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Simões J, Tilley P. Decision Making in Severe Equine Asthma-Diagnosis and Monitoring. Animals (Basel) 2023; 13:3872. [PMID: 38136909 PMCID: PMC10740644 DOI: 10.3390/ani13243872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Decision making consists of gathering quality data in order to correctly assess a situation and determine the best course of action. This process is a fundamental part of medicine and is what enables practitioners to accurately diagnose diseases and select appropriate treatment protocols. Despite severe equine asthma (SEA) being a highly prevalent lower respiratory disease amongst equids, clinicians still struggle with the optimization of routine diagnostic procedures. The use of several ancillary diagnostic tests has been reported for disease identification and monitoring, but many are only suitable for research purposes or lack practicality for everyday use. The aim of this paper is to assist the equine veterinarian in the process of decision making associated with managing SEA-affected patients. This review will focus on disease diagnosis and monitoring, while also presenting a flow-chart which includes the basic data that the clinician must obtain in order to accurately identify severely asthmatic horses in their everyday routine practice. It is important to note that European and American board-certified specialists on equine internal medicine can provide assistance in the diagnosis and treatment plan of SEA-affected horses.
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Affiliation(s)
- Joana Simões
- Equine Health and Welfare Academic Division, Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisbon, Portugal
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4Animals), Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Paula Tilley
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4Animals), Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
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Frippiat T, Art T, Tosi I. Airway Hyperresponsiveness, but Not Bronchoalveolar Inflammatory Cytokines Profiles, Is Modified at the Subclinical Onset of Severe Equine Asthma. Animals (Basel) 2023; 13:2485. [PMID: 37570294 PMCID: PMC10417247 DOI: 10.3390/ani13152485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
Airway hyperresponsiveness (AHR) and inflammation are both observed in human and equine asthma. The aim of this study was to assess the timeline and relationship of both features at the subclinical onset of severe equine asthma (SEA). First, the repeatability of the pulmonary function test (PFT) using impulse oscillometry system, and the methacholine bronchoprovocation test (BPT) were assessed at a 1-day interval on six SEA horses in clinical remission and six control horses. Then, clinical and ancillary tests were performed before and after a 1-week low-dust environmental challenge, including weighted clinical score, respiratory endoscopy, bronchoalveolar fluid cytology, PFT, and BPT. Both PFT and BPT showed acceptable repeatability. No test allowed SEA horses in clinical remission to be distinguished from control, unlike in human patients. Because of the low-dust environment, no significant difference was observed in the results of clinical and conventional ancillary examinations after the challenge. However, SEA horses showed increased AHR after the environmental challenge. At that stage, no signs of inflammation or changes in pro-inflammatory cytokines profiles (quantification and gene expression) were observed, suggesting AHR is present at an earlier stage of equine asthma than airway inflammation. This feature indicates SEA could present in a different disease pathway than neutrophilic human asthma.
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Affiliation(s)
- Thibault Frippiat
- Equine Sports Medicine Centre, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000 Liege, Belgium
- Sportpaardenarts–Equine Sports Medicine, 1250AD Laren, The Netherlands
| | - Tatiana Art
- Equine Sports Medicine Centre, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000 Liege, Belgium
| | - Irene Tosi
- Equine Sports Medicine Centre, FARAH Research Centre, Faculty of Veterinary Medicine, University of Liège, 4000 Liege, Belgium
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Lo Feudo CM, Stucchi L, Conturba B, Stancari G, Ferrucci F. Impact of Lower Airway Inflammation on Fitness Parameters in Standardbred Racehorses. Animals (Basel) 2022; 12:ani12223228. [PMID: 36428455 PMCID: PMC9687017 DOI: 10.3390/ani12223228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
Abstract
Mild-moderate equine asthma (MEA) is a common respiratory disorder among racehorses, characterized by lower airway inflammation. Although it is generally agreed that MEA causes poor performance, contrasting results have been reported about the effects of tracheal mucus and the leukocyte populations of the bronchoalveolar lavage (BAL) on performance. This study aims to investigate the associations between airway inflammation and fitness parameters measured during an incremental treadmill test on Standardbred racehorses. For this purpose, the clinical records of 116 Standardbreds subjected to a diagnostic protocol for poor performance were retrospectively reviewed. Parametric and nonparametric statistics were used to evaluate the relationships between endoscopic scores, BAL cytological results, and fitness parameters. Moreover, horses were divided into MEA and non-MEA groups and into neutrophilic, eosinophilic-mastocytic, and mixed MEA groups; fitness parameters were compared between groups. Neutrophils percentages were inversely correlated with the speed at a heart rate of 200 bpm, the speed and heart rate at a plasma lactate concentration of 4 mmol/L (VLa4 and HRLa4), and the maximal speed, while they were positively correlated with higher lactate concentrations. Moreover, significant differences were detected between different MEA subtypes concerning VLa4, HRLa4, and lactate concentrations. These results suggest that airway neutrophilic inflammation impairs athletic capacity in Standardbreds.
