study of the equine respiratory system, its function, and the various conditions that can affect it. The respiratory system in horses includes the upper airways, lungs, and associated structures, which facilitate gas exchange and are vital for maintaining physiological homeostasis during rest and exercise. Common respiratory conditions in horses include equine asthma, infectious diseases like strangles, and exercise-induced pulmonary hemorrhage (EIPH). These conditions can impact a horse's performance and overall health. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, physiology, pathophysiology, and management of respiratory health in horses.
Analgesic and Cardiopulmonary Effects of Epidural Romifidine and Morphine Combination in Horses.
Journal of equine veterinary science    April 5, 2021   Volume 102 103459 doi: 10.1016/j.jevs.2021.103459
Natalini CC, Paes SD, Polydoro ADS.The study aim is to compare the effects of epidural administration of two different doses of romifidine combined with morphine in horses. A prospective crossover blinded experimental design was used. Five adult healthy horses two males and three females with a mean body weight of 380 ± 45 Kg (335-425 kg), were studied. Treatments consisted of romifidine 30 μg/kg (R30) or 60 μg/kg (R60) combined with morphine 0.1 mg/kg with a washout interval of 72 hours, administered through an epidural catheter placed at the first intercoccygeal space. Heart rate (HR) and respiratory rate (f), pH, blood ga...
Nebulized dexamethasone sodium phosphate in the treatment of horses with severe asthma.
Journal of veterinary internal medicine    April 4, 2021   Volume 35, Issue 3 1604-1611 doi: 10.1111/jvim.16113
de Wasseige S, Picotte K, Lavoie JP.A study reported low systemic availability of injectable dexamethasone nebulized to healthy horses using the Flexineb mask. When used in horses with severe asthma and a different nebulizer, lack of efficacy and cortisol suppression were observed. Objective: Nebulized dexamethasone is as effective as PO administration for the treatment of severe asthma in horses. Methods: Twelve horses with severe asthma from a research herd. Methods: Randomized clinical trial. Horses were divided into 2 groups and received 5 mg of dexamethasone sodium phosphate by nebulization using a Flexineb mask (NE, n = 6)...
Tissue Microarrays to Visualize Influenza D Attachment to Host Receptors in the Respiratory Tract of Farm Animals.
Viruses    March 31, 2021   Volume 13, Issue 4 586 doi: 10.3390/v13040586
Nemanichvili N, Berends AJ, Wubbolts RW, Gröne A, Rijks JM, de Vries RP, Verheije MH.The trimeric hemagglutinin-esterase fusion protein (HEF) of influenza D virus (IDV) binds 9-O-acetylated sialic acid receptors, which are expressed in various host species. While cattle are the main reservoir for IDV, the viral genome has also been detected in domestic pigs. In addition, antibodies against IDV have been detected in other farm animals such as sheep, goats, and horses, and even in farmers working with IDV positive animals. Viruses belonging to various IDV clades circulate, but little is known about their differences in host and tissue tropism. Here we used recombinantly produced...
Translating research into practice: Adoption of endocrine diagnostic testing in cases of equine laminitis.
Veterinary journal (London, England : 1997)    March 18, 2021   Volume 272 105656 doi: 10.1016/j.tvjl.2021.105656
Ireland JL, McGowan CM.Research demonstrating insulin's causal role in endocrinopathic laminitis has greatly advanced understanding of equine laminitis. However, the degree to which this knowledge has been translated into clinical practice has not been assessed. This two-part study aimed to investigate veterinary surgeons' current diagnostic approach to laminitis, whether this had changed over time, and the impact of diagnosing an endocrinopathy on laminitis case management and outcome. Two cross-sectional online surveys of equine veterinary surgeons working within the UK were undertaken. The first study population ...
Comparison of the proteomes in sera between healthy Thoroughbreds and Thoroughbreds with respiratory disease associated with transport using mass spectrometry-based proteomics.
