Effect of dorsal displacement of the soft palate on ventilation and airflow during high-intensity exercise

Associations between Medical Disorders and Racing Outcomes in Poorly Performing Standardbred Trotter Racehorses: A Retrospective Study

Poor performance in racehorses is commonly associated with subclinical diseases. This study aims to evaluate the associations between medical disorders and racing results in Standardbred trotters. The clinical records of 248 poorly performing Standardbreds were retrospectively reviewed, and their racing results were extracted from an online database, concerning the periods 3 months before and 6 months after hospitalization and the entire lifetime. Generalized linear models were used to evaluate the effects of different disorders on racing outcomes. Airway neutrophilia was associated with limiting lifetime starts and wins pre- and post-hospitalization, while mastocytosis was associated with less wins in the post-hospitalization period. Therefore, lower airway inflammation showed both short- and long-term impacts on racing performance. Severe upper airway obstructions and gastric ulcers showed associations with less placings in the post-discharge period but no long-term influence on performance. The significance of exertional rhabdomyolysis was indeterminable, yet interference with the number of starts in the post-discharge period was reported and associated with lower total career earnings. Exercise-induced pulmonary hemorrhage and cardiac arrhythmias were not associated with worse racing outcomes: therefore, their role in poor performance remains unclear.

Association between dynamic upper airway obstructions and fitness parameters in Standardbred racehorses during high-speed treadmill exercise

OBJECTIVE

To evaluate the association between the severity of dynamic upper airway obstruction (DUAO) and selected fitness parameters in Standardbred racehorses measured by treadmill test.

ANIMALS

191 Standardbred racehorses that underwent a standardized diagnostic protocol for poor performance evaluation between 2002 and 2021 at the Veterinary Teaching Hospital, University of Milan.

PROCEDURES

Horses underwent a diagnostic protocol including clinical examination, lameness evaluation, laboratory analyses, ECG, resting upper airway endoscopy, metabolic incremental treadmill test, high-speed treadmill endoscopy, postexercise tracheobronchoscopy, and bronchoalveolar lavage fluid cytology. On the basis of findings of the high-speed treadmill endoscopy, horses were divided into the following groups: no DUAO, mild DUAO (medial deviation of the aryepiglottic folds or epiglottic entrapment), severe DUAO (dorsal displacement of the soft palate, nasopharyngeal collapse, dynamic laryngeal collapse, or epiglottic retroversion), and multiple DUAOs (different forms of DUAO occurring concomitantly). Fitness parameters, measured by incremental treadmill test, included speed at a heart rate of 200 bpm (V200), speed and heart rate at a lactate concentration of 4 mmol/L (VLa4, HRLa4), peak lactate, maximum speed, maximum hematocrit, and minimum pH. Data were compared between groups by use of descriptive and statistical analyses.

RESULTS

Horses affected by severe or multiple DUAOs showed lower V200 and VLa4, compared to the no-DUAO group; horses with multiple DUAOs also had higher peak lactate concentrations compared to horses without DUAOs.

CLINICAL RELEVANCE

While mild forms of DUAO do not affect athletic capacity, severe forms of DUAO and multiple DUAOs may lead to reduced fitness in Standardbred racehorses by impairing aerobic capacity.

Evaluation of postsale endoscopy as a predictor of future racing performance in an Australian thoroughbred yearling population

Introduction

Upper airway endoscopy of thoroughbred (TB) yearlings is commonly used in an attempt to predict laryngeal function (LF) and its impact on future race performance. The aim of this study was to determine if different grading systems and laryngeal grades were correlated with future performance.

Materials and Methods

Postsale endoscopic recordings were obtained from an Australian TB yearling sale during a four‐year period from 2008 to 2011. Horses were included if they had a diagnostic postsale video endoscopic recording and raced within Australia. Recordings were graded using the Havemeyer system and subsequently recategorised according to the Lane scale and two condensed scales. Performance data were sourced from Racing Australia and comparisons were made between groups.

