FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / J Vet Intern Med / Relationship between tracheobronchoscopic score and bronchoa...
Journal of veterinary internal medicine2019; 34(1); 322-329; doi: 10.1111/jvim.15676

Relationship between tracheobronchoscopic score and bronchoalveolar lavage red blood cell numbers in the diagnosis of exercise-induced pulmonary hemorrhage in horses.

Abstract: Exercise-induced pulmonary hemorrhage (EIPH) is diagnosed and its severity assessed by post-exercise tracheobronchoscopy, and enumeration of bronchoalveolar lavage fluid red blood cells (BALFRBC). Minimal information is available regarding the relationship of tracheobronchoscopy score to BALFRBC number. Objective: Evaluate the relationship between BALFRBC number and tracheobronchoscopy scores and determine their diagnostic sensitivities. Methods: Nine sedentary horses, 21 fit Thoroughbreds, 129 Barrel Racers. Methods: Normal BALFRBC number and the effect of bronchoalveolar lavage (BAL) on it were evaluated by performing 2 BALs 24 hours apart in sedentary horses. Tracheobronchoscopy followed by BAL was performed 247 times on 150 horses after treadmill, racetrack, or barrel racing exercise. Lastly, a BALFRBC diagnostic threshold number that optimized the geometric mean of the sensitivity and precision (F1-score) was determined using Bayesian analysis. Results: No increase in BALFRBC occurred after the second BAL (mean ± SD, 304 ± 173/μL). Tracheobronchoscopy scores ranged from 0 (n = 112) to 4 (n = 4) and BALFRBC ranged from 102 to 4605268/μL. Spearman correlation between tracheobronchoscopy score and BALFRBC was weak (P < .001; rs = 0.42) with large ranges of BALFRBC associated with each tracheobronchoscopy score. The highest F1-score occurred for a BALFRBC threshold number = 992/μL. Seventy-five tracheobronchoscopy scores equaled 0 although BALFRBC number was ≥992/μL. Sensitivity of tracheobronchoscopy for diagnosing EIPH was poor (0.59; 95% confidence intervals [CI], 0.49-0.68), compared to BALFRBC number ≥992/μL (0.93; 95% CI, 0.88-0.96). Conclusions: False negatives are common with tracheobronchoscopy. Follow-up determination of BALFRBC may be indicated for tracheobronchoscopy scores = 0 before EIPH can be ruled out.
© 2019 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Get Full Text
Publication Date: 2019-12-27 PubMed ID: 31880352PubMed Central: PMC6979084DOI: 10.1111/jvim.15676Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • 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.

The research article studies the relationship between bronchoalveolar lavage fluid red blood cells (BALFRBC) count and the tracheobronchoscopy scores, a method used in diagnosing Exercise-Induced Pulmonary Hemorrhage (EIPH) in horses. The study finds a weak correlation between the two, suggesting a higher emphasis on the BALFRBC count in diagnosis for more accurate results.

Research Purpose

  • The primary purpose of this research is to evaluate the relationship between the number of bronchoalveolar lavage fluid red blood cells (BALFRBC) and the tracheobronchoscopic scores in horses, which are used in diagnosing Exercise-Induced Pulmonary Hemorrhage (EIPH).

Methodology

  • The research involved examining nine sedentary horses and 21 physically fit thoroughbreds, along with 129 Barrel Racing horses.
  • Normalization of BALFRBC numbers and the influence of bronchoalveolar lavage (BAL) on it were gauged by conducting two BAL tests 24 hours apart on the sedentary horses.
  • Tracheobronchoscopic tests followed by BAL were conducted a total of 247 times on a group of 150 different horses after they underwent treadmill, racetrack, or barrel racing exercises.
  • By using Bayesian analysis, a BALFRBC diagnostic threshold number was determined that optimizes the geometric mean of the sensitivity and precision, also known as the F1-score.