Journal of equine science    March 16, 2021   Volume 32, Issue 1 11-15 doi: 10.1294/jes.32.11
Minamijima Y, Niwa H, Uchida E, Yamamoto K.In the past decade, mass spectrometry has become an important technology for protein identification. Recent developments in mass spectrometry allow a large number of identifications in samples; therefore, mass-spectrometry-based techniques have been applied to the discovery of biomarkers. Here, we conducted a proteomic study to compare the proteomes in sera between healthy Thoroughbreds and Thoroughbreds with respiratory disease associated with transport (RDT). We found that four proteins, apolipoprotein F, lipopolysaccharide binding protein, lysozyme and protein S100-A8, were upregulated, whi...
Pharmacokinetics and pulmonary distribution of Draxxin® (tulathromycin) in healthy adult horses.
Journal of veterinary pharmacology and therapeutics    March 14, 2021   Volume 44, Issue 5 714-723 doi: 10.1111/jvp.12968
Leventhal HR, McKenzie HC, Estell K, Council-Troche M, Davis JL.The objective of this study was to determine the pharmacokinetics and tolerability of tulathromycin (Draxxin ; 2.5 mg/kg once) after intramuscular (IM), subcutaneous (SC), and slow intravenous (IV) administration to six adult horses. A three-phase design and 4-week washout period were used. Drug concentrations in blood and bronchoalveolar lavage (BAL) samples were determined by ultra-performance liquid chromatography tandem mass spectrometry and pharmacokinetic parameters calculated using noncompartmental analysis. Following SC and IM administration, all horses exhibited sweating, discomfort,...
Dust exposure and pulmonary inflammation in Standardbred racehorses fed dry hay or haylage: A pilot study.
Veterinary journal (London, England : 1997)    March 13, 2021   Volume 271 105654 doi: 10.1016/j.tvjl.2021.105654
Olave CJ, Ivester KM, Couetil LL, Kritchevsky JE, Tinkler SH, Mukhopadhyay A.Respirable dust exposure is linked to airway inflammation in racehorses. Feeding haylage may reduce dust exposure by 60-70%. The objective of this study was to compare dust exposure, airway cytology, and inflammatory cytokine concentrations between horses fed haylage or hay over 6 weeks while in training. Seven healthy Standardbred horses were randomly assigned to be fed alfalfa hay (n = 3) or grass-alfalfa mix haylage (n = 4) for six weeks while training on a treadmill. Dust exposure was measured gravimetrically at the breathing zone. Endotoxin and β-glucan concentrations in respirable dust ...
Evaluation of Treatment With Respiratory Gene Technology and Serum in a Group of Standard Bred Racehorses With Cytological Evidence of Mild Equine Asthma.
Journal of equine veterinary science    March 8, 2021   Volume 101 103435 doi: 10.1016/j.jevs.2021.103435
Hansen S, Laustsen L, Otten ND, Skovgaard K, Bech R, Byrgesen S, Hopster-Iversen C, Fjeldborg J.Alternative treatment options to glucocorticoids for equine asthma is desirable due to withdrawal time. The objective was to evaluate if serum and Respiratory Gene Technology (RGT), a commercial kit to produce autologous conditioned serum, was effective in reducing bronchoalveolar lavage (BAL) neutrophils and mast cells in racehorses with cytological evidence of mild equine asthma . Thirty-six Standardbred trotters in active training were enrolled in this randomized clinical trial; a healthy control group (n=11), a RGT group (n=12) and a serum group (n=13). Endoscopy including tracheal wash (T...
Transendoscopic Ventriculocordectomy Using Monopolar Electrosurgical Instrumentation for Conjunctive Treatment of Laryngeal Hemiplegia in Horses: 24 Cases (2017-2019).
Frontiers in veterinary science    March 1, 2021   Volume 8 628410 doi: 10.3389/fvets.2021.628410
Caspers MK, Bell CD, Tatarniuk DM.Objective: The objective of this study is to evaluate the safety, efficacy, and owner satisfaction following electrosurgical ventriculocordectomy (EVC), in conjunction with prosthetic laryngoplasty, in equine clinical cases affected with left- or right-sided recurrent laryngeal neuropathy. Methods: Retrospective data analysis of clinical signalment, surgery, athletic outcome, intra- and postoperative complications, and postoperative examinations from clinical cases wherein EVC was performed in conjunction with traditional prosthetic laryngoplasty from one practice. Owners were contacted by pho...
