Aerosol deposition in equine lungs following ultrasonic nebulisation versus jet aerosol delivery system

Nebulisation of dexamethasone sodium phosphate for the treatment of severe asthmatic horses

BACKGROUND

Inhaled corticosteroids are effective in the treatment of equine asthma. A recent study reported that nebulisation of injectable dexamethasone had low systemic bioavailability in healthy horses and could represent a cost-effective therapy for equine inflammatory lung diseases.

OBJECTIVES

To determine the effects of dexamethasone nebulisation on lung function in severe asthmatic horses. It was hypothesised that dexamethasone administered by nebulisation would be more effective than the same dose administered orally.

STUDY DESIGN

Randomised blinded experimental study in severe asthmatic horses.

METHODS

Twelve severe asthmatic horses in clinical exacerbation were randomly assigned to treatment with 5 mg of dexamethasone sodium phosphate by nebulisation (n = 6) or by oral administration (n = 6), once daily for 7 days. Lung function was evaluated at baseline, after four treatment days (D4) and 24 h after the last dose (D8). The presence of residual bronchospasm was assessed on D8 with N-butylscopolammonium bromide administration (0.3 mg/kg i.v.). A respiratory clinical score was performed daily. Serum cortisol concentration was measured at baseline, D4 and D8.

RESULTS

The pulmonary elastance was unchanged in both groups while pulmonary resistance was significantly improved in the oral group on D8 (mean reduction in 1 cm H₂ O/L/s [CI: 0.34-1.65, P = 0.003]). All horses had residual bronchospasm at the end of the study. There was a group difference in the respiratory clinical score as it was significantly reduced in the oral group, from D5 to D8. Serum cortisol concentration decreased in all subjects.

MAIN LIMITATIONS

Low number of horses and lack of placebo group.

CONCLUSIONS

Considering the lack of improvement of lung function and the hypothalamic-pituitary-adrenal axis suppression, the results of this study do not support aerosolisation of an injectable form of dexamethasone for the treatment of severe equine asthma at the dose and with the nebuliser evaluated.

Inhalation Therapy in Horses

This article discusses the benefits and limitations of inhalation therapy in horses. Inhalation drug therapy delivers the drug directly to the airways, thereby achieving maximal drug concentrations at the target site. Inhalation therapy has the additional advantage of decreasing systemic side effects. Inhalation therapy in horses is delivered by the use of nebulizers or pressured metered dose inhalers. It also requires the use of a muzzle or nasal mask in horses. Drugs most commonly delivered through inhalation drug therapy in horses include bronchodilators, antiinflammatories, and antimicrobials.

Efficacy of Inhaled Levalbuterol Compared to Albuterol in Horses with Recurrent Airway Obstruction

Background

The (R)‐enantiomer of racemic albuterol (levalbuterol) has bronchodilatory properties whereas the (S)‐enantiomer causes adverse effects in human airways, animal models, and isolated equine bronchi. Levalbuterol is commercially available and improves pulmonary function of asthmatic patients with a longer duration of effect than albuterol.

Objective

To determine the dose at which inhaled levalbuterol produces maximal bronchodilatory effect (EDmax) and determine its duration of action in recurrent airway obstruction (RAO)‐affected horses in comparison to racemic albuterol.

Animals

Nine horses with inducible and reversible RAO.

Methods

Randomized, crossover trial. Horses were challenged with moldy hay to induce airway obstruction. Horses were treated with nebulized albuterol or levalbuterol chosen randomly. Pulmonary function testing (PFT) was measured before and for up to 3 hours after bronchodilatation challenge. Maximum change in transpulmonary pressure (DP_max) was measured to assess the dose effect and duration of action of each drug. After a 24 hours washout period, the bronchodilatation challenge was repeated with the second bronchodilator.

Results

The duration of effect was 60 minutes for albuterol and 120 minutes for levalbuterol. The dose of bronchodilator EDmax was not significantly different between albuterol and levalbuterol (EDmax = 125.0 [125–125 μg] and EDmax = 188 [125–188 μg] respectively; P = .068). The magnitude of bronchodilatation was not significantly different between the 2 treatments (61.1 and 59.9% decrease in DP_max for albuterol and levalbuterol respectively; P = .86).