Results

  • The second BAL test did not show an increase in BALFRBC (mean ± SD, 304 ± 173/μL).
  • Tracheobronchoscopy scores ranged from 0 (n = 112) to 4 (n = 4), and BALFRBC ranged from 102 to 4605268/μL.
  • There was a weak correlation between tracheobronchoscopy score and BALFRBC (P <  .001; rs = 0.42), with large ranges of BALFRBC associated with each tracheobronchoscopy score.
  • The highest F1-score (a measure of test accuracy) was found when the BALFRBC threshold number was set at 992/μL.
  • Even when tracheobronchoscopy scores were at 0, 75 results had BALFRBC numbers above or equal to the diagnostic threshold of 992/μL.
  • The sensitivity of the tracheobronchoscopy test in diagnosing EIPH was quite low (0.59; 95% confidence intervals [CI], 0.49-0.68) compared to BALFRBC number ≥992/μL (0.93; 95% CI, 0.88-0.96).

Conclusions

  • The study concludes that tracheobronchoscopy has a high rate of false negatives in diagnosing EIPH.
  • Research suggests that a follow-up determination of BALFRBC may be necessary when tracheobronchoscopy scores are equal to 0, in order to properly rule out the presence of EIPH.

Cite This Article

APA
Lopez Sanchez CM, Kogan C, Gold JR, Sellon DC, Bayly WM. (2019). Relationship between tracheobronchoscopic score and bronchoalveolar lavage red blood cell numbers in the diagnosis of exercise-induced pulmonary hemorrhage in horses. J Vet Intern Med, 34(1), 322-329. https://doi.org/10.1111/jvim.15676

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 34
Issue: 1
Pages: 322-329

Researcher Affiliations

Lopez Sanchez, Carolina M
  • Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington.
Kogan, Clark
  • Center for Interdisciplinary Statistical Education and Research, Washington State University, Pullman, Washington.
Gold, Jenifer R
  • Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington.
Sellon, Debra C
  • Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington.
Bayly, Warwick M
  • Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington.

MeSH Terms

  • Animals
  • Bronchoalveolar Lavage Fluid / cytology
  • Bronchoscopy / veterinary
  • Erythrocyte Count
  • Hemorrhage / diagnosis
  • Hemorrhage / etiology
  • Hemorrhage / veterinary
  • Horse Diseases / diagnosis
  • Horse Diseases / etiology
  • Horses
  • Lung Diseases / diagnosis
  • Lung Diseases / etiology
  • Lung Diseases / veterinary
  • Physical Conditioning, Animal / adverse effects

Grant Funding

  • New York Racing Association
  • American Association of Equine Practitioners Foundation
  • Churchill Downs
  • Del Mar Thoroughbred Club
  • Grayson-Jockey Club Research Foundation
  • Keeneland Racetrack
  • Kentucky Downs
  • Oak Tree Racing Association
  • Oaklawn Racetrack
  • The Stronach Group
  • Thoroughbred Horseman's Association
  • Washington State University College of Veterinary Medicine Equine Research Program

Conflict of Interest Statement

Dr. Bayly and Dr. Sellon are former members of the Board of Directors of the American Association of Equine Practitioners. Dr. Bayly is currently a member of the Grayson‐Jockey Club Research Advisory Committee, but was not at the time of funding. The other authors have no conflicts of interest.