Bronchoalveolar lavage fluid cytological findings in healthy Amiata donkeys.
Open veterinary journal    February 28, 2021   Volume 11, Issue 1 160-164 doi: 10.4314/ovj.v11i1.23
The approach to respiratory diseases in donkeys is similar to that for horses; nevertheless, Bronchoalveolar lavage fluid (BALF) and tracheal wash cytology in this species have been described only a few times in the literature. To describe BALF cytological findings in a cohort of 24 healthy Amiata donkeys. Bronchoalveolar lavage (BAL) was carried out via standing sedation with a large animal where the BAL catheter passed blindly through the nasal passage into the trachea. The total nucleated cell count of the BALF was found similar to that already described in healthy horses and donkeys. No di...
The Reported Use of Tongue-Ties and Nosebands in Thoroughbred and Standardbred Horse Racing-A Pilot Study.
Animals : an open access journal from MDPI    February 26, 2021   Volume 11, Issue 3 doi: 10.3390/ani11030622
Weller D, Franklin S, White P, Shea G, Fenner K, Wilson B, Wilkins C, McGreevy P.This article reports on the results of a survey of racehorse trainers (n = 112) outlining the reasons for tongue-tie (TT) and noseband (NB) use by Thoroughbred trainers (TBTs) (n = 72) and Standardbred trainers (SBTs) (n = 40). The study also investigated the reported effectiveness of TTs and possible complications arising from their use. Tongue-tie use was reported by 62.5% (n = 70) of racehorse trainers. The reasons for TT use varied between TBTs and SBTs. For TBTs, the most common reason for TT use was to prevent or reduce airway obstruction (72.3%, n = 34), followed closely by to prevent o...
Comparison of intraoperative cardiorespiratory and behavioral responses to medetomidine combined with tramadol or butorphanol during standing laparoscopic ovariectomy in horses.
The Journal of veterinary medical science    February 11, 2021   Volume 83, Issue 4 643-647 doi: 10.1292/jvms.20-0397
Kim A, Sasaki N, Lee I, Seo JP.The purpose of this study was to assess the cardiorespiratory and behavioral responses to the combination of medetomidine and tramadol (M-T) or butorphanol (M-B) in standing laparoscopic ovariectomy in horses. One ovary was removed under M-T and the contralateral ovary was removed under M-B with at least 4 weeks between operations at random. Horses were sedated using intravenous medetomidine (5 µg/kg) followed by tramadol (1 mg/kg) or butorphanol (10 µg/kg) after 5 min. Sedation was maintained through the repeated injection of medetomidine (1 µg/kg) and tramadol (0.4 mg/kg) or medetomidine ...
Survey of the equine broodmare industry, abortion, and equine herpesvirus-1 vaccination in Ontario.
The Canadian veterinary journal = La revue veterinaire canadienne    February 6, 2021   Volume 62, Issue 2 124-132 
Cooper CJ, Arroyo LG, Pearl DL, Hewson J, Lillie BN.A survey of Ontario horse breeders was conducted in 2016 and retrospectively asked farm-level management questions regarding herd sizes, vaccination, respiratory disease, and abortion over the years 2014 to 2015. A total of 88 farm owners completed the survey, reporting 857 broodmares. Using logistic regression modelling, management influences on vaccine use, and the reporting of respiratory disease or abortion was investigated. Having veterinary records and the reasons for breeding were significantly associated with the odds of an abortion even after controlling for broodmare herd size. The o...
Evaluation of Overground Endoscopy Findings in Colombian Criollo Paso Horses.
Journal of equine veterinary science    January 12, 2021   Volume 99 103374 doi: 10.1016/j.jevs.2021.103374
Joó K, Duque Betancourt D, Vasquez Marin T, Parra Moyano LA.The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < ...
Appraising the Welfare of Thoroughbred Racehorses in Training in Queensland, Australia: The Incidence, Risk Factors and Outcomes for Horses after Retirement from Racing.
