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Animals : an open access journal from MDPI2025; 15(17); 2609; doi: 10.3390/ani15172609

Comparison Between Tracheal Wash and Bronchoalveolar Lavage Cytology for the Assessment of Airway Inflammation in Racehorses Affected by Exercise-Induced Pulmonary Hemorrhage.

Abstract: 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 reported. This retrospective study aimed to verify the agreement between TW and BALF in assessing lower airway inflammation in racehorses with EIPH. Cytological data from 123 poorly performing racehorses regarding neutrophils, eosinophils, and mast cells percentages were reviewed. Non-parametric statistical tests were used to assess the difference and the correlation between TW and BALF, and the distribution of inflammatory patterns in BALF. A strong correlation between TW and BALF was found for neutrophils (ρ = 0.817, < 0.001) and eosinophils percentage (ρ = 0.806, < 0.001); while a moderate correlation was found for mast cells percentage (ρ = 0.584, < 0.001). The eosinophilic-mastocytic inflammation was the prevalent pattern observed in our population. Based on our findings, TW cannot be considered an alternative to BALF cytology for fully characterizing lower airway inflammation in racehorses with EIPH.
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Publication Date: 2025-09-05 PubMed ID: 40941404PubMed Central: PMC12427357DOI: 10.3390/ani15172609Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This study compared two diagnostic methods, tracheal wash (TW) and bronchoalveolar lavage fluid (BALF) cytology, to assess airway inflammation in racehorses suffering from exercise-induced pulmonary hemorrhage (EIPH).
  • The researchers aimed to determine how well TW reflects the airway inflammation measured by BALF, which is considered the gold standard but is more invasive.

Background

  • Exercise-Induced Pulmonary Hemorrhage (EIPH): A condition where intense exercise causes the rupture of small blood vessels in the lungs, leading to bleeding and inflammation.
  • Importance of Cytology: Cytological analysis of airway fluids helps clinicians understand the type and degree of airway inflammation.
  • Diagnostic Methods:
    • Bronchoalveolar Lavage Fluid (BALF) Cytology: Involves collecting fluid from deep within the lungs, providing detailed information about airway inflammation; considered the gold standard.
    • Tracheal Wash (TW): Collects fluid from the trachea; less invasive but potentially less informative.
  • Previous studies showed TW can help diagnose and grade EIPH severity but its efficacy for assessing airway inflammation was unclear.

Study Objective

  • To assess how well TW cytology correlates with BALF cytology in evaluating airway inflammation in racehorses with EIPH.
  • Focus was on specific inflammatory cells: neutrophils, eosinophils, and mast cells, which indicate different types of inflammation.

Methods

  • Study Design: Retrospective review involving 123 poorly performing racehorses diagnosed with EIPH.
  • Data Analyzed: Percentage values of neutrophils, eosinophils, and mast cells from both TW and BALF samples.
  • Statistical Analysis:
    • Non-parametric tests used to compare differences between TW and BALF results.
    • Correlation tests measured how strongly TW results correspond to BALF findings.
    • Distribution of inflammatory patterns in BALF samples was also evaluated.

Key Findings

  • Neutrophils: Strong positive correlation between TW and BALF (correlation coefficient ρ = 0.817, highly significant).
  • Eosinophils: Also showed strong correlation between TW and BALF (ρ = 0.806, highly significant).
  • Mast Cells: Moderate correlation observed (ρ = 0.584, highly significant), indicating more variability between TW and BALF.
  • Inflammatory Pattern: The most common inflammation type in BALF samples was eosinophilic-mastocytic, signaling that these cell types are prevalent in EIPH-related airway inflammation.

Interpretation

  • While TW cytology moderately to strongly reflects some inflammatory cell populations (neutrophils and eosinophils), it is less reliable for mast cells which are critical for fully characterizing airway inflammation.
  • The moderate correlation for mast cells suggests TW cannot capture the complete complexity of the inflammatory environment in lungs affected by EIPH.
  • Since BALF is more invasive but provides more comprehensive information, it remains the preferred method for detailed airway inflammation assessment in these horses.

Conclusions

  • TW should not be used as a substitute for BALF cytology when precise characterization of airway inflammation is necessary in racehorses with EIPH.
  • TW may still have diagnostic value due to its less invasive nature, particularly in evaluating neutrophilic and eosinophilic populations.
  • Clinicians must weigh the invasiveness versus the diagnostic completeness when choosing between TW and BALF.

Cite This Article

APA
Bozzola C, Sala G, Stancari G, Ferrucci F, Zucca E. (2025). Comparison Between Tracheal Wash and Bronchoalveolar Lavage Cytology for the Assessment of Airway Inflammation in Racehorses Affected by Exercise-Induced Pulmonary Hemorrhage. Animals (Basel), 15(17), 2609. https://doi.org/10.3390/ani15172609

Publication

Animals : an open access journal from MDPI
ISSN: 2076-2615
NlmUniqueID: 101635614
Country: Switzerland
Language: English
Volume: 15
Issue: 17
PII: 2609

Researcher Affiliations

Bozzola, Chiara
  • Department of Veterinary Medicine and Animal Science, Università degli Studi di Milano, 26900 Lodi, Italy.
Sala, Giulia
  • Department of Veterinary Sciences, Università di Pisa, 56122 San Piero a Grado, Italy.
Stancari, Giovanni
  • Department of Veterinary Medicine and Animal Science, Università degli Studi di Milano, 26900 Lodi, Italy.
Ferrucci, Francesco
  • Department of Veterinary Medicine and Animal Science, Università degli Studi di Milano, 26900 Lodi, Italy.
Zucca, Enrica
  • Department of Veterinary Medicine and Animal Science, Università degli Studi di Milano, 26900 Lodi, Italy.

Conflict of Interest Statement

The authors declare no conflicts of interest.

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