Conclusions and clinical importance

Levalbuterol is as effective a bronchodilator as albuterol; although levalbuterol lasts twice as long as albuterol, its duration of action is still too short to make it practical for RAO treatment.

Recurrent airway obstruction: a review

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.

Vibrational spectroscopic study of terbutaline hemisulphate

The Raman spectrum of terbutaline hemisulphate is reported for the first time, and molecular assignments are proposed on the basis of ab initio BLYP DFT calculations with a 6-31G* basis set and vibrational frequencies predicted within the quasi-harmonic approximation; these predictions compare favourably with the observed vibrational spectra. Comparison with previously published infrared data explains several spectral features. The results from this study provide data that can be used for the preparative process monitoring of terbutaline hemisulphate, an important beta(2) agonist drug in various dosage forms and its interaction with excipients and other components.

Advanced Techniques in the Diagnosis and Management of Infectious Pulmonary Diseases in Horses

Techniques for novel approaches to the diagnosis and management of equine pulmonary disease continue to be developed and used in clinical practice. Diagnostic techniques involving immunoassays and nucleic acid-based tests not only decrease the time in which results become available but increase the sensitivity and specificity of test results. These assays do not substitute for careful clinical evaluation but can shorten the time to a confirmed accurate diagnosis, and thus allow for early initiation of therapeutic strategies and prevention protocols. With further understanding of the molecular biology and immunology of equine pulmonary disease, diagnostic and management techniques should become further refined.

Extraction and preconcentration of salbutamol and terbutaline from aqueous samples using hollow fiber supported liquid membrane containing anionic carrier

This paper presents a new three-phase liquid-phase microextraction (LPME) strategy for extraction and preconcentration of salbutamol (SB) and terbutaline (TB) from aqueous samples, including urine. The drugs were extracted from 11 ml of aqueous sample (source phase; SP) into an organic phase with microliter volume located inside the pores of a polypropylene hollow fiber, and then back-extracted into 24 microl of a second aqueous solution as the receiving phase (RP), located in the lumen of the hollow fiber. In preliminary experiments, we tried to transport the drugs using a pH gradient between the two sides of the hollow fiber. Due to the existence of both amine and phenolic groups on the drugs, very little transport occurred and enrichment factors (EF) less than one were obtained. Further experiments were done in the presence of bis(2-ethylhexyl) monohydrogenphosphoric acid (D2EHPA) or methyltrioctylammonium chloride (Aliquat 336) in the organic phase, to extract drugs from acidic and basic matrices, respectively. Results showed that transport of drugs from alkaline solution into 1M of sodium bromide occurred when the membrane was impregnated with dihexyl ether containing 20% Aliquat 336. To optimize the EF, the effects of different parameters such as the nature of organic solvent used to impregnate the membrane, compositions and volumes of SP and RP, type and concentration of carrier, extraction time and stirring rate were investigated. Optimal results were obtained in the presence of 0.005 M of NaOH (pH 11.70) in the SP, 1M of NaBr in the RP, 20% of Aliquat 336 in dihexyl ether as membrane impregnation solvent, stirring rate of 500 rpm and extraction time of 60 min. Under these conditions, enrichment factors of 52.9 and 213.1, dynamic linear ranges of 20-5000 and 10-5000, and limits of detection of 2.5 and 0.5 ng/ml were obtained for salbutamol and terbutaline, respectively. Also determination of drugs in environmental water and urine samples in the range of nanograms per millilitre with RSDs<10% was possible using HPLC-photodiode array detection or HPLC-MS.

Use of the impulse oscillometry system for testing pulmonary function during methacholine bronchoprovocation in horses

OBJECTIVE

To compare sensitivity of the impulse oscillometry system (IOS) with that of the conventional reference technique (CRT; ie, esophageal balloon method) for pulmonary function testing in horses.

ANIMALS

10 horses (4 healthy; 6 with recurrent airway obstruction [heaves] in remission).

PROCEDURE

Healthy horses (group-A horses) and heaves-affected horses (group-B horses) were housed in a controlled environment. At each step of a methacholine bronchoprovocation test, threshold concentration (TC(2SD); results in a 2-fold increase in SD of a value) and sensitivity index (SI) were determined for respiratory tract system resistance (R(rs)) and respiratory tract system reactance (X(rs)) at 5 to 20 Hz by use of IOS and for total pulmonary resistance (RL) and dynamic lung compliance (C(dyn)), by use of CRT.

