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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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Morini M, Gobbo F, Rinnovati R, Romagnoli N, Peli A, Massarenti C, Spadari A, Pietra M. Bronchoalveolar Lavage Cytology in Severe Equine Asthma: Cytocentrifugated versus Sediment Smear Preparations. Vet Sci 2023; 10:527. [PMID: 37624314 PMCID: PMC10459724 DOI: 10.3390/vetsci10080527] [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: 06/15/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023] Open
Abstract
Equine asthma is a common respiratory disease that may affect horses of any age. The diagnosis of severe equine asthma (SEA) (historically referred as recurrent airway obstruction or RAO) is based mainly on the history of the animal and clinical signs, which are further supported by the cytological examination of the bronchoalveolar lavage (BAL). This can also be helpful in monitoring the inflammation of the lower airways in response to environmental management and medication. The cytocentrifugated preparation is usually considered the method of choice for BAL cytological interpretation. The aim of this study was to compare the results in terms of differential cell counts (DCC) in BAL cytology performed on sedimented smears and cytocentrifugated preparations. To carry this out, 48 BAL samples were collected from six horses with SEA that were subjected to a process of exacerbation of the disease by environmental stimuli, which was later followed by the appropriate treatment. Each collected BAL fluid was equally divided into duplicate portions: one processed by cytocentrifugation and one by sediment smear from simple centrifugation. Cytologic examination of all BAL by both methods showed poor concordance in DCC, although it was still able to allow diagnostic recognition of severe lung neutrophilic disorders. These results suggest that sediment smear preparation, although remaining a useful method in general equine practice associated with clinical assessments in the diagnosis of SEA under conditions where there is no possibility of using a cytocentrifuge, cannot be considered a comparable alternative.
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Affiliation(s)
- Maria Morini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy; (F.G.); (R.R.); (N.R.); (A.S.); (M.P.)
| | - Francesca Gobbo
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy; (F.G.); (R.R.); (N.R.); (A.S.); (M.P.)
| | - Riccardo Rinnovati
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy; (F.G.); (R.R.); (N.R.); (A.S.); (M.P.)
| | - Noemi Romagnoli
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy; (F.G.); (R.R.); (N.R.); (A.S.); (M.P.)
| | - Angelo Peli
- Department for Life Quality Studies, University of Bologna, Rimini Campus, 47921 Rimini, Italy;
| | - Chiara Massarenti
- Anicura Veterinary Institute of Novara, Granozzo con Monticello, 20060 Novara, Italy;
| | - Alessandro Spadari
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy; (F.G.); (R.R.); (N.R.); (A.S.); (M.P.)
| | - Marco Pietra
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, 40064 Bologna, Italy; (F.G.); (R.R.); (N.R.); (A.S.); (M.P.)
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Herteman N, Mosing M, Waldmann AD, Gerber V, Schoster A. Exercise-induced airflow changes in horses with asthma measured by electrical impedance tomography. J Vet Intern Med 2021; 35:2500-2510. [PMID: 34505734 PMCID: PMC8478024 DOI: 10.1111/jvim.16260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Equine asthma (EA) causes airflow impairment, which increases in severity with exercise. Electrical impedance tomography (EIT) is an imaging technique that can detect airflow changes in standing healthy horses during a histamine provocation test. OBJECTIVES To explore EIT-calculated flow variables before and after exercise in healthy horses and horses with mild-to-moderate (MEA) and severe equine asthma (SEA). ANIMALS Nine healthy horses 9 horses diagnosed with MEA and 5 with SEA were prospectively included. METHODS Recordings were performed before and after 15 minutes of lunging. Absolute values from global and regional peak inspiratory (PIF, positive value) and expiratory (PEF, negative value) flows were calculated. Data were analyzed using a mixed model analysis followed by Bonferroni's multiple comparisons test to evaluate the impact of exercise and diagnosis on flow indices. RESULTS Control horses after exercise had significantly lower global PEF and PIF compared to horses with SEA (mean difference [95% confidence interval, CI]: 0.0859 arbitrary units [AU; 0.0339-0.1379], P < .001 and 0.0726 AU [0.0264-0.1188], P = .001, respectively) and horses with MEA (0.0561 AU [0.0129-0.0994], P = .007 and 0.0587 AU [0.0202-0.0973], P = .002, respectively). No other significant differences were detected. CONCLUSIONS AND CLINICAL IMPORTANCE Electrical impedance tomography derived PIF and PEF differed significantly between healthy horses and horses with SEA or MEA after exercise, but not before exercise. Differences between MEA and SEA were not observed, but the study population was small.