Animals : an open access journal from MDPI    January 11, 2021   Volume 11, Issue 1 142 doi: 10.3390/ani11010142
Crawford KL, Finnane A, Greer RM, Phillips CJC, Woldeyohannes SM, Perkins NR, Ahern BJ.There is international public concern regarding retirement of racehorses, including the reason for retirement and the outcome for horses after racing. However, there are currently no prospective studies investigating these factors. A recent independent inquiry in Queensland, Australia, highlighted that the true outcomes for horses after retirement from racing are largely unknown. Furthermore, there are currently no measures to monitor the outcome for racehorses and their welfare once they have left the care of the trainer. This study investigated these gaps in knowledge through a weekly survey...
Safe and effective aerosolization of in vitro transcribed mRNA to the respiratory tract epithelium of horses without a transfection agent.
Scientific reports    January 11, 2021   Volume 11, Issue 1 371 doi: 10.1038/s41598-020-79855-1
Legere RM, Cohen ND, Poveda C, Bray JM, Barhoumi R, Szule JA, de la Concha-Bermejillo A, Bordin AI, Pollet J.Vaccines and therapeutics using in vitro transcribed mRNA hold enormous potential for human and veterinary medicine. Transfection agents are widely considered to be necessary to protect mRNA and enhance transfection, but they add expense and raise concerns regarding quality control and safety. We found that such complex mRNA delivery systems can be avoided when transfecting epithelial cells by aerosolizing the mRNA into micron-sized droplets. In an equine in vivo model, we demonstrated that the translation of mRNA into a functional protein did not depend on the addition of a polyethylenimine (...
Breath-Jockey: Development and Feasibility Assessment of a Wearable System for Respiratory Rate and Kinematic Parameter Estimation for Gallop Athletes.
Sensors (Basel, Switzerland)    December 29, 2020   Volume 21, Issue 1 152 doi: 10.3390/s21010152
Di Tocco J, Sabbadini R, Raiano L, Fani F, Ripani S, Schena E, Formica D, Massaroni C.In recent years, wearable devices for physiological parameter monitoring in sports and physical activities have been gaining momentum. In particular, some studies have focused their attention on using available commercial monitoring systems mainly on horses during training sessions or competitions. Only a few studies have focused on the jockey's physiological and kinematic parameters. Although at a glance, it seems jockeys do not make a lot of effort during riding, it is quite the opposite. Indeed, especially during competitions, they profuse a short but high intensity effort. To this extend, ...
Cardiopulmonary function during supramaximal exercise in hypoxia, normoxia and hyperoxia in Thoroughbred horses.
Journal of equine science    December 18, 2020   Volume 31, Issue 4 67-73 doi: 10.1294/jes.31.67
Ohmura H, Mukai K, Matsui A, Takahashi T, Jones JH.Supramaximal exercise while inspiring different O gases may induce different responses in cardiopulmonary function at the same relative and/or absolute exercise intensity. The purpose of this study was to compare the effects of supramaximal exercise in hypoxia, normoxia and hyperoxia on cardiopulmonary function in Thoroughbred horses. Using a crossover design, five well-trained horses were made to run up a 6% grade on a treadmill at supramaximal speeds sustainable for approximately 110 sec (approximately 115% Omax) while breathing normoxic gas (NO, 21% O) or hypoxic gas (LO, 15.3% O) in random...
The effects of flumazenil on ventilatory and recovery characteristics in horses following midazolam-ketamine induction and isoflurane anaesthesia.
Equine veterinary journal    December 17, 2020   Volume 53, Issue 6 1257-1267 doi: 10.1111/evj.13391
Douglas H, Hopster K, Cerullo M, Hopster-Iversen C, Stefanovski D, Driessen B.Flumazenil antagonises the actions of benzodiazepines. There has been no prior research specifically investigating this anaesthetic reversal agent for horses. Objective: To determine the effects of flumazenil administration in horses on (a) ventilatory parameters after midazolam-ketamine induction and maintenance with isoflurane in oxygen and on (b) the characteristics of recovery from general anaesthesia. Methods: Blinded, randomised, crossover experiment. Methods: Six horses were randomly assigned to receive high-dose flumazenil (F , 20 µg/kg), low-dose flumazenil (F , 10 µg/kg) and sali...
