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Hansen S, Otten ND, Nissen SD, Carstensen H, Hopster-Iversen C, Fjeldborg J, Staun SH, Fenner M, Hesselkilde EM, Buhl R. Atrial fibrillation as a risk factor for exercise-induced pulmonary haemorrhage following a standardised exercise test. Equine Vet J 2024; 56:552-561. [PMID: 37654233 DOI: 10.1111/evj.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) has been proposed as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) due to increased pressure in the left atrium. OBJECTIVE To evaluate if AF was associated with EIPH following a standardised exercise test (SET) to fatigue. STUDY DESIGN Two-arm controlled experiment. METHODS Ten untrained Standardbred mares mean (standard deviation [SD]) age 6 (2) years performed a SET on the treadmill in sinus rhythm (SR) (SET1) and 25-44 days after induction of self-sustained AF (SET2). AF was induced by tachypacing using a pacing device. Endoscopy, including tracheal wash and bronchoalveolar lavage (BAL), was performed 48-72 h before and 24 h after the two SETs. In addition, endoscopic grading of tracheal blood was performed 2 h after each SET. RESULTS After SET1, none of the horses showed blood in the trachea, and two horses showed erythrophagocytosis. Following SET2, two horses had grade 1 blood in the trachea and free erythrocytes and erythrophagocytosis in the BAL, while another two horses had erythrophagocytosis in the BAL. In SET2, the overall performance on the treadmill was decreased with a lower maximum velocity (SET1 10.3 ± 0.8 m/s vs. SET2 8.9 ± 0.9 m/s, p = 0.004), a higher heart rate (284 ± 21 vs. 221 ± 18 bpm, p = 0.003) and more abnormal QRS complexes (p < 0.001) compared with SET1. CONCLUSIONS Two horses showed signs of EIPH, resulting in visible blood in the trachea, when exercising in AF compared with SR. However, a possible link between EIPH, pulmonary pressure and AF needs to be further elucidated.
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Affiliation(s)
- Sanni Hansen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Nina D Otten
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Sarah D Nissen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Charlotte Hopster-Iversen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Julie Fjeldborg
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Sophie H Staun
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Merle Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Eva M Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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Shoemaker S, Wang Y, Sellon D, Gold J, Fisher A, Bagshaw J, Leguillette R, Sanz M, Bayly W. Prevalence and severity of exercise-induced pulmonary hemorrhage in 2-year-old Thoroughbred racehorses and its relationship to performance. J Vet Intern Med 2024; 38:1167-1176. [PMID: 38363079 PMCID: PMC10937470 DOI: 10.1111/jvim.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Little has been reported regarding the prevalence and severity of exercise-induced pulmonary hemorrhage (EIPH) in 2-year-old Thoroughbred racehorses. OBJECTIVES Evaluate EIPH prevalence and severity and its association with performance, speed index, furosemide administration, race distance, and track surface. ANIMALS A total of 830 2-year-old Thoroughbreds. METHODS Prospective blinded observational study. Videoendoscopy was performed 30 to 60 minutes postrace at 15 American racetracks. Three blinded observers independently assigned an EIPH grade (0-4) to each video, and prevalence and severity of EIPH were determined. Relationships of EIPH grade to performance, speed index, race distance, track surface, and prerace administration of furosemide were evaluated using Pearson's chi-squared test for categorical variables and analysis of variance (ANOVA) for numerical variables. Multivariable logistic regression assessed relationships between EIPH prevalence and severity, respectively, and the aforementioned independent variables. A P < .05 was considered significant. RESULTS A total of 1071 tracheoendoscopies were recorded. The EIPH prevalence was 74% and for EIPH grade ≥3 was 8%. Speed index (P = .02) and finishing place (P = .004) were lower with EIPH ≥3. The EIPH prevalence and severity were lower at 2 tracks where postrace tracheoendoscopy was mandatory rather than voluntary (P < .001). Probability of observing EIPH was negatively associated with speed index (P = .01) at tracks where postrace tracheoendoscopy was mandatory. Prerace furosemide administration decreased the probability of EIPH occurrence (P = .007) and severity (P = .01) where study participation was voluntary. CONCLUSIONS AND CLINICAL IMPORTANCE Prevalence and severity of EIPH in 2-year-old racehorses were consistent with that of older racehorses. An EIPH grade ≥3 was associated with decreased performance. Prerace furosemide administration was associated with a decreased likelihood, but not severity, of EIPH at most tracks.