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Affiliation(s)
- Nicolas Herteman
- Clinic for Equine Internal Medicine, Equine Hospital, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Martina Mosing
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Vinzenz Gerber
- Equine Clinic, Swiss Institute of Equine Medicine, University of Bern and Agroscope, Berne, Switzerland
| | - Angelika Schoster
- Clinic for Equine Internal Medicine, Equine Hospital, Vetsuisse Faculty, University of Zurich, Switzerland
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Bowser JE, Costa LRR, Rodil AU, Lopp CT, Johnson ME, Wills RW, Swiderski CE. Effect of a syringe aspiration technique versus a mechanical suction technique and use of N-butylscopolammonium bromide on the quantity and quality of bronchoalveolar lavage fluid samples obtained from horses with the summer pasture endophenotype of equine asthma. Am J Vet Res 2018; 79:348-355. [PMID: 29466051 DOI: 10.2460/ajvr.79.3.348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of 2 bronchoalveolar lavage (BAL) sampling techniques and the use of N-butylscopolammonium bromide (NBB) on the quantity and quality of BAL fluid (BALF) samples obtained from horses with the summer pasture endophenotype of equine asthma. ANIMALS 8 horses with the summer pasture endophenotype of equine asthma. PROCEDURES BAL was performed bilaterally (right and left lung sites) with a flexible videoendoscope passed through the left or right nasal passage. During lavage of the first lung site, a BALF sample was collected by means of either gentle syringe aspiration or mechanical suction with a pressure-regulated wall-mounted suction pump. The endoscope was then maneuvered into the contralateral lung site, and lavage was performed with the alternate fluid retrieval technique. For each horse, BAL was performed bilaterally once with and once without premedication with NBB (21-day interval). The BALF samples retrieved were evaluated for volume, total cell count, differential cell count, RBC count, and total protein concentration. RESULTS Use of syringe aspiration significantly increased total BALF volume (mean volume increase, 40 mL [approx 7.5% yield]) and decreased total RBC count (mean decrease, 142 cells/μL), compared with use of mechanical suction. The BALF nucleated cell count and differential cell count did not differ between BAL procedures. Use of NBB had no effect on BALF retrieval. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that retrieval of BALF by syringe aspiration may increase yield and reduce barotrauma in horses at increased risk of bronchoconstriction and bronchiolar collapse. Further studies to determine the usefulness of NBB and other bronchodilators during BAL procedures in horses are warranted.
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Effects of sedation and salbutamol administration on hyperpnoea and tidal breathing spirometry in healthy horses. Vet J 2017; 222:22-28. [PMID: 28410672 DOI: 10.1016/j.tvjl.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 02/26/2017] [Accepted: 03/05/2017] [Indexed: 11/20/2022]
Abstract
Sedation is often required to perform pulmonary function testing (PFT) in horses, but drug effects may influence respiratory function. The current study was designed to characterise the effects of sedation and bronchodilator administration on absolute and relative indices of pulmonary function during eupnoeic respiration and carbon dioxide-induced hyperpnoea (rebreathing) in healthy horses using a pneumotachographic spirometry system. Sedation with acetylpromazine (ACP), xylazine, or both drugs in combination was associated with significant reductions in respiratory frequency, minute ventilation and peak airflows during eupnoeic respiration. Peak expiratory airflow occurred later in the respiratory cycle than was observed in untreated horses, and expiratory relative flow-time indices were also affected during eupnoeic respiration. Rebreathing attenuated the effects of sedation on indices of pulmonary function, suggesting that future studies should consider the use of induced hyperpnoea as part of the spirometry protocol. Based on the finding that all sedative agents had some effect on eupnoeic respiration, albeit least pronounced with ACP, the latter drug should be considered for sedation of horses undergoing PFT. Salbutamol increased peak inspiratory flow during eupnoeic respiration in healthy horses.
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Ambrisko TD, Schramel JP, Adler A, Kutasi O, Makra Z, Moens YPS. Assessment of distribution of ventilation by electrical impedance tomography in standing horses. Physiol Meas 2015; 37:175-86. [PMID: 26711858 DOI: 10.1088/0967-3334/37/2/175] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim was to evaluate the feasibility of using electrical impedance tomography (EIT) in horses. Thoracic EIT was used in nine horses. Thoracic and abdominal circumference changes were also measured with respiratory ultrasound plethysmography (RUP). Data were recorded during baseline, rebreathing of CO2 and sedation. Three breaths were selected for analysis from each recording. During baseline breathing, horses regularly took single large breaths (sighs), which were also analysed. Functional EIT images were created using standard deviations (SD) of pixel signals and correlation coefficients (R) of each pixel signal with a reference respiratory signal. Left-to-right ratio, centre-of-ventilation and global-inhomogeneity-index were calculated. RM-ANOVA and Bonferroni tests were used (P < 0.05). Distribution of ventilation shifted towards right during sighs and towards dependent regions during sighs, rebreathing and sedation. Global-inhomogeneity-index did not change for SD but increased for R images during sedation. The sum of SDs for the respiratory EIT signals correlated well with thoracic (r(2) = 0.78) and abdominal (r(2) = 0.82) tidal circumferential changes. Inverse respiratory signals were identified on the images at sternal location and based on reviewing CT images, seemed to correspond to location of gas filled intestines. Application of EIT in standing non-sedated horses is feasible. EIT images may provide physiologically useful information even in situations, such as sighs, that cannot easily be tested by other methods.