RESULTS

Bronchoconstriction resulted in an increase in R(rs) at 5 Hz (R(5Hz)) and a decrease in X(rs) at all frequencies. Most sensitive parameters were X(rs) at 5 Hz (X(5Hz)), R(5Hz), and R(5Hz):R(10Hz) ratio; RL and the provocation concentration of methacholine resulting in a 35% decrease in dynamic compliance (PC(35)C(dyn)) were significantly less sensitive than these IOS parameters. The TC(2SD) for X(rs) at 5 and 10 Hz was significantly lower in group-B horses, compared with group-A horses. The lowest TC(2SD) was obtained for X(5Hz) in group-B horses and R(5Hz) in group-A horses.

CONCLUSIONS AND CLINICAL RELEVANCE

In contrast to CRT parameters, IOS parameters were significantly more sensitive for testing pulmonary function. The IOS provides a practical and noninvasive pulmonary function test that may be useful in assessing subclinical changes in horses.

Detection of inhaled salbutamol in equine urine by ELISA and GC/MS2

Salbutamol is a beta-adrenergic agonist that is used in the treatment of asthma in humans and chronic obstructive pulmonary disease in horses. Because of its stimulating and growth promoting properties, it is prohibited by horse racing authorities. Recently a number of adapters (eg Equinehaler) have been designed, allowing the use of metered dose inhalers (MDI) approved for human use. However, information on detection times of salbutamol after administration of salbutamol in therapeutic doses by inhalation is lacking. In this study, 2 mg salbutamol (Ventolin) was administered to four standardbred mares via an MDI with an Equinehaler and urine was collected during 48 h. Quantification of salbutamol in horse urine was done via an overnight beta-agonist ELISA kit. Salbutamol was detected between 1 and 48 h post-administration. Relatively large interindividual variations in the total amount excreted during the first 12 h were noticed. The maximum urinary concentrations varied between 4.6 and 8.1 ng/mL. The total amount excreted within the first 12 h varied between 0.2 and 0.7% of the administered dose. For confirmatory analysis in doping control, a GC/MS(2) method was developed and validated. Analysis was performed on an ion trap instrument after solid phase extraction. The limit of detection was 0.25 ng/mL and was lower than in previously reported methods in human urine.

Detection of inhaled clenbuterol in horse urine by GC/MS2

Clenbuterol, a beta-adrenergic agonist, is used in the treatment of recurrent airway obstruction in horses. It is prohibited by horse racing authorities, because of its stimulating and growth-promoting properties. However, information on detection times of clenbuterol after administration by nebulization is lacking. In this study, a fast, sensitive quantitative GC-MS(2) method for the detection of clenbuterol in urine was developed. Alkaline liquid-liquid extraction was followed by derivatization to a cyclic methyl boronate derivative and analysis on a Finnigan MAT GCQ instrument. Method validation showed good linearity in the range 0.1-2.0 ng/mL, excellent repeatability and specificity. The limit of quantitative detection of the method was 0.1 ng/ml. Different instrumental parameters of the ion trap mass spectrometer were changed to increase the number of diagnostic ions for the cyclic methyl boronate derivative of clenbuterol. The influence of these changes and their applicability within the requirements and the criteria for mass spectrometry set by the responsible regulatory bodies are discussed. Clenbuterol was administered via nebulization to five standardbred mares (0.4 micro g/kg body weight). Analysis of the urine samples resulted in the detection of clenbuterol, as early as 2 h post administration and for up to 36 h post treatment. Generally, maximum urinary concentrations of 1.2 ng/mL were reached after -6-9 h.