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Affiliation(s)
- Sierra Shoemaker
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Yuan Wang
- Center for Interdisciplinary Statistical Education and ResearchWashington State UniversityPullmanWashingtonUSA
| | - Debra Sellon
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Jenifer Gold
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Allison Fisher
- Center for Interdisciplinary Statistical Education and ResearchWashington State UniversityPullmanWashingtonUSA
| | - Julia Bagshaw
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Renaud Leguillette
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Macarena Sanz
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Warwick Bayly
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
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Sugiyama F, Takahashi Y, Nomura M, Ebisuda Y, Mukai K, Yoshida T. Risk Factors for Epistaxis in Thoroughbred Flat Races in Japan (2001-2020). Animals (Basel) 2023; 13:ani13081348. [PMID: 37106911 PMCID: PMC10135158 DOI: 10.3390/ani13081348] [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: 02/27/2023] [Revised: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
We investigated the risk factors for epistaxis in Japanese flat races over a 20-year period. The veterinary records of horses identified as having epistaxis by endoscopy on the race day, and the official racing records of all flat races from April to September between 2001 and 2020, were reviewed. The racecourses (n = 10), surface type, surface condition, race class, race distance, race year, sex, age, two training centers, ambient temperature, and body weight on race days were assessed using multivariable logistic regression (p < 0.05). Of 475,709 race starts, 616 (1.30 cases per 1000 starts; 95% confidence interval [CI], 1.20-1.40) included an epistaxis event. Nine variables were significantly associated with epistaxis. Seven of the variables have been reported in previous studies: lower ambient temperature, soft surface conditions, shorter racing distances (≤1400 m), increasing age, females and geldings compared to males, training center, and race year. However, two novel variables were identified as significantly associated with epistaxis, increasing body weight per 20 kg (p < 0.001, odds ratio [OR], 1.33; 95% CI, 1.25-1.41) and the racecourses that the horses were running at (p < 0.001, especially Sapporo [OR; 4.74, 95% CI, 3.07-7.31], Hakodate [OR, 4.66; 95% CI, 3.05-7.11], and Kokura [OR, 4.14; 95% CI, 2.65-6.48] compared to the reference racecourse [Kyoto]). These results can facilitate developing interventions to reduce epistaxis in flat racing.
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Affiliation(s)
- Fumi Sugiyama
- Sports Science Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke 329-0412, Tochigi, Japan
| | - Yuji Takahashi
- Sports Science Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke 329-0412, Tochigi, Japan
| | - Motoi Nomura
- Equine Department, Japan Racing Association, 1-1-1, Nishi-Shinbashi, Minato 105-0003, Tokyo, Japan
| | - Yusaku Ebisuda
- Sports Science Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke 329-0412, Tochigi, Japan
| | - Kazutaka Mukai
- Sports Science Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke 329-0412, Tochigi, Japan
| | - Toshinobu Yoshida
- Sports Science Division, Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke 329-0412, Tochigi, Japan
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McGilvray TA, Cardwell JM. Training related risk factors for exercise induced pulmonary haemorrhage in British National Hunt racehorses. Equine Vet J 2021; 54:283-289. [PMID: 33843093 DOI: 10.1111/evj.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/25/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise induced pulmonary haemorrhage (EIPH) is an important condition of horses performing high intensity exercise, with reported prevalence among racehorses of up to 95%, based on the detection of blood on tracheobronchoscopy. Previously identified risk factors include age, sex, season, race type, years spent in racing and lower airway inflammation. OBJECTIVES To estimate the prevalence of EIPH in British National Hunt racehorses as indicated by two outcome measures: presence of tracheal blood on tracheobronchoscopy, and presence of moderate-large (significant) proportions of haemosiderophages in tracheal wash (TW) fluid; and to identify training-related risk factors for these indicators of EIPH. STUDY DESIGN Prospective longitudinal study. METHODS Data from tracheobronchoscopy and TW cytology were analysed using univariable and multivariable mixed-effects logistic regression. RESULTS 1184 observations, from 177 horses, were analysed. The prevalence of tracheal blood was 7.2% (95%CI: 5.8, 8.8) and significant haemosiderophages in TW fluid was 36% (95%CI: 33.3, 38.8). Increased time in training was significantly associated with increased odds of EIPH. For each additional year spent in training the odds of tracheal blood and presence of significant proportions haemosiderophages increased approximately 1.5-fold (OR = 1.5; 95%CI: 1.1-2.0; P = .005; and OR = 1.5; 95%CI: 1.3, 1.8; P < .001, respectively). Current inflammation was associated with previous haemorrhage, but not current haemorrhage. MAIN LIMITATIONS There are no standardised measures for quantification of TW cytological parameters for EIPH diagnosis. Few horses were examined following jumping. Recent racing dates were not included in analysis. CONCLUSIONS Increasing time in training was a risk factor for both indicators of EIPH. Current inflammation was associated with previous haemorrhage, but not current or future haemorrhage, suggesting that haemorrhage leads to inflammation but not that inflammation leads to haemorrhage. Overall, our findings are consistent with the capillary stress failure theory of EIPH. The development of standardised measures for TW cytological diagnosis of EIPH is warranted.