Results

A total of 1244 horses met the inclusion criteria. There were no significant differences in sex or sales price between groups. There were no significant differences in the number of starts or wins between groups for any grading system. For the condensed Havemeyer scale, horses with intermediate LF were separated into two groups. Significant differences in earnings were found between ‘normal’ and ‘abnormal’ (P = 0.02) and ‘intermediate‐low’ and ‘abnormal’ grades (P = 0.03). There were no significant differences between horses with ‘intermediate‐high’ and ‘abnormal’ grades (P = 0.40). No significant differences were found between the two intermediate grades (P = 0.60) or between horses with normal LF and either ‘intermediate‐low’ or ‘intermediate‐high’ grades (P = 0.99).

Discussion

Resting LF in Australian yearling TBs assessed using a condensed Havemeyer grading scale had some predictive value for future racing performance. This information should be considered when performing yearling endoscopic examinations.

Racing performance of National Hunt thoroughbred racehorses after treatment of palatal dysfunction with a laryngeal tie-forward procedure and thermocautery of the soft palate with or without aryepiglottic folds resection

OBJECTIVE

To assess racing performance of National Hunt thoroughbred (NH) racehorses with a definite diagnosis of palatal dysfunction treated with a laryngeal tie-forward procedure (LTF) and soft palate cautery (SPC) with or without transendoscopic laser excision of the aryepiglottic folds (TLEAF) and to determine correlation between performance measures.

STUDY DESIGN

Retrospective cohort study.

ANIMALS

National Hunt racehorses treated with LTF, SPC ± TLEAF (n = 44) and nonaffected controls (n = 88).

METHODS

Performance was evaluated by using Racing Post ratings (RPR), race earnings (RE), and performance index (PIndex). Affected horses were compared with nonaffected horses. The effect of TLEAF and correlations between measures were analyzed.

RESULTS

Racing Post rating, RE and PIndex improved by 50%, 26%, and 12% in treated, and by 50%, 39%, and 24% in control horses, respectively, when measurements were evaluated for the median of three presurgical and postsurgical races. Lower postsurgical performance was detected when five postsurgical races were compared with two presurgical races (P ≤ .03). The number of postsurgical earnings rated at zero was greater in treated horses than in control horses (P < .05). Race earnings and RPR correlated more strongly (r = 0.634-0.796) than PIndex and other measures (r = 0.378-0.692).

CONCLUSION

Postsurgical performance of NH racehorses with palatal dysfunction after LTF and SPC ± TLEAF was decreased compared with unaffected controls. The negative effect of TLEAF on performance was detected.

CLINICAL SIGNIFICANCE

Although LTF is widely performed in NH racehorses, it may not be the most efficient treatment for palatal dysfunction.

Alar fold resection in 25 horses: Clinical findings and effect on racing performance and airway mechanics (1998-2013)

OBJECTIVE

To report clinical findings and performance in horses in which alar fold collapse (AFC) had been diagnosed and surgically treated and to assess form and degree of respiratory obstruction.

STUDY DESIGN

Retrospective case series.

ANIMALS

Twenty-one standardbreds, 2 coldblooded trotter racehorses, 1 thoroughbred, and 1 Icelandic horse.

METHODS

Alar fold collapse was diagnosed on the basis of continuous abnormal expiratory flutter noise coinciding with filling of the false nostrils during exercise on a high-speed treadmill that was alleviated by suturing the alar folds (AF) temporarily in a dorsal position. In 5 cases, nasopharyngeal airway pressures were assessed. Performance after complete, bilateral AF resection was assessed by reviewing career race records and by owner or trainer telephone interviews.

RESULTS

Horses presented because of poor performance, abnormal respiratory noise, or both. Additional dynamic disorders were identified in 12 of 21 standardbreds (intermittent dorsal displacement of the soft palate: n = 10; collapse of the roof of the nasopharynx: n = 2). Expiratory nasopharyngeal pressures seemed elevated in horses with AFC (range, +10.8 to +21.8 cm H₂ O) compared with normal reference values. Dorsal fixation as well as complete surgical resection of the AF improved expiratory nasopharyngeal pressures to reported normal levels. At a mean of 68 months (range, 7-121) follow-up, 20 of 25 horses had competed after surgery, and 13 of 17 of the harness racehorses had established or improved their kilometer racing time marks.

CONCLUSION

Alar fold collapse caused mild to moderate expiratory obstruction and may have contributed to secondary nasopharyngeal collapse in this population.

