Local airborne particulate concentration is associated with visible tracheal mucus in Thoroughbred racehorses

Environmental Management of Equine Asthma

Environmental practices related to the inhalation of airborne dust have been identified as the main cause of equine asthma (EA) and reasonably, they are truly relevant in its treatment and control, especially for horses with its severe form. Vast research regarding environmental recommendations has been conducted in recent years. However, no recent exhaustive reviews exist that gather all this new evidence. The aim of this review is to report and compare the most pertinent information concerning the environmental management of EA. The main findings highlight the importance of the type of forage used for feeding but also its method of production and possible contamination during manufacture and/or storage. Procedures to reduce this, such as soaking and steaming hay, improve its hygienic quality, although they also decrease forage's nutritional value, making dietetic supplementation necessary. Regarding stabling, despite some conflicting results, avoiding straw as bedding and improving barn ventilation continue to be the common recommendations if turning to pasture is not feasible. Finally, owners' compliance has been identified as the most critical point in correct environmental control. Educating owners about the genuine benefits of these measures should be a cornerstone of EA management.

The Microbiota and Equine Asthma: An Integrative View of the Gut-Lung Axis

Both microbe-microbe and host-microbe interactions can have effects beyond the local environment and influence immunological responses in remote organs such as the lungs. The crosstalk between the gut and the lungs, which is supported by complex connections and intricate pathways, is defined as the gut-lung axis. This review aimed to report on the potential role of the gut-lung gut-lung axis in the development and persistence of equine asthma. We summarized significant determinants in the development of asthma in horses and humans. The article discusses the gut-lung axis and proposes an integrative view of the relationship between gut microbiota and asthma. It also explores therapies for modulating the gut microbiota in horses with asthma. Improving our understanding of the horse gut-lung axis could lead to the development of techniques such as fecal microbiota transplants, probiotics, or prebiotics to manipulate the gut microbiota specifically for improving the management of asthma in horses.

Changes in eating time, chewing activity and dust concentration in horses fed either alfalfa cubes or long-stem hay

BACKGROUND

Chewing is an essential physiological process in horses; yet, the physical form of feeds may affect their chewing and feeding behaviour with consequences for equine digestion and health.

OBJECTIVES AND METHODS

The present study evaluated the potential of a commercial forage cubes made from alfalfa and mixed meadow grasses to maintain chewing activity when compared with a traditional long and fibre-rich hay. An additional aim was to measure the dust formation during feeding. The experiment was a crossover design with six horses (11 ± 4 years old, mean ± SD), fed with 5 kg (as-fed basis) of their feed (long hay or alfalfa cubes) overnight. Eating and chewing activity was measured using the EquiWatch system with a sensor-based halter.

RESULTS

Data showed that by feeding the same amount of feed overnight, cube feeding led to 24% shorter eating time (on average 67 min less) and 26% fewer total chews compared to the long hay. On an hourly basis, horses also spent more time eating and chewing the long hay compared to the cubes. The cube feeding led to a higher dust concentration of the inhalable fraction (<100 μm), but not of the thoracic (<10 μm) fraction. Nevertheless, average dust concentrations were generally low for both cubes and hay, whereby both were of sound hygienic status.

CONCLUSION AND RECOMMENDATION

Our data suggest that feeding alfalfa-based cubes overnight generated shorter eating time and less chews than the long hay without major differences in the thoracic dust. Therefore, because of the decreased eating time and chews, alfalfa-based cubes should not be fed a sole forage source, especially when it is to be fed without restriction.

A Scoping Review of Non-Structural Airway Disease as a Cause of Poor Performance in Racehorses

The association between poor performance and respiratory disease in Thoroughbred racehorses that do not have a structural abnormality of the respiratory tract, is often based on anecdotal evidence. The objective of this scoping review was to examine the scientific evidence for such associations. Publications were selected based on a search of three databases (PubMed, Scopus, and CAB Direct), in English and without date restriction, followed by a screening process to exclude non-relevant papers, duplicates, and reviews. This process identified 996 publications of which 20 were analysed using the Quality in Prognosis Studies (QUIPS) tool. The results indicated that the evidence supporting the relationship between proposed diagnostic indicators and poor performance is variable. There is a need for better quality evidence. In particular, there are conflicting reports relating to the impact of equine asthma and EIPH on athletic performance. Furthermore, a lack of standardisation in the measurement of racehorse performance makes it difficult to compare findings from different studies. The industry would benefit from high-level guidance concerning the design of controlled performance studies in Thoroughbred racehorses to collect comprehensive data and facilitate targeted interventions.