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Crispe EJ, Lester GD. Exercise-induced Pulmonary Hemorrhage: Is It Important and Can It Be Prevented? Vet Clin North Am Equine Pract 2019; 35:339-350. [PMID: 31084976 DOI: 10.1016/j.cveq.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Exercise-induced pulmonary hemorrhage (EIPH) occurs commonly in horses undergoing strenuous exercise. Reported risk factors include racing in cold temperatures and wearing of bar shoes. In horses with documented moderate to severe EIPH, increasing the interval between races and adopting a negative race pace strategy may reduce the severity of EIPH in subsequent races. EIPH seems to have an impact on performance only when moderate to severe. This occurs in a small number of starters, approximately 6%. EIPH often is erratic in severity from race to race, although across a population it is weakly progressive over increasing race starts.
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Affiliation(s)
- Eleanor J Crispe
- Simon Miller Racing, PO Box 7298, Shenton Park, Western Australia 6008, Australia
| | - Guy D Lester
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Box 100136, Gainesville, FL 32610-0136, USA.
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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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Crispe EJ, Secombe CJ, Perera DI, Manderson AA, Turlach BA, Lester GD. Exercise-induced pulmonary haemorrhage in Thoroughbred racehorses: a longitudinal study. Equine Vet J 2018; 51:45-51. [DOI: 10.1111/evj.12957] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- E. J. Crispe
- College of Veterinary Medicine; School of Veterinary and Life Sciences; Murdoch University; Murdoch Western Australia Australia
| | - C. J. Secombe
- College of Veterinary Medicine; School of Veterinary and Life Sciences; Murdoch University; Murdoch Western Australia Australia
| | - D. I. Perera
- School of Engineering and Information Technology, Mathematics & Statistics; Murdoch University; Murdoch Western Australia Australia
| | - A. A. Manderson
- Centre for Applied Statistics (M019); University of Western Australia; Nedlands Western Australia Australia
| | - B. A. Turlach
- Centre for Applied Statistics (M019); University of Western Australia; Nedlands Western Australia Australia
| | - G. D. Lester
- College of Veterinary Medicine; School of Veterinary and Life Sciences; Murdoch University; Murdoch Western Australia Australia
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8
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Crispe EJ, Lester GD, Secombe CJ, Perera DI. The association between exercise‐induced pulmonary haemorrhage and race‐day performance in Thoroughbred racehorses. Equine Vet J 2017; 49:584-589. [DOI: 10.1111/evj.12671] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- E. J. Crispe
- College of Veterinary Medicine School of Veterinary and Life Sciences Murdoch University Murdoch Western Australia Australia
| | - G. D. Lester
- College of Veterinary Medicine School of Veterinary and Life Sciences Murdoch University Murdoch Western Australia Australia
| | - C. J. Secombe
- College of Veterinary Medicine School of Veterinary and Life Sciences Murdoch University Murdoch Western Australia Australia
| | - D. I. Perera
- College of Veterinary Medicine School of Veterinary and Life Sciences Murdoch University Murdoch Western Australia Australia
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9
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Poole DC, Erickson HH. Exercise-induced pulmonary hemorrhage: where are we now? VETERINARY MEDICINE (AUCKLAND, N.Z.) 2016; 7:133-148. [PMID: 30050846 PMCID: PMC6044800 DOI: 10.2147/vmrr.s120421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As the Thoroughbreds race for the final stretch, 44 hooves flash and thunder creating a cacophony of tortured air and turf. Orchestrated by selective breeding for physiology and biomechanics, expressed as speed, the millennia-old symphony of man and beast reaches its climax. At nearly 73 kilometers per hour (45 mph) over half a ton of flesh and bone dwarfs its limpet-like jockey as, eyes wild and nostrils flaring, their necks stretch for glory. Beneath each resplendent livery-adorned, latherin-splattered coat hides a