Pharmacological treatments in asthma-affected horses: A pair-wise and network meta-analysis.
Abstract: Equine asthma is a disease characterised by reversible airflow obstruction, bronchial hyper-responsiveness and airway inflammation following exposure of susceptible horses to specific airborne agents. Although clinical remission can be achieved in a low-airborne dust environment, repeated exacerbations may lead to irreversible airway remodelling. The available data on the pharmacotherapy of equine asthma result from several small studies, and no head-to-head clinical trials have been conducted among the available medications. Objective: To assess the impact of the pharmacological interventions in equine asthma and compare the effect of different classes of drugs on lung function. Methods: Pair-wise and network meta-analysis. Methods: Literature searches for clinical trials on the pharmacotherapy of equine asthma were performed. The risk of publication bias was assessed by funnel plots and Egger's test. Changes in maximum transpulmonary or pleural pressure, pulmonary resistance and dynamic lung compliance vs. control were analysed via random-effects models and Bayesian networks. Results: The results obtained from 319 equine asthma-affected horses were extracted from 32 studies. Bronchodilators, corticosteroids and chromones improved maximum transpulmonary or pleural pressure (range: -8.0 to -21.4 cmH O; P<0.001). Bronchodilators, corticosteroids and furosemide reduced pulmonary resistance (range: -1.2 to -1.9 cmH O/L/s; P<0.001), and weakly increased dynamic lung compliance. Inhaled β -adrenoreceptor (β -AR) agonists and inhaled corticosteroids had the highest probability of being the best therapies. Long-term treatments were more effective than short-term treatments. Conclusions: Weak publication bias was detected. Conclusions: This study demonstrates that long-term treatments with inhaled corticosteroids and long-acting β -AR agonists may represent the first choice for treating equine asthma. Further high quality clinical trials are needed to clarify whether inhaled bronchodilators should be preferred to inhaled corticosteroids or vice versa, and to investigate the potential superiority of combination therapy in equine asthma.
© 2017 EVJ Ltd.
Publication Date: 2017-04-09 PubMed ID: 28295526DOI: 10.1111/evj.12680Google Scholar: Lookup
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- Journal Article
- Meta-Analysis
Summary
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The research article analyses the effects of different pharmacological treatments on equine asthma, a chronic condition in horses. Data from several small studies was combined to better understand which therapeutic approach is most effective, with particular focus on bronchodilators, corticosteroids, and other drugs.
Objectives and Methodology
- The main goal of this study was to assess the impact of various drugs on lung function in horses suffering from equine asthma, and to compare the efficiacy of different classes of medication.
- The researchers compiled data from multiple small-scale clinical trials on the subject. They performed pair-wise and network meta-analysis, which are statistical techniques used to combine results from different studies. This allowed them to draw more robust conclusions from the scattered data.
- To ensure the validity of their findings, the risk of publication bias was evaluated by means of funnel plots and Egger’s test.
Results
- The analysis encompassed results from 32 studies involving a total of 319 horses affected by equine asthma.
- The researchers found that bronchodilators, corticosteroids and chromones improved maximum transpulmonary or pleural pressure, which implies better lung function. Additionally, these drugs reduced pulmonary resistance, making it easier for the horses to breathe.
- In terms of specific drugs, inhaled β-adrenoreceptor (β-AR) agonists and inhaled corticosteroids showed the greatest potential for being the most effective treatments.
- Interestingly, it was shown that long-term treatments were more effective than short-term treatments in managing equine asthma.
Conclusions
- The study concluded that long-term treatments with inhaled corticosteroids and long-acting β-AR agonists should be the first line of treatment for equine asthma.
- However, the researchers found a weak publication bias, which suggests some caution should be exercised in interpreting the results.
- Finally, they advocate for additional, higher-quality clinical trials. The aim of these proposed studies would be to further investigate the potential benefits of inhaled bronchodilators over inhaled corticosteroids, or vice versa, and to explore the effectiveness of combined therapy for treating equine asthma.