References

This article includes 31 references
  1. Sullivan S, Hinchcliff K. Update on exercise‐induced pulmonary hemorrhage. Vet Clin Equine Pract 2015;31:187‐198.
    doi: 10.1016/j.cveq.2014.11.011pubmed: 25770069google scholar: lookup
  2. Hinchcliff KW, Couetil LL, Knight PK. Exercise induced pulmonary hemorrhage in horses: American College of Veterinary Internal Medicine consensus statement. J Vet Intern Med 2015;29:743‐758.
    doi: 10.1111/jvim.12593pmc: PMC4895427pubmed: 25996660google scholar: lookup
  3. Hopkins SR, Schoene RB, Henderson WR, Spragg RG, Martin TR, West JB. Intense exercise impairs the integrity of the pulmonary blood‐gas barrier in elite athletes. Am J Resp Crit Care Med 1997;155:1090‐1094.
    pubmed: 9116992
  4. Epp TS, Szladovits B, Buchannan A. Evidence supporting exercise‐induced pulmonary haemorrhage in racing greyhounds. Comp Exerc Physiol 2008;5:21‐32.
    doi: 10.1017/S147806150891906Xgoogle scholar: lookup
  5. Schnabel R, van der Velden K, Osinski A. Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients. BMC Pulm Med 2015;15:107‐115.
    doi: 10.1186/s12890-015-0104-1pmc: PMC4588466pubmed: 26420333google scholar: lookup
  6. Langsetmo I, Fedde MR, Meyer TS. Relationship of pulmonary arterial pressure to pulmonary haemorrhage in exercising horses. Equine Vet J 2000;32:379‐382.
    pubmed: 11037258
  7. Meyer TS, Fedde MR, Gaughan EM. Quantification of exercise‐induced pulmonary haemorrhage with bronchoalveolar lavage. Equine Vet J 1998;30:284‐288.
    pubmed: 9705109
  8. McKane S, Canfield P, Rose R. Equine bronchoalveolar lavage cytology: survey of thoroughbred racehorses in training. Aust Vet J 1993;70:401‐404.
    doi: 10.1111/j.1751-0813.1993.tb06072.xpubmed: 8280021google scholar: lookup
  9. Poole DC, Kindig CA, Fenton G, Ferguson L, Rush BR, Erickson HH. Effects of external nasal support on pulmonary gas exchange and EIPH in the horse. J Equine Vet Sci 2000;20:579‐585.
    doi: 10.1016/S0737-0806(00)70266-8google scholar: lookup
  10. Gold JR, Knowles DP, Coffey T, Bayly WM. Exercise‐induced pulmonary hemorrhage in barrel racing horses in the Pacific northwest region of the United States. J Vet Intern Med 2018;32:839‐845.
    doi: 10.1111/jvim.15066pmc: PMC5866954pubmed: 29460489google scholar: lookup
  11. Hinchcliff KW, Jackson MA, Morley PS. Association between exercise‐induced pulmonary hemorrhage and performance in thoroughbred racehorses. J Am Vet Med Assoc 2005;227:768‐774.
    pubmed: 16178399
  12. Rose RJ, Hodgson DR, Bayly WM, Gollnick PD. V˙O2 max, and V˙O2 kinetics in the horse: comparison of exercise protocols. Equine Vet J Suppl 1990;9:39‐42.
    pubmed: 9259804
  13. Bayly WM, Slocombe RF, Schott HC, Hodgson DR. Effect of intravenous administration of furosemide on mass‐specific maximal oxygen consumption and breathing mechanics in exercising horses. Am J Vet Res 1999;60:1415‐1422.
    pubmed: 10566819
  14. Walker A, Arent SM, McKeever KH. Maximal aerobic capacity (V˙O2max) in horses: a retrospective study to identify the age‐related decline. Comp Exer Physiol 2010;6:177‐181.
  15. Praet N, Verweij JJ, Mwape KE. Bayesian modelling to estimate the test characteristics of coprology, coproantigen ELISA and a novel real‐time PCR for the diagnosis of taeniasis. Trop Med Int Health 2013;18:608‐614.
    doi: 10.1111/tmi.12089pubmed: 23464616google scholar: lookup
  16. Powers DM. Evaluation: from precision, recall and F‐measure to ROC, informedness, markedness and correlation. J Machine Learning Tech 2011;2:37‐63.
  17. Plummer M. JAGS: a program for analysis of Bayesian graphical models using Gibbs sampling. Proceedings of the 3rd International Workshop on Distributed Statistical Computing, vol. 124, Vienna, Austria; 2003.
  18. Léguillette R, Steinmann M, Bond SL, Stanton B. Tracheobronchoscopic assessment of exercise‐induced pulmonary hemorrhage and airway inflammation in barrel racing horses. J Vet Intern Med 2016;30:1327‐1332.
    doi: 10.1111/jvim.13959pmc: PMC5089608pubmed: 27278854google scholar: lookup
  19. Sweeney CR, Soma LR, Maxson AD, Thompson JE, Holcombe SJ, Spencer PA. Effects of furosemide on the racing times of thoroughbreds. Am J Vet Res 1990;51:772‐778.
    pubmed: 2337276
  20. Lapointe J‐M, Vrins A, McCarvill E. A survey of exercise‐induced pulmonary haemorrhage in Q Standardbred racehorses. Equine Vet J 1994;26:482‐485.
    pubmed: 7889923
  21. Raphel CF, Soma LR. Exercise‐induced pulmonary hemorrhage in thoroughbreds after racing and breezing. Am J Vet Res 1982;43:1123‐1127.
    pubmed: 7103190
  22. Voynick BT, Sweeney CR. Exercised‐induced pulmonary hemorrhage in polo and racing horses. J Am Vet Med Assoc 1986;188:301‐302.
    pubmed: 3949607
  23. Clark C, Lester G, Vetro T, Rice B. Bronchoalveolar lavage in horses: effect of exercise and repeated sampling on cytology. Aust Vet J 1999;72:249‐252.
    doi: 10.1111/j.1751-0813.1995.tb03537.xpubmed: 8534227google scholar: lookup
  24. McKane SA, Slocombe RF. Sequential changes in bronchoalveolar cytology after autologous blood inoculation. Equine Vet J 1999;31(Suppl 30):126‐130.
    doi: 10.1111/j.2042-3306.1999.tb05202.xpubmed: 10659236google scholar: lookup
  25. Step DL, Freeman KP, Gleed RD, Hackett RP. Cytologic and endoscopic findings after intrapulmonary blood inoculation in horses. J Equine Vet Sci 1991;11:3‐345.
  26. Pascoe JR, McCabe AE, Franti CE, Arthur RM. Efficacy of furosemide in the treatment of exercise‐induced pulmonary hemorrhage in thoroughbred racehorses. Am J Vet Res 1985;46:2000‐2003.
    pubmed: 4051304
  27. Fogarty U. Evaluation of a bronchoalveolar lavage technique. Equine Vet J 1990;22:174‐176.
    pubmed: 2361503
  28. Fogarty U, Buckley T. Bronchoalveolar lavage findings in horses with exercise intolerance. Equine Vet J 1991;23:434‐437.
    doi: 10.1111/j.2042-3306.1991.tb03756.xpubmed: 1778160google scholar: lookup
  29. Birks EK, Shuler KM, Soma LR. EIPH: postrace endoscopic evaluation of Standardbreds and thoroughbreds. Equine Vet J Suppl 2002;34(Suppl 34):375‐378.
    doi: 10.1111/j.2042-3306.2002.tb05451.xpubmed: 12405719google scholar: lookup
  30. Hinchcliff KW, Morley PS, Guthrie AJ. Efficacy of furosemide for prevention of exercise‐induced pulmonary hemorrhage in thoroughbred racehorses. J Am Vet Med Assoc 2009;235:76‐82.
    doi: 10.2460/javma.235.1.76pubmed: 19566461google scholar: lookup
  31. Morley PS, Bromberek JL, Saulez MN, Hinchcliff KW, Guthrie AJ. Exercise‐induced pulmonary haemorrhage impairs racing performance in thoroughbred racehorses. Equine Vet J 2015;47:358‐365.
    doi: 10.1111/evj.12368pubmed: 25290262google scholar: lookup
Subscribe to our newsletter
Join 99,344 horse owners like you who receive our email updates on horse health and nutrition.