Quantitative detection of salmeterol after inhalation in equine urine by liquid chromatography/tandem mass spectrometry

A sensitive, accurate and precise liquid chromatography/tandem mass spectrometry (LC/MS(2)) method was developed for the quantification of salmeterol in the urine of horses. The method consists of a liquid-liquid extraction with tert-butylmethyl ether and isopropanol at pH 12 after enzymatic hydrolysis. The extracts are analysed using an LC/MS system equipped with an electrospray ionisation (ESI) probe. Method validation showed excellent linearity, specificity, accuracy, precision and intra-laboratory repeatability and reproducibility. The limit of quantitative detection was 0.25 ng/mL and the limit of detection was 0.125 ng/mL. The excretion profile was determined after administration of 500 microg salmeterol (Serevent) to four standard-bred mares via a metered dose inhaler (MDI) with an Equinehaler adapter. Salmeterol was detected from 1 h until 12 h post-administration. Maximum urinary concentrations varied between 2.3 and 14.9 ng/mL.

Pulmonary and systemic effects of inhaled endotoxin in control and heaves horses

To investigate whether inhaled endotoxin contributes to airway inflammation and dysfunction in stabled horses, control (n = 6) and asymptomatic heaves (previously termed chronic obstructive pulmonary disease)-susceptible (n = 7) horses were given inhalation challenges with 20, 200 and 2,000 microg of soluble Salmonella typhimurium Ra60 lipopolysaccharide (LPS). LPS inhalation induced a dose-dependent neutrophilic airway inflammatory response in both groups. Inhalation with 2,000 microg of LPS also induced detectable lung dysfunction in the heaves group. LPS inhalation did not alter clinical score, tracheal secretion volume or airway reactivity in either group. The no-response thresholds were lower for the heaves group (<20 microg for airway inflammation; 200 to 2,000 microg for lung dysfunction) than for the control group (20 to 200 microg for airway inflammation; >2,000 microg for lung dysfunction). To enable comparison of these threshold levels with airborne endotoxin concentrations in stables, horses also received a 5 h duration hay/straw challenge, during which the total and respirable airborne endotoxin concentrations were determined. Comparison of the effects of acute LPS inhalation and hay/straw challenges suggest that inhaled endotoxin is not the sole cause of heaves. However, it is likely that it contributes to airway inflammation, both in heaves horses in concert with other inhalants, and in normal horses when they are exposed to high levels in poor stable environments.

Effects of inhalation of albuterol sulphate, ipratroprium bromide and frusemide on breathing mechanics and gas exchange in healthy exercising horses

The possibility that pre-exercise inhalation of a bronchodilator by healthy horses could improve their mechanics of breathing and enhance performance was investigated. Ipratropium bromide (0.35 microg/kg bwt; n = 7) was administered by nebulisation 30 min before exercise and frusemide (1 mg/kg bwt; n = 6) was given in the same manner 2 h before exercise. Albuterol sulphate (360 and 720 microg; n = 7) were administered with a metered dose inhaler 2 h before exercise. Each drug was investigated independently of the others using cross-over protocols. Horses completed incremental exercise tests and oxygen consumption, carbon dioxide production, arterial blood gases, heart rate and measures of breathing mechanics including total pulmonary resistance (RL) and nasopharyngeal resistance (RU) were determined for each exercise intensity. The resistance of the lower airways was calculated subsequently from the difference between RL and RU. None of the drugs tested had an effect on any of the variables measured, possibly because maximal bronchodilation is stimulated in healthy horses by the normal sympathoadrenergic response to exercise. Therefore, the pre-exercise inhalation of a bronchodilator by a healthy horse is unlikely to improve performance capacity.

Airflow and device effects on aerosol delivery for large animals

Aerosol delivery of medications has recently gained acceptance in large animal veterinary medicine. However, delivery of therapeutic aerosols currently relies on equipment modified from human use and delivery of medical aerosols may be adversely affected by the equipment design. In this study, we demonstrate the effect of typical large animal inspiratory flow rates on aerosol delivery characteristics. A benchtop system was assembled to simulate aerosol delivery to large animals. Phasic airflow was generated using a large animal anesthesia machine set to deliver 6 bpm (7 L/breath) at 100, 150 and 180 L/min mean inspiratory airflow. Aerosol from a DeVilbis ultrasonic nebulizer was delivered to a simulated facemask using standard 22 mm tubing and fittings. Total mass, delivery efficiency and mass median aerosol diameter (MMAD) was measured with and without an inspiratory one-way valve on the facemask. Delivered aerosol mass ranged from 0.26 to 0.08 g/min and delivery efficiency ranged from 30 to 6%. Both parameters were significantly reduced by both increasing flow rates and the presence of a one-way valve between the nebulizer and the facemask. Average MMAD was 0.7 microm and was not affected by any experimental variable. These results demonstrate that current aerosol equipment used on large animals has a substantial adverse effect on aerosol delivery. Elimination of one-way valves between the aerosol source and the patient is expected to improve delivery of the aerosol in these patients.

Concentrations of gentamicin in serum and bronchial lavage fluid after intravenous and aerosol administration of gentamicin to horses

OBJECTIVE

To compare concentrations of gentamicin in serum and bronchial lavage fluid after IV and aerosol administration of gentamicin to horses.

ANIMALS

9 healthy adult horses.

PROCEDURE

Gentamicin was administered by aerosolization (20 ml of gentamicin solution [50 mg/ml]) and IV injection (6.6 mg of gentamicin/kg of body weight) to each horse, with a minimum of 2 weeks between treatments. Samples of pulmonary epithelial lining fluid were collected by small volume (30 ml) bronchial lavage 0.5, 4, 8, and 24 hours after gentamicin administration. Serum samples were obtained at the same times. All samples were analyzed for gentamicin concentration, and cytologic examinations were performed on aliquots of bronchial lavage fluid collected at 0.5, 8, and 24 hours.

RESULTS

Gentamicin concentrations in bronchial lavage fluid were significantly greater 0.5, 4, and 8 hours after aerosol administration, whereas serum concentrations were significantly less at all times after aerosol administration, compared with IV administration. Neutrophil counts in bronchial lavage fluid increased from 0.5 to 24 hours, regardless of route of gentamicin administration.

CONCLUSIONS AND CLINICAL RELEVANCE

Aerosol administration of gentamicin to healthy horses resulted in gentamicin concentrations in bronchial fluid that were significantly greater than those obtained after IV administration. A mild inflammatory cell response was associated with aerosol delivery of gentamicin and repeated bronchial lavage. Aerosol administration of gentamicin may have clinical use in the treatment of bacterial bronchopneumonia in horses.

Analysis of scintigraphical lung images before and after treatment of horses suffering from chronic pulmonary disease

Scintigraphical analysis of the ratio of inhalation (I) to perfusion (Q) was designed to determine whether chronic pulmonary disease in horses induced mismatches in I/Q and to assess whether medical treatment would restore an I/Q distribution pattern identical to that of control horses. In addition, the results of the I/Q analysis were correlated with the alveolar-arterial PO2 difference (AaDO2). The I/Q matching found in a group of control horses was compared with the I/Q analysis of a group of diseased horses before and after their clinical signs had been treated. The analysis indicated that there was mismatching between I and Q before they were treated. The treatment improved the diseased horses, pulmonary function but there was still heterogeneity in the I/Q distribution after they had been treated. The I/Q analysis parameters were well correlated with the ratio of ventilation (VA) and pulmonary blood flow (Q), evaluated by the determination of AaDO2.

Scintigraphical evaluation of alveolar clearance in horses

This study proposed a standardized method for measuring alveolar epithelium membrane permeability in the horse. The normal rate of clearance (%.min-1) from lung into blood of nebulized 99mTc-DTPA has been established for healthy horses (Group A) compared with values obtained with horses suffering from chronic obstructive pulmonary disease (COPD; Group B). The 99mTc-DTPA clearance was measured in the caudoventral (R1) and in the half caudal (R2) parts of the left lung during different time intervals. The two regions aimed to define the influence of the airways on measured clearance (R2 contained proportionally more conducting airways than R1). It was concluded that a comparison of groups of subjects may be performed in R2 and on data collected during a 20 min period. The normal clearance rate in R2 was 1.80 +/- 0.46%.min-1 (T1/2R2 = 40.99 +/- 12.45 min) in Group A. In Group B, a significantly faster 99mTc-DTPA transfer rate was found (4.17 +/- 0.83%.min-1 or T1/2R2 = 17.17 +/- 3.38min). Bronchoalveolar lavage (BAL) suggested that the increased permeability measured in Group B could be the result of lung inflammatory responses. Our results have demonstrated the ability of the 99mTc-DTPA clearance test to detect alveolar epithelial damage in horses. Furthermore, we were able to show that a regional analysis of the alveolar-capillary barrier integrity may be performed satisfactorily in the equine patient.