CLINICAL SIGNIFICANCE

Complete surgical resection seems effective for treating AFC. Nasopharyngeal pressure measurement is a potential tool for confirming the diagnosis of AFC.

The prevalence of abnormal breathing patterns during exercise and associations with dynamic upper respiratory tract obstructions

REASONS FOR PERFORMING STUDY

There is very limited published information on the prevalence and significance of abnormal breathing patterns adopted during canter/gallop.

OBJECTIVES

The aim of this study was to report the prevalence of abnormal breathing patterns during canter/gallop and to investigate whether these may be associated with dynamic upper respiratory tract (URT) obstructions.

STUDY DESIGN

Retrospective analysis of clinical records.

METHODS

Simultaneous audio and URT videoendoscopy recordings from 365 horses referred for treadmill evaluation were analysed.

RESULTS

Thirty percent of horses had an abnormal breathing pattern at canter or gallop, of which 23% had a 2:1 breathing pattern (i.e. one breath is taken over two strides). The prevalence of abnormal breathing patterns was higher at low canter speeds than during strenuous exercise. There was a significant association between breathing pattern during strenuous exercise and the presence of an URT obstruction.

CONCLUSIONS

This study suggests that abnormal breathing patterns during canter and gallop may be associated with dynamic URT obstructions; therefore, horses identified by owners or veterinary surgeons to have an abnormal breathing pattern during exercise, in particular a 2:1 breathing pattern, may warrant investigations for diagnosis of respiratory tract disease.

Respiratory diseases and their effects on respiratory function and exercise capacity

Given that aerobic metabolism is the predominant energy pathway for most sports, the respiratory system can be a rate-limiting factor in the exercise capacity of fit and healthy horses. Consequently, respiratory diseases, even in mild forms, are potentially deleterious to any athletic performance. The functional impairment associated with a respiratory condition depends on the degree of severity of the disease and the equestrian discipline involved. Respiratory abnormalities generally result in an increase in respiratory impedance and work of breathing and a reduced level of ventilation that can be detected objectively by deterioration in breathing mechanics and arterial blood gas tensions and/or lactataemia. The overall prevalence of airway diseases is comparatively high in equine athletes and may affect the upper airways, lower airways or both. Diseases of the airways have been associated with a wide variety of anatomical and/or inflammatory conditions. In some instances, the diagnosis is challenging because conditions can be subclinical in horses at rest and become clinically relevant only during exercise. In such cases, an exercise test may be warranted in the evaluation of the patient. The design of the exercise test is critical to inducing the clinical signs of the problem and establishing an accurate diagnosis. Additional diagnostic techniques, such as airway sampling, can be valuable in the diagnosis of subclinical lower airway problems that have the capacity to impair performance. As all these techniques become more widely used in practice, they should inevitably enhance veterinarians' diagnostic capabilities and improve their assessment of treatment effectiveness and the long-term management of equine athletes.

Pulmonary function measurements immediately after exercise are correlated with neutrophil percentage in tracheal aspirates in horses with poor racing performance

Inflammatory airway disease (IAD) is common in racehorses, and is a cause of wastage in the industry. IAD has been diagnosed by measurement of percent neutrophils (N%) in tracheal aspirates (TA). The aim of this study was to investigate whether spirometric indices of pulmonary function were correlated with N% in TAs. Limits to breathing were measured by analyses of relationships between relative times and relative respiratory gas flows during inspiration and expiration in individual breaths recorded after exercise. Horses with higher N% had significantly lower relative gas flows at the same relative times during inspiration and expiration, suggesting a limit to breathing. These findings confirm a physiological basis for the measurement of N% in TA after exercise for diagnosis of IAD. Spirometric pulmonary function testing using analyses of individual breaths after exercise has application for assessment of pulmonary function and poor exercise performance.

Comparisons of overground endoscopy and treadmill endoscopy in UK Thoroughbred racehorses

REASONS FOR PERFORMING STUDY

To date there is no information on the comparison of the more recently documented technique of performing endoscopy during ridden exercise in the field, with the more traditional method of endoscopy during high-speed treadmill exercise.

OBJECTIVES

To compare the results of upper respiratory tract endoscopy in UK Thoroughbred racehorses performed during ridden exercise in the field with those obtained during exercise on the treadmill.

METHODS

A direct comparison was undertaken in 4 horses whereby both procedures were performed in the same horse within 10 days of each other. An indirect comparison was also undertaken whereby the results of overground endoscopy performed in 50 racehorses was compared to the results obtained during treadmill endoscopy in a further 50 racehorses. Horses were matched for age, gender, use (National Hunt vs. Flat) and presenting complaint (abnormal respiratory noise vs. poor performance).

RESULTS

Dorsal displacement of the soft palate was diagnosed less frequently during overground endoscopy than during treadmill endoscopy. There was no significant difference in the diagnosis of dynamic laryngeal collapse between the 2 techniques. The treadmill exercise test was performed over longer distances at higher inclines, albeit at lower speeds than the overground test. In contrast to the treadmill test, the overground test was frequently performed in intervals.

CONCLUSIONS

The results of both the direct and indirect comparisons suggest that dorsal displacement of the soft palate is diagnosed less often during overground endoscopy than during treadmill endoscopy. Strenuous exercise tests may be more easily performed on a treadmill than by performing multiple exercise intervals in the field.

POTENTIAL RELEVANCE

Care should be taken in interpreting negative findings during both procedures, but particularly during overground endoscopy if racing conditions have not been appropriately replicated.

Role of the hypoglossal nerve in equine nasopharyngeal stability

The equine upper airway is highly adapted to provide the extremely high oxygen demand associated with strenuous aerobic exercise in this species. The tongue musculature, innervated by the hypoglossal nerve, plays an important role in airway stability in humans who also have a highly adapted upper airway to allow speech. The role of the hypoglossal nerve in stabilizing the equine upper airway has not been established. Isolated tongues from eight mature horses were dissected to determine the distal anatomy and branching of the equine hypoglossal nerve. Using this information, a peripheral nerve location technique was used to perform bilateral block of the common trunk of the hypoglossal nerve in 10 horses. Each horse was subjected to two trials with bilateral hypoglossal nerve block and two control trials (unblocked). Upper airway stability at exercise was determined using videoendoscopy and measurement of tracheal and pharyngeal pressure. Three main nerve branches were identified, medial and lateral branches and a discrete branch that innervated the geniohyoid muscle alone. Bilateral hypoglossal block induced nasopharyngeal instability in 10/19 trials, and none of the control trials (0/18) resulted in instability ( P < 0.001). Mean treadmill speed (± SD) at the onset of instability was 10.8 ± 2.5 m/s. Following its onset, nasopharyngeal instability persisted until the end of the treadmill test. This instability, induced by hypoglossal nerve block, produced an expiratory obstruction similar to that seen in a naturally occurring equine disease (dorsal displacement of the soft palate, DDSP) with reduced inspiratory and expiratory pharyngeal pressure and increased expiratory tracheal pressure. These data suggest that stability of the equine upper airway at exercise may be mediated through the hypoglossal nerve. Naturally occurring DDSP in the horse shares a number of anatomic similarities with obstructive sleep apnea. Study of species with extreme respiratory adaptation, such as the horse, may provide insight into respiratory functioning in humans.

A quantitative study of the equine soft palate using histomorphometry

Dorsal displacement of the soft palate is a common cause of upper airway obstruction in racehorses and is of unknown aetiology. To determine whether the palate may displace for structural reasons, knowledge of the normal soft palate is required. The present study aimed to describe, qualitatively and quantitatively, the structure of the normal equine soft palate using histomorphometry. In soft palates from 12 Thoroughbreds, glandular tissue predominated (ca. 40% of total area), located mainly in the rostral and ventral regions. Rostrally, muscles attached to a tendinous aponeurosis located dorsal to the glandular tissue. Muscle was most abundant in the dorsal mid region and decreased caudally. The oral mucosa consisted of a non-keratinised stratified squamous epithelium whereas the nasopharyngeal mucosa was pseudostratified, columnar and ciliated. Elastin fibres were observed in the nasopharyngeal submucosa, becoming more prevalent caudally. The palates were bilaterally symmetrical although the proportion of tissue types varied considerably between individuals.