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Affiliation(s)
- Chiara Maria Lo Feudo
- Equine Sports Medicine Laboratory “Franco Tradati”, Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900 Lodi, Italy
| | - Luca Stucchi
- Equine Unit, Veterinary Teaching Hospital, Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900 Lodi, Italy
| | - Bianca Conturba
- Equine Unit, Veterinary Teaching Hospital, Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900 Lodi, Italy
| | - Giovanni Stancari
- Equine Unit, Veterinary Teaching Hospital, Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900 Lodi, Italy
| | - Francesco Ferrucci
- Equine Sports Medicine Laboratory “Franco Tradati”, Department of Veterinary Medicine and Animal Sciences, University of Milan, 26900 Lodi, Italy
- Correspondence: ; Tel.: +39-0250334146
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Lo Feudo CM, Stucchi L, Alberti E, Stancari G, Conturba B, Zucca E, Ferrucci F. The Role of Thoracic Ultrasonography and Airway Endoscopy in the Diagnosis of Equine Asthma and Exercise-Induced Pulmonary Hemorrhage. Vet Sci 2021; 8:vetsci8110276. [PMID: 34822649 PMCID: PMC8619806 DOI: 10.3390/vetsci8110276] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 01/23/2023] Open
Abstract
Mild-moderate (MEA), severe (SEA) equine asthma and exercise-induced pulmonary hemorrhage (EIPH) are common respiratory disorders in horses. The present retrospective study aims to evaluate the role of ultrasonography and endoscopy in the diagnosis of these conditions. Three hundred and three horses were included and divided into SEA, MEA and MEA + EIPH groups, on the basis of history, clinical examination and bronchoalveolar lavage fluid (BALf) cytology; scores were assigned to lung ultrasonography, pharyngeal lymphoid hyperplasia (PLH), tracheal mucus (TM) and tracheal bifurcation edema (TB). These scores were compared between groups, and their associations with age, BALf cytology, tracheal wash microbiology and between endoscopic and ultrasonographic scores were statistically analyzed. Ultrasonographic scores were higher in the SEA and MEA + EIPH groups and associated with increased BALf neutrophils and hemosiderophages. The PLH score was higher in younger horses affected by MEA and EIPH and associated with increased eosinophils and hemosiderophages. TM and TB scores were greater in older horses affected by SEA, associated with increased neutrophils and inversely correlated with hemosiderophages. Moreover, TM grade was negatively correlated with mast cells. Thoracic ultrasonography and airway endoscopy can provide useful information about the inflammatory status of upper and lower airways in the horse.
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Affiliation(s)
- Chiara Maria Lo Feudo
- Equine Sports Medicine Laboratory “Franco Tradati”, Department of Veterinary Medicine, Università Degli Studi di Milano, 26900 Lodi, Italy; (C.M.L.F.); (E.A.); (E.Z.)
| | - Luca Stucchi
- Veterinary Teaching Hospital, Università Degli Studi di Milano, 26900 Lodi, Italy; (L.S.); (G.S.); (B.C.)
| | - Elena Alberti
- Equine Sports Medicine Laboratory “Franco Tradati”, Department of Veterinary Medicine, Università Degli Studi di Milano, 26900 Lodi, Italy; (C.M.L.F.); (E.A.); (E.Z.)
| | - Giovanni Stancari
- Veterinary Teaching Hospital, Università Degli Studi di Milano, 26900 Lodi, Italy; (L.S.); (G.S.); (B.C.)
| | - Bianca Conturba
- Veterinary Teaching Hospital, Università Degli Studi di Milano, 26900 Lodi, Italy; (L.S.); (G.S.); (B.C.)
| | - Enrica Zucca
- Equine Sports Medicine Laboratory “Franco Tradati”, Department of Veterinary Medicine, Università Degli Studi di Milano, 26900 Lodi, Italy; (C.M.L.F.); (E.A.); (E.Z.)
| | - Francesco Ferrucci
- Equine Sports Medicine Laboratory “Franco Tradati”, Department of Veterinary Medicine, Università Degli Studi di Milano, 26900 Lodi, Italy; (C.M.L.F.); (E.A.); (E.Z.)
- Correspondence: ; Tel.: +39-0250334146
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Barton AK, Schulze T, Doherr MG, Gehlen H. Influence of bronchoalveolar lavage on thoracic radiography in the horse. J Vet Sci 2018; 19:563-569. [PMID: 29486534 PMCID: PMC6070596 DOI: 10.4142/jvs.2018.19.4.563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
Bronchoalveolar lavage (BAL) and thoracic radiography are routinely performed diagnostic procedures. We hypothesized that BAL increases the interstitial opacity of caudoventral and caudodorsal thoracic radiographs. Fifty-three horses, including 8 clinic owned and 45 from a referral hospital population, were classified as healthy controls (n = 12), severe equine asthma (recurrent airway obstruction, n = 12) or mild-to-moderate equine asthma (inflammatory airway disease, n = 21) based on the results of a clinical scoring system. Eight were excluded due to different diagnoses and poor image quality. Four randomized thoracic radiographs of each horse were scored by two blinded observers, who were also asked to identify the image as obtained before or after a BAL procedure. In severe equine asthma, the chance (adjusted odds) of misinterpretation of the correct imaging time was approximately 5 times higher than in controls (odds ratio [OR] = 5.373, p = 0.028). The chance of misinterpretation was approximately 4 times lower in caudodorsal images than in caudoventral projections (OR = 0.241, p = 0.004). Identification of the correct imaging time was highly correlated with an increase in interstitial opacity (OR = 9.976, p < 0.0001). In conclusion, we recommend performing BAL after thoracic radiography to avoid possible misinterpretation.
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Affiliation(s)
- Ann K Barton
- Equine Clinic for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Thorben Schulze
- Equine Clinic for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Marcus G Doherr
- Institute for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Heidrun Gehlen
- Equine Clinic for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
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Mazan MR. Lower Airway Disease in the Athletic Horse. Vet Clin North Am Equine Pract 2018; 34:443-460. [PMID: 30007452 DOI: 10.1016/j.cveq.2018.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The airways are the first part of the pathway in the oxygen transport chain that is critical to excellent athletic performance, and the lower airways are considered the final gatekeeper before oxygen enters the blood and carbon dioxide exits. Horses are blessed with large airways and lungs that allow them to be superb athletes, but the down side of this largesse on the part of evolution is that unless they are truly elite athletes they may withstand noninfectious disease of the lower respiratory tract for months to years before the owner or trainer notices. The two conditions of the lower respiratory tract that affect the athletic horse during exercise are exercise-induced pulmonary hemorrhage and inflammatory airway disease. The former may be considered, at least at the onset, as a problem of physiology rather than a disease, and the latter is a disease primarily of domestication: both are widespread among the athletic horse population and account for an impressive number of horses that fail to perform to their potential. Because of the high demands for oxygen in the athletic horse, even minor insults to the oxygen-carrying capacity of the body can affect performance, so it is of critical importance to keep the lungs as healthy as possible.
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Affiliation(s)
- Melissa R Mazan
- Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01536, USA.
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Mazan MR. Update on noninfectious inflammatory diseases of the lower airway. Vet Clin North Am Equine Pract 2015; 31:159-85. [PMID: 25770068 DOI: 10.1016/j.cveq.2014.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Inflammatory airway disease and recurrent airway obstruction are 2 nonseptic diseases of the equine respiratory system with a shared cause of exposure to particulate matter. They appear to occupy 2 ends of a spectrum of disease, but are differentiated by history, clinical signs, and response to treatment. Diagnosis can be made by sampling of respiratory fluids and lung function testing. Treatment consists of environmental modification and pharmacologic treatment with systemic or inhaled corticosteroids and bronchodilators.
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Affiliation(s)
- Melissa R Mazan
- Large Animal Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, 200 Westborough Road, North Grafton, MA 01536, USA.
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Pirie RS. Recurrent airway obstruction: a review. Equine Vet J 2014; 46:276-88. [PMID: 24164473 DOI: 10.1111/evj.12204] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/05/2013] [Indexed: 12/01/2022]
Abstract
Recurrent airway obstruction is a widely recognised airway disorder, characterised by hypersensitivity-mediated neutrophilic airway inflammation and lower airway obstruction in a subpopulation of horses when exposed to suboptimal environments high in airborne organic dust. Over the past decade, numerous studies have further advanced our understanding of different aspects of the disease. These include clarification of the important inhaled airborne agents responsible for disease induction, improving our understanding of the underlying genetic basis of disease susceptibility and unveiling the fundamental immunological mechanisms leading to establishment of the classic disease phenotype. This review, as well as giving a clinical overview of recurrent airway obstruction, summarises much of the work in these areas that have culminated in a more thorough understanding of this debilitating disease.
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Affiliation(s)
- R S Pirie
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Roslin, Midlothian, UK
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Depecker M, Richard EA, Pitel PH, Fortier G, Leleu C, Couroucé-Malblanc A. Bronchoalveolar lavage fluid in Standardbred racehorses: Influence of unilateral/bilateral profiles and cut-off values on lower airway disease diagnosis. Vet J 2014; 199:150-6. [DOI: 10.1016/j.tvjl.2013.10.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 01/30/2023]
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Tilley P, Sales Luis J, Branco Ferreira M. Correlation and discriminant analysis between clinical, endoscopic, thoracic X-ray and bronchoalveolar lavage fluid cytology scores, for staging horses with recurrent airway obstruction (RAO). Res Vet Sci 2012; 93:1006-14. [DOI: 10.1016/j.rvsc.2011.10.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 09/01/2011] [Accepted: 10/28/2011] [Indexed: 10/28/2022]
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Koblinger K, Nicol J, McDonald K, Wasko A, Logie N, Weiss M, Léguillette R. Endoscopic Assessment of Airway Inflammation in Horses. J Vet Intern Med 2011; 25:1118-26. [DOI: 10.1111/j.1939-1676.2011.00788.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/21/2011] [Accepted: 07/15/2011] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - J. Nicol
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - K. McDonald
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - A. Wasko
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - N. Logie
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - M. Weiss
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
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