monstrous heart trilling at 4 beats per second, and each minute, driving over 400 L (105 gallons) of oxygen-rich blood from lungs to muscles. Matching breath to stride frequency, those lungs will inhale 16 L (4 gallons) of air each stride moving >1,000 L/min in and out of each nostril - and yet failing. Engorged with blood and stretched to breaking point, those lungs can no longer redden the arterial blood but leave it dusky and cyanotic. Their exquisitely thin blood-gas barrier, a mere 10.5 μm thick (1/50,000 of an inch), ruptures, and red cells invade the lungs. After the race is won and lost, long after the frenetic crowd has quieted and gone, that blood will clog and inflame the airways. For a few horses, those who bleed extensively, it will overflow their lungs and spray from their nostrils incarnadining the walls of their stall: a horrifically poignant canvas that strikes at horse racing's very core. That exercise-induced pulmonary hemorrhage (EIPH) occurs is a medical and physiological reality. That every reasonable exigency is not taken to reduce/prevent it would be a travesty. This review is not intended to provide an exhaustive coverage of EIPH for which the reader is referred to recent reviews, rather, after a brief reminder of its physiologic and pathologic bases, focus is brought on the latest developments in EIPH discovery as this informs state-of-the-art knowledge, the implementation of that knowledge and recommendations for future research and treatment.
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Affiliation(s)
- David C Poole
- Department of Anatomy and Physiology,
- Department of Kinesiology, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA,
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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; 30:1327-32. [PMID: 27278854 PMCID: PMC5089608 DOI: 10.1111/jvim.13959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/22/2016] [Accepted: 04/13/2016] [Indexed: 11/27/2022] Open
Abstract
Background Poor performance is often suspected to be associated with EIPH in barrel racing horses; however, there are no published reports of EIPH for this discipline. The prevalence of EIPH in barrel racing horses is also unknown. Objectives This study was performed to determine the prevalence of EIPH and signs of airway inflammation in barrel racing horses under normal racing conditions in Alberta. Animals About 170 barrel racing horses. Methods Observational cross‐sectional study. Tracheobronchoscopic examinations were performed at least 30 minutes postrace. Video recordings were scored off‐site independently by two observers for EIPH and tracheal mucus accumulation (TMA). Horses with an EIPH score ≥2 were not assessed for TMA. Interobserver agreement was calculated by weighted κ statistics. Run times, environmental variables, and clinical information were also recorded for analysis. Results 77/170 (45.3%) of horses examined showed evidence of EIPH (grade ≥ 1). Interobserver agreement was 0.94. 140/141 (99.3%) of horses assessed for TMA showed evidence of tracheal mucus accumulation (grade ≥ 1) with 104/141 (73.8%) having a TMA score ≥ 2. Interobserver agreement was 0.73. A weak positive association was found between EIPH scores and average run speed, the presence of cough at rest reported by the riders, increased recovery time, exercise intolerance, and outdoor pattern. Conclusions and clinical importance The high prevalence of EIPH observed in the sampled population indicates that barrel racing induces substantial stress on the lungs. The presence of EIPH did not impact negatively on performance. Factors such as environmental dust and frequent traveling might have contributed to the high prevalence of TMA observed.
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Affiliation(s)
- R Léguillette
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada.,Moore Equine Veterinary Centre, 260048A Writing Creek Cres, Rocky View County, AB, T4A 0M9, Canada
| | - M Steinmann
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - S L Bond
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - B Stanton
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada.,Moore Equine Veterinary Centre, 260048A Writing Creek Cres, Rocky View County, AB, T4A 0M9, Canada
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