Cite This Article
APA
Calzetta L, Roncada P, di Cave D, Bonizzi L, Urbani A, Pistocchini E, Rogliani P, Matera MG.
(2017).
Pharmacological treatments in asthma-affected horses: A pair-wise and network meta-analysis.
Equine Vet J, 49(6), 710-717.
https://doi.org/10.1111/evj.12680 Publication
Researcher Affiliations
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
- Istituto Sperimentale Italiano Lazzaro Spallanzani, Milan, Italy.
- Dipartimento di Scienze Cliniche e Medicina Traslazionale, University of Rome Tor Vergata, Rome, Italy.
- Dipartimento di Medicina Veterinaria, University of Milan, Milan, Italy.
- Istituto di Biochimica e Biochimica Clinica, Università Cattolica, Milan, Italy.
- CDVet, Laboratorio Analisi Veterinarie, Rome, Italy.
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
MeSH Terms
- Adrenal Cortex Hormones / therapeutic use
- Animals
- Asthma / drug therapy
- Asthma / veterinary
- Bronchodilator Agents / therapeutic use
- Horse Diseases / drug therapy
- Horses
Citations
This article has been cited 11 times.- Stucchi L, Lo Feudo CM, Stancari G, Conturba B, Ferrucci F. Effect of the Administration of a Nutraceutical Supplement in Racehorses with Lower Airway Inflammation. Animals (Basel) 2022 Sep 19;12(18).
- Calzetta L, Pistocchini E, Ritondo BL, Cavalli F, Camardelli F, Rogliani P. Muscarinic receptor antagonists and airway inflammation: A systematic review on pharmacological models. Heliyon 2022 Jun;8(6):e09760.
- Mainguy-Seers S, Lavoie JP. Glucocorticoid treatment in horses with asthma: A narrative review. J Vet Intern Med 2021 Jul;35(4):2045-2057.
- Calzetta L, Ritondo BL, Coppola A, Matera MG, Di Daniele N, Rogliani P. Factors Influencing the Efficacy of COVID-19 Vaccines: A Quantitative Synthesis of Phase III Trials. Vaccines (Basel) 2021 Apr 1;9(4).
- de Wasseige S, Picotte K, Lavoie JP. Nebulized dexamethasone sodium phosphate in the treatment of horses with severe asthma. J Vet Intern Med 2021 May;35(3):1604-1611.
- Hu D, O'Connor AM, Wang C, Sargeant JM, Winder CB. How to Conduct a Bayesian Network Meta-Analysis. Front Vet Sci 2020;7:271.
- Sheats MK, Davis KU, Poole JA. Comparative Review of Asthma in Farmers and Horses. Curr Allergy Asthma Rep 2019 Oct 10;19(11):50.
- Boivin R, Pilon F, Lavoie JP, Leclere M. Adherence to treatment recommendations and short-term outcome of pleasure and sport horses with equine asthma. Can Vet J 2018 Dec;59(12):1293-1298.
- Lavoie JP, Leclere M, Rodrigues N, Lemos KR, Bourzac C, Lefebvre-Lavoie J, Beauchamp G, Albrecht B. Efficacy of inhaled budesonide for the treatment of severe equine asthma. Equine Vet J 2019 May;51(3):401-407.
- Jacobson GA, Raidal S, Hostrup M, Calzetta L, Wood-Baker R, Farber MO, Page CP, Walters EH. Long-Acting β2-Agonists in Asthma: Enantioselective Safety Studies are Needed. Drug Saf 2018 May;41(5):441-449.
- Rogliani P, Matera MG, Ora J, Cazzola M, Calzetta L. The impact of dual bronchodilation on cardiovascular serious adverse events and mortality in COPD: a quantitative synthesis. Int J Chron Obstruct Pulmon Dis 2017;12:3469-3485.
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