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Affiliation(s)
- T D Ambrisko
- Anaesthesiology and perioperative Intensive-Care Medicine, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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Cian F, Monti P, Durham A. Cytology of the lower respiratory tract in horses: An updated review. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12376] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- F. Cian
- Animal Health Trust; Newmarket Suffolk UK
| | - P. Monti
- Dick White Referrals; Six Mile Bottom Suffolk UK
| | - A. Durham
- Liphook Equine Hospital; Liphook Hampshire UK
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Rettmer H, Hoffman AM, Lanz S, Oertly M, Gerber V. Owner-reported coughing and nasal discharge are associated with clinical findings, arterial oxygen tension, mucus score and bronchoprovocation in horses with recurrent airway obstruction in a field setting. Equine Vet J 2014; 47:291-5. [DOI: 10.1111/evj.12286] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 04/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- H. Rettmer
- Swiss Institute of Equine Medicine; University of Berne and ALP-Haras; Switzerland
| | - A. M. Hoffman
- Department of Clinical Sciences; Tufts University Cummings School of Veterinary Medicine; Boston Massachusetts USA
| | - S. Lanz
- Swiss Institute of Equine Medicine; University of Berne and ALP-Haras; Switzerland
| | - M. Oertly
- Swiss Institute of Equine Medicine; University of Berne and ALP-Haras; Switzerland
| | - V. Gerber
- Swiss Institute of Equine Medicine; University of Berne and ALP-Haras; Switzerland
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Tee SY, Dart AJ, MacDonald MH, Perkins NR, Horadagoda N, Jeffcott LB. Effects of collecting serial tracheal aspirate and bronchoalveolar lavage samples on the cytological findings of subsequent fluid samples in healthy Standardbred horses. Aust Vet J 2012; 90:247-51. [DOI: 10.1111/j.1751-0813.2012.00950.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Time-dependent changes of cytokines mRNA in bronchoalveolar lavage fluid from symptomatic recurrent airway obstruction-affected horses. Pol J Vet Sci 2011; 14:343-51. [PMID: 21957726 DOI: 10.2478/v10181-011-0052-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During an 18 day test, we measured the cytokine mRNA expression (Interleukin-1beta [IL-1beta], Interleukin-8 [IL-8], Interferon-gamma [IFN-gamma], Tumor Necrosis Factor-alpha [TNF-alpha]) of cells from bronchoalveolar lavage fluid [BALF] in five horses previously diagnosed with RAO, before and during challenge exposure, and after the desensitization phase which involved dexamethasone treatment and environmental modification. Simultaneously, the same cytokine mRNA expression of cells from BALF in four asymptomatic RAO-affected horses maintained outdoors was analyzed. An evident respiratory distress was observed in the challenge group within 3 days, with a significant overexpression of IL-8 and TNF-alpha mRNA on the ninth day. The pharmacological and environmental desensitization provided a down regulation of all the cytokines. No statistical modification characterized the cytokine kinetics of the asymptomatic horses maintained outdoors. A comparison for each time point of the cytokines between the exposed and unexposed horses showed no significant differences. The study suggested that a standardized exposure protocol and sampling time in experimental studies of RAO is mandatory for a correct comparison of the results obtained by different Authors. However, the absence of significant changes between the exposed and unexposed horses could depend on the lack of the sample uniformity since the evolution of the disease represents a continuum from a healthy to a pathological condition.
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Mazan MR, Vin R, Hoffman AM. Radiographic scoring lacks predictive value in inflammatory airway disease. Equine Vet J 2006; 37:541-5. [PMID: 16295932 DOI: 10.2746/042516405775314899] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Diagnosis of inflammatory airway disease (IAD) currently rests upon the results of bronchoalveolar lavage (BAL) cytology, lung function testing and histamine bronchoprovocation (HBP), none of which provides direct information about structural change in the lung. HYPOTHESIS That thoracic radiography might better portray structural change in the lungs and therefore offer a good clinical assessment of IAD. METHODS A radiographic scoring system was developed to assess the extent of bronchial and interstitial pattern on thoracic radiographs in the dorsocaudal, dorsocranial and caudoventral regions in 16 control horses and 33 horses with IAD. Mean scores were compared to ascertain whether thoracic radiographs could distinguish between the 2 groups. In order to determine whether independent observers reliably scored radiographs similarly, an inter-rater reliability score was employed for each radiographic observation. Correlations between radiographic scores, BAL cytology, lung function testing using the forced oscillatory technique and HBP were examined. RESULTS Inter-rater reliability was only moderate. Radiographic scoring demonstrated no differences between the 2 groups. There were no correlations among BAL cytology, lung function testing, HBP and radiographic scores. CONCLUSIONS AND POTENTIAL RELEVANCE Thoracic radiographs are a low-yield diagnostic modality in horses with a clinical history compatible with IAD. In the absence of clinical evidence of more extensive, infectious disease, thoracic radiographs neither refine nor improve diagnosis of IAD, but increase diagnostic costs.
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Affiliation(s)
- M R Mazan
- Lung Function Laboratory, Tufts University School of Veterinary Medicine, 200 Westboro Road, North Grafton, Massachusetts 01536, USA
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