Quantitative and qualitative analysis of operator inhaled aerosols during routine motorised equine dental treatment.
Equine veterinary journal    November 30, 2020   Volume 53, Issue 5 1036-1046 doi: 10.1111/evj.13379
Bescoby SR, Davis SA, Sherriff M, Ireland AJ.Routine equine odontoplasty is performed by both Veterinary Surgeons and Equine Dental Technicians. The production of aerosolised particulates from motorised equipment has been well documented in human orthodontics but has yet to be investigated in the veterinary industry. Objective: To assess the size, quantity and composition of particulates produced during routine motorised odontoplasty and to model their deposition in the human respiratory tree. Methods: Analytic observational study. Methods: Fifteen-minute routine motorised odontoplasties were performed on cadaver heads with monitoring eq...
Hypercapnia and hyperlactatemia were positively associated with higher-grade arrhythmias during peak exercise in horses during poor performance evaluation on a high-speed treadmill.
Veterinary journal (London, England : 1997)    November 9, 2020   Volume 266 105572 doi: 10.1016/j.tvjl.2020.105572
Reef VB, Davidson EJ, Slack J, Stefanovski D.Cardiac arrhythmias are common in horses during exercise, especially immediately post-exercise. The objectives of this study were to: (1) describe the frequency and type of cardiac arrhythmias detected in horses during incremental high-speed treadmill exercise testing (ITET); (2) determine if arterial blood gas (ABG) changes at peak and immediately post-exercise were associated with arrhythmias; and (3) determine whether upper or lower airway disease was associated with exercising cardiac arrhythmias. Horses (n = 368) presenting for an ITET underwent resting and exercising upper airway endosco...
Asthmatic Disease as an Underlying Cause of Dorsal Displacement of the Soft Palate in Horses.
Journal of equine veterinary science    October 31, 2020   Volume 96 103308 doi: 10.1016/j.jevs.2020.103308
Joó K, Povázsai Á, Nyerges-Bohák Z, Szenci O, Kutasi O.It is important to treat the upper and lower respiratory tracts as a single unit, as lower respiratory tract diseases can often cause upper respiratory functional disorders, whereas upper respiratory obstructions could be a factor in lower respiratory problems. The present study aimed to investigate the hypothesis that asthmatic diseases may be an underlying cause of dorsal displacement of the soft palate in horses. Pleasure or sport horses (n = 57) with a history of asthmatic disease were incorporated in the study. All horses were examined in the exacerbation phase of the asthmatic disease. ...
Recellularization of Bronchial Extracellular Matrix With Primary Bronchial Smooth Muscle Cells.
Journal of equine veterinary science    October 31, 2020   Volume 96 103313 doi: 10.1016/j.jevs.2020.103313
Ben Hamouda S, Vargas A, Boivin R, Miglino MA, da Palma RK, Lavoie JP.Severe asthma is associated with an increased airway smooth muscle (ASM) mass and altered composition of the extracellular matrix (ECM). Studies have indicated that ECM-ASM cell interactions contribute to this remodeling and its limited reversibility with current therapy. Three-dimensional matrices allow the study of complex cellular responses to different stimuli in an almost natural environment. Our goal was to obtain acellular bronchial matrices and then develop a recellularization protocol with ASM cells. We studied equine bronchi as horses spontaneously develop a human asthma-like disease...
Clinical Research Abstracts of the British Equine Veterinary Association Congress 2020.
Equine veterinary journal    October 30, 2020   Volume 52 Suppl 54 5-17 doi: 10.1111/evj.01_13365
No abstract available
Exercise-associated rhythm disturbances in poorly performing Thoroughbreds: risk factors and association with racing performance.
Equine veterinary journal    October 29, 2020   Volume 53, Issue 4 656-669 doi: 10.1111/evj.13354
Marr CM, Franklin S, Garrod G, Wylie C, Smith L, Dukes-McEwan J, Bright J, Allen K.Exercise-associated cardiac rhythm disturbances are common, but there is a lack of evidence-based criteria on which to distinguish clinically relevant rhythm disturbances from those that are not. Objective: To describe and characterise rhythm disturbances during clinical exercise testing; to explore potential risk factors for these rhythm disturbances and to determine whether they influenced future racing. Methods: Retrospective cohort using a convenience sample. Methods: Medical records were reviewed from two clinical services to identify horses with poor performance and/or respiratory noise ...
[Equine chorionic gonadotrophin: Biology and veterinary use].
Tierarztliche Praxis. Ausgabe G, Grosstiere/Nutztiere    October 20, 2020   Volume 48, Issue 5 344-354 doi: 10.1055/a-1235-7973
Schuler G.The pituitary gonadotrophins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) play a prominent role in the control of gonadal functions. Therefore, their use in the treatment of fertility disorders (e. g. anovulatory anestrus) as well as in biotechnology (e. g. superovulation, hormone programs for cycle synchronization) is of substantial interest. Preparations of FSH or LH are relatively expensive due to the laborious extraction from pituitary tissue and are therefore reserved for special indications. In primates and equids, the chorionic epithelium expresses an LH-like molecule...
Arterial oxygenation in anesthetized horses placed in a 5-degree reverse Trendelenburg position.
Research in veterinary science    October 9, 2020   Volume 135 304-309 doi: 10.1016/j.rvsc.2020.10.005
Trenholme HN, Barletta M, Quandt JE, Reed RA, Kleine SA, Hofmeister EH.Low arterial oxygen is a common complication in anesthetized horses and placing the animal in reverse Trendelenburg (RT) position may treat hypoxemia. The objective of this study was to assess the arterial partial pressure of oxygen (PaO) in horses placed in a 5-degree RT compared to horizontal (H) position. Client-owned healthy horses (n = 60) undergoing elective surgeries were enrolled in a randomized controlled clinical study. Horses were sedated with butorphanol, an α-adrenoceptor agonist, ± acepromazine and induced with ketamine combined with a benzodiazepine, propofol, or guaifenesin...
Evaluation of the effects of medial saphenous venous pressures as an indirect method of measurement of intra-abdominal pressures in the horse.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    October 8, 2020   Volume 30, Issue 6 660-669 doi: 10.1111/vec.13000
Munsterman AS, Gillen AM, Coleridge MOD, Hanson RR.To evaluate the effect of changes in intra-abdominal pressure (IAP) on medial saphenous venous pressure (MSVP) and hemodynamics in normal horses. Methods: Experimental, in-vivo study. Methods: University Teaching Hospital. Methods: Convenience sample of 7 mixed breed horses; 5 geldings, and 2 mares. Methods: Pneumoperitoneum was induced in horses under standing sedation with carbon dioxide gas using a laparoscopic insufflator for a total of 60 minutes to simulate clinical elevation in IAP. Pressure was increased stepwise to 20 mm Hg over 30 minutes, and maintained at that pressure for 30 minu...
Validation of a Rapid Bronchoalveolar Lavage Fluid Colorimetric Evaluation for Assessing the Severity of Exercise-Induced Pulmonary Hemorrhage in Horses in Field Conditions.
Journal of equine veterinary science    October 8, 2020   Volume 95 103284 doi: 10.1016/j.jevs.2020.103284
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...
Pathology, infectious agents and horse- and management-level risk factors associated with signs of respiratory disease in Ethiopian working horses.
Equine veterinary journal    October 2, 2020   Volume 53, Issue 4 670-681 doi: 10.1111/evj.13339
Laing G, Christley R, Stringer A, Ashine T, Cian F, Aklilu N, Newton R, Radford A, Pinchbeck G.Respiratory disease is a common cause for presentation of working horses to clinics in Ethiopia and a priority concern for owners. Objective: To identify risk factors for and association of pathogens with respiratory signs in working horses. Methods: Unmatched case-control study. Methods: Cases were those animals recently coughing (last 7 days) or observed with coughing, nasal discharge or altered respiration at the time of examination. A physical exam and respiratory endoscopy were performed including a tracheal wash sample to detect the presence of pathogens and serology performed on blood....
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