Champing at the Bit for Improvements: A Review of Equine Welfare in Equestrian Sports in the United Kingdom

Equestrian sports, including racing (e.g., flat, steeple-chasing, harness or donkey derby); show-jumping; cross-country; dressage; polo; polocrosse; endurance; carriage driving; vaulting and hunting; are hugely popular in the UK, and they involve a significant number of people, both as participants and spectators, and tens of thousands of equids. In this paper, we discuss animal welfare as a complex and disputed issue, clarifying what the term means and how it can be measured. We review many aspects of welfare risk to equids used for sport, addressing issues encountered throughout their lives, including housing, feeding, veterinary intervention, shoeing, handling, training, breeding and equipment. This is followed by a unique exploration of the institutions and social processes influencing equine welfare. The institutional components comprise the rules of competition, the equids, attributes of the stakeholders and the space where participants strive to achieve a common purpose. We endeavour to untangle the most significant elements that create barriers or provide opportunities for equine welfare improvement. We expose the challenges faced by a broad range of stakeholders with differing ethics, attitudes and values. Evidently, there are many welfare risks to which equids used in sports continue to be exposed. It is also evident that significant improvements have occurred in recent times, but there remains a barrier to reducing the risks to an acceptable level. We conclude with recommendations regarding a process for change, involvement of stakeholders and management of knowledge to improve equine welfare that involves identifying and prioritising the risk factors and ultimately leading to interventions, further research and/or education.

Bacterial aerosol, particulate matter, and microclimatic parameters in the horse stables in Poland

Keeping horses in good condition requires providing them with living conditions that meet welfare requirements. These animals should be accommodated with suitable space, access to high nutritional fodder and water, and a suitable microclimate in their shelters. When it comes to the environment in the stables, a serious problem is created by particulate matter (PM), which consists of bacteria. PM concentration may be responsible for developing multiple lower respiratory tract diseases in horses, including allergies and recurrent airway obstruction (RAO). In turn, these ailments may lead to decreasing equine physical and mental fitness. Additionally, people who spend time in the stables are exposed to the same harmful factors. The study was conducted in Udórz Stud Farm located in the southern region of Poland. The study was carried out in 2 different types of stables: 3 runners (a type of stable where horses are housed together and occasionally linked up, e.g., for feeding or grooming) and 2 box stables. The research continued for 2 years and the samples were collected in each season. The bioaerosol samples were collected using a six-stage Andersen-Graseby cascade impactor to assess size distribution and concentrations of airborne bacteria. PM concentration was analyzed using the DustTrak™ II Aerosol Monitor 8530, while microclimate parameters were measured using the Kestrel 5000 Weather Meter. There are almost no studies concerning size distribution of airborne bacteria, individual PM fractions, and the impact of everyday handling on the changes in the bioaerosol and PM concentration. This preliminary study provided basic information on this subject. We have revealed a strong correlation between high PM and bacterial aerosol concentrations. Higher contamination levels were recorded in runners, as compared to box stables. The highest bacterial aerosol level was detected in the spring. The analysis of the fractions of the bacterial aerosol in the stables indicated the highest share of ultra-fine fraction (0.65-2.1 µm), while respirable fraction (below 4.7 µm) exceeded 75%. It was established that the concentration of the bacterial aerosol inside the stables was many times higher than outside. It depended significantly on everyday activities undertaken in the stables, like feeding or cleaning. Taking the above into account, a different cleaning system should be developed (a wet cleaning system, with the use of water) and excrement should be removed more frequently.

Effects of forages, dust exposure and proresolving lipids on airway inflammation in horses

OBJECTIVE

To investigate the role of omega-3 polyunsaturated fatty acids (Ω-3)-derived proresolving lipid mediators (PRLM) in the resolution of mild airway inflammation in horses.

ANIMALS

20 horses with mild airway inflammation.

PROCEDURES

Horses previously eating hay were fed hay pellets (low Ω-3 content; n = 10) or haylage (high Ω-3 content; 9) for 6 weeks. Dust exposure was measured in the breathing zone with a real-time particulate monitor. Bronchoalveolar lavage (BAL) was performed at baseline, week 3, and week 6. The effect of PRLM on neutrophil apoptosis and efferocytosis was examined in vitro. BAL fluid inflammatory cell proportions, apoptosis of circulating neutrophils, efferocytosis displayed by alveolar macrophages, and plasma lipid concentrations were compared between groups fed low and high amounts of Ω-3 by use of repeated measures of generalized linear models.

RESULTS

Dust exposure was significantly higher with hay feeding, compared to haylage and pellets, and equivalent between haylage and pellets. BAL fluid neutrophil proportions decreased significantly in horses fed haylage (baseline, 11.8 ± 2.4%; week 6, 2.5 ± 1.1%) but not pellets (baseline, 12.1 ± 2.3%; week 6, 8.5% ± 1.7%). At week 6, horses eating haylage had significantly lower BAL neutrophil proportions than those eating pellets, and a significantly lower concentration of stearic acid than at baseline. PRLM treatments did not affect neutrophil apoptosis or efferocytosis.

CLINICAL RELEVANCE

Despite similar reduction in dust exposure, horses fed haylage displayed greater resolution of airway inflammation than those fed pellets. This improvement was not associated with increased plasma Ω-3 concentrations. Feeding haylage improves airway inflammation beyond that due to reduced dust exposure, though the mechanism remains unclear.

Equine respiratory viruses, airway inflammation and performance in thoroughbred racehorses

Equine asthma is a common cause of poor performance in racehorses but it is unclear if respiratory viruses contribute to its etiology. The objective of the study was to determine if respiratory viruses were associated with clinical signs and bronchoalveolar lavage fluid (BALF) cytology in Thoroughbred racehorses. Equine herpesviruses (EHV-1, 2, 4, 5) and equine rhinitis A and B viruses (ERBV, ERAV) genomes were quantified by qPCR in nasopharyngeal, tracheal, and BALF samples collected after racing. The relationships between virus detection and load and clinical signs, performance, BALF cytology, and environmental exposures were examined with generalized linear mixed models. Ninety-two samples were collected from 31 horses. EHV-1 and ERAV were not found; EHV-4 was detected in only one sample. EHV-2, EHV-5 and ERBV were more likely to be detected in upper airway samples than in BALF (P < 0.0001). Neither respiratory virus detection nor load was associated with clinical signs or performance. Nasopharyngeal detection and load of ERBV and tracheal detection and load of EHV-5 were associated with increased proportions of neutrophils in BALF (P < 0.003). However, nasopharyngeal detection and load of EHV-5 was not (P = 0.11). Nasopharyngeal detection and load of EHV-2 were associated with decreased BALF mast cell proportions. Respirable dust exposures were significantly higher in horses with detection of ERBV when compared to horses with no detectable ERBV (P < 0.001). Our results suggest that ERBV, EHV-2 and EHV-5 are commonly present in upper airways of healthy racehorses; however, the role they play in the etiology of equine asthma remains unclear.

Equine Asthma: Current Understanding and Future Directions

The 2019 Havemeyer Workshop brought together researchers and clinicians to discuss the latest information on Equine Asthma and provide future research directions. Current clinical and molecular asthma phenotypes and endotypes in humans were discussed and compared to asthma phenotypes in horses. The role of infectious and non-infectious causes of equine asthma, genetic factors and proposed disease pathophysiology were reviewed. Diagnostic limitations were evident by the limited number of tests and biomarkers available to field practitioners. The participants emphasized the need for more accessible, standardized diagnostics that would help identify specific phenotypes and endotypes in order to create more targeted treatments or management strategies. One important outcome of the workshop was the creation of the Equine Asthma Group that will facilitate communication between veterinary practice and research communities through published and easily accessible guidelines and foster research collaboration.

Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards

Inflammatory airway disease (IAD) is a commonly diagnosed but variably defined syndrome of equine lower airway inflammation. The most recent American College of Veterinary Internal Medicine (ACVIM) consensus statement, informed by research evidence, recommends a case definition based on clinical signs (poor performance or occasional coughing of at least 3 weeks duration), increased endoscopically-visible tracheal mucus, and bronchoalveolar lavage cytology, and proposes that the condition should be termed ‘mild-moderate equine asthma' (mEA). In British Thoroughbred racehorses, research to date has focused on airway inflammation defined by increased tracheal mucus and inflammatory tracheal wash sample cytology. It has been unclear whether or to what extent the ACVIM consensus statement has influenced the practice of British racing veterinarians. The aim of this qualitative study was to characterize and understand rationales for current practices relating to diagnosing and managing airway inflammation in British racehorses. Audio-recorded focus group discussions were conducted with 25 participants from four veterinary practices in England. Practices were purposively selected to represent those responsible for different types of racehorse, in different geographical regions. Thematic analysis of transcripts identified (i) an over-arching theme of serving the racing industry within which two further themes (ii) disregarding of the consensus and (iii) the pragmatic clinician were nested. The requirement to serve the racing industry was a key driver of clinical approaches, strongly influenced in particular by the trainer. Participants widely disregarded the consensus case definition of IAD/mEA for British racehorses because of perceived differences in etiology, perceived lack of practicability, particularly of BAL sampling, and perceived lack of understanding of the British racing context by consensus authors. Participants shared a strong professional identity as pragmatic clinicians providing an individualized clinical approach based on direct experience, which was often prioritized as the most valuable evidence with which to inform clinical decision-making. Lack of alignment with international consensus presents a barrier to practicing and furthering evidence-based medicine. Improved dialogue and partnership in research would be valuable and further research tailored for this population, including continuing development of contextually acceptable diagnostic methods, may be required.

Increased Weekly Mean PM2.5, and NO2 Are Associated With Increased Proportions of Lower Airway Granulocytes in Ontario Horses

Ambient pollution is associated with the development and exacerbation of human asthma, but whether air pollution exposure is associated with lower airway inflammation in horses has not been fully evaluated. The Air Quality Health Index (AQHI) is an online tool used by asthmatic Ontarians to modify their outdoor activity when ambient pollution is high. A single AQHI value, falling on a scale from 1 to 10⁺, is calculated from measurements of fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃). Increased AQHI values predict an increased risk for presenting to a health care provider for assessment of asthma exacerbation, with a time lag of 0-9 days after an increase. Whether ambient air pollution is a risk factor for identifying increased lower airway inflammatory cells on cytologic evaluation of bronchoalveolar lavage fluid (BALF) of horses has not yet been explored. To investigate this relationship, case data including BALF cytology preparations from horses across southern Ontario, Canada, were retrieved from the Guelph Animal Health Laboratory's archives. Spanning the years 2007-2017, 154 cases were identified within a 41- by 30-km area surrounding the cities of Guelph and Kitchener. In 78 of 154 cases, cytologic reevaluation identified increased proportions of one or a combination of BALF neutrophils (mean 5%, range 0-15%), eosinophils (mean 2%, range 0-31%), and mast cells (mean 4%, range 0-10%). To assess the effect of lagged pollutant and temperature exposures in these 78 cases, weekly mean values of AQHI, PM_2.5, NO₂, O₃, and temperature were recorded for the 4 weeks prior to the date of the horse's presentation for respiratory tract evaluation. The relationship between ambient exposures and increased proportions of lower airway granulocytes was evaluated using a case-crossover design. Single unit increases in 2-, and 3-week lagged weekly mean PM_2.5 and NO₂, were associated, respectively, with an 11% (p = 0.04, 95% confidence interval, CI = 1.01-1.22), and 24% (p = 0.03, 95% CI = 1.08-1.43) greater risk of identifying increased lower airway granulocytes. These findings suggest that exposure to increased ambient pollutants is associated with lower airway inflammation in Guelph and Kitchener area horses.

Effects of nebulized dexamethasone on the respiratory microbiota and mycobiota and relative equine herpesvirus-1, 2, 4, 5 in an equine model of asthma

Background

Prolonged exposure to environmental antigens or allergens elicits an immune response in both healthy horses and those with mild asthma. Corticosteroids often are used to treat lower airway inflammation.

Objective

To investigate the changes in equine herpesvirus (EHV)‐1,2,4,5 glycoprotein B gene expression and changes in respiratory bacterial and fungal communities after nebulized dexamethasone treatment of horses with asthma.

Animals

Horses with naturally occurring mild asthma (n = 16) and healthy control horses (n = 4).

Methods

Prospective, randomized, controlled, blinded clinical trial. Polymerase chain reaction amplification of EHV‐1,2,4,5 in bronchoalveolar lavage fluid, and 16S (microbiome) and ITS2 (mycobiome) genes with subsequent sequencing was performed on DNA extracted from nasal swabs and transendoscopic tracheal aspirates before and after 13 days treatment with nebulized dexamethasone (15 mg q24h) and saline (control).

Results

Nebulized dexamethasone treatment decreased microbial diversity; relative abundance of 8 genera in the upper respiratory tract were altered. For both the microbiota and the mycobiota, environment had a dominant effect over treatment. Alternaria, an opportunistic pathogen and allergen in humans recognized as a risk factor for asthma, asthma severity, and exacerbations, was increased with treatment. Treatment affected relative quantification of the equine gamma herpesviruses (EHV‐2 and ‐5); EHV‐2 DNA levels increased and those of EHV‐5 decreased.

Conclusions

Nebulized dexamethasone treatment affected the upper respiratory tract microbiota, but not the mycobiota, which was overwhelmed by the effect of a sustained dusty environment.

Effect of injected dexamethasone on relative cytokine mRNA expression in bronchoalveolar lavage fluid in horses with mild asthma

Background

Mild equine asthma is a common inflammatory airway disease of the horse. The primary treatment of mild equine asthma is corticosteroids. The purpose of this study was to investigate the effects of injected dexamethasone on relative IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p35, IL-17, IL-23, IFN-γ, Eotaxin-2 and TNF-α mRNA expression in bronchoalveolar lavage (BAL) fluid in healthy Thoroughbred horses (n = 6), and those with mild equine asthma (n = 7).

Results

Horses with mild equine asthma had a significantly greater bronchoalveolar lavage mast cell percentage than healthy horses both before and after treatment. Mild equine asthma was associated with a 4.95-fold up-regulation of IL-17 (p = 0.026) and a 2.54-fold down-regulation of IL-10 (p = 0.049) compared to healthy horses. TNF-α was down-regulated in response to dexamethasone treatment in both healthy horses (3.03-fold, p = 0.023) and those with mild equine asthma (1.75-fold, p = 0.023). IL-5 was also down-regulated in horses with mild asthma (2.17-fold, p = 0.048).

Conclusions

Horses with mild equine asthma have a lower concentration of IL-10 in BAL fluid than healthy controls which concurs with human asthmatics. The marked up-regulation of IL-17 in horses with mild asthma suggests these horses had a true tendency of “allergic” airway inflammation in response to environmental allergens. Dexamethasone administration exerted anti-inflammatory effects associated with down-regulation of TNF-α in all horses, and decreased levels of IL-5 mRNA expression in horses with mild equine asthma. The inhibition of the Th-2 response, without any alterations to the airway cytology, indicates that maintained exposure to environmental allergens perpetuates airway inflammation.

Determination of the Moisture Content and the Generation of Airborne Particulate Matter From Various Types of Footing From Indoor Riding Arenas Considered to Have Optimal Rideability

It has been known for some years now that the occurrence of lameness in horses is closely related to the characteristics of the riding surface and that respiratory tract diseases can be induced by airborne particles. To ensure both optimal rideability (e.g., grip, elasticity, etc.) and low dust production, riding surfaces have to be regularly attended to, which also includes watering the floor. However, at present, it is not known what the individual moisture content of the various types of riding surface should be to ensure optimal rideability or what their potential for releasing dust is at the time of optimal rideability. The aim of the present study was to determine the moisture content, the density as weight/liter, particle size distribution and the release of airborne particulate matter (APM) with a diameter <10 μm (PM10) of the footing material from three types of indoor riding arena surfaces considered to have optimal rideability. Loose footing material samples were taken from the surfaces of 25 indoor riding arenas [5 pure sand (S), 10 sand-wood chips (SW), and 10 sand-fibre (SF)] and investigated under standardized conditions. The evaluation of the surface's rideability was carried out subjectively by the respective facility manager. The ambient particulate monitor TEOM 1400a was used to measure the PM10 production from the footing samples. Although, according to the facility managers, all of the investigated riding surfaces had optimal rideability at the time of sampling; obvious differences could be found with respect to their moisture content, density, particle size distribution, and release of APM, both between and within the 25 indoor arenas. The moisture content of SW (14.96 ± 4.00%) was significantly higher than that of SF (8.99 ± 2.95%; P = .0046), but the S moisture content (10.82 ± 2.65%) was not significantly different to either of them (S vs. SW: P = .0982 and S vs. SF: P = .2446). With respect to the release of APM, it could be shown that the average release from SF was 2.50-5.47 times higher than either for the S or SW (C_Sum-S: 12.81 mg/m³air, SW: 5.86 mg/m³air, and SF: 32.06 mg/m³air; t-test-S vs. SW: P = .3882, S vs. SF: P = .2560, and SW vs. SF: P = .0031). The reason for this was the extremely high APM release in three of the ten investigated SF samples. In addition, significant differences were also observed in the APM release within the three individual types of footing. Although no factors significantly affected the release of APM in either the S or SW footings, the density of the SF footing was found to have a significant influence on its APM production: the higher the density, the lower the APM release. The density itself was related to both the footing's moisture content and fiber content. The reason why SF footings with a low density (associated with a high fibrous material content) and a high moisture content tended to cause a greater release of APM is that there was a segregation of the fibrous material caused by the measuring technique used. This led to the fibrous material rising to the top of the sample resulting in a release of APM directly from this material. To prevent such a high release of particles from SF footings with a high fiber content occurring in practice, such footings should be regularly and adequately watered, and any segregation of the fibrous material should be prevented using suitable arena grooming techniques.

Fungi in respiratory samples of horses with inflammatory airway disease

Background

Fungi contribute to the inflammatory response of lungs in horses with recurrent airway obstruction and in some forms of asthma in humans. The role of fungi in inflammatory airway disease (IAD) has not been assessed.

Objectives

Evaluate the prevalence of fungi in the respiratory samples of horses diagnosed with IAD, describe clinical signs associated with the presence of fungi in respiratory samples, and assess the risk factors associated with IAD and with the presence of fungi in the airways.

Animals

Seven‐hundred thirty‐one active horses referred to a specialized ambulatory practice for signs of respiratory disease or poor performance.

Methods

A prospective observational study was performed, collecting clinical data, environmental conditions, and results of a tracheal wash (TW; cytology, fungal culture, and bacterial culture), and bronchoalveolar lavage (cytology).

Results

A positive fungal culture was obtained in 55% (402/731) of horses. Horses with fungal elements observed on the TW cytology had 2 times greater chance of having IAD than horses without fungi (odds ratio [OR] = 2.1; 95% CI 1.08‐3.33; P = .0003). Risks of being diagnosed with IAD and likelihood of fungi in TW were higher when horses were bedded on straw (OR = 2.0; 95% CI 1.2‐3.2 and OR = 1.9; 95% CI 1.3‐2.6, respectively) or fed dry hay (OR = 2.7; 95% CI 1.7‐4.4 and OR = 2.6; 95% CI 1.6‐3.4, respectively).

Conclusions and Clinical Importance

Horses inhaling aerosolized fungal particles are at a significantly higher risk of developing IAD. The type of bedding and forage represent significant risk factors for IAD and fungal contamination of equine airways.

Equine asthma: Integrative biologic relevance of a recently proposed nomenclature

The term “equine asthma” has been proposed as a unifying descriptor of inflammatory airway disease (IAD), recurrent airway obstruction (RAO), and summer pasture‐associated obstructive airway disease. Whilst the term will increase comprehensibility for both the lay and scientific communities, its biologic relevance must be compared and contrasted to asthma in human medicine, recognizing the limited availability of peer‐reviewed equine‐derived data, which are largely restricted to clinical signs, measures of airway obstruction and inflammation and response to therapy. Such limitations constrain meaningful comparisons with human asthma phenotypes. Suggested minimum inclusion criteria supporting the term asthma, as well as similarities and differences between IAD, RAO, and multiple human asthma phenotypes are discussed. Furthermore, differences between phenotype and severity are described, and typical features for equine asthma subcategories are proposed. Based on shared features, we conclude that mild/moderate (IAD) and severe (RAO) equine asthma are biologically appropriate models for both allergic and non‐allergic human asthma, with RAO (severe equine asthma) also being an appropriate model for late‐onset asthma. With the development of new biologic treatments in humans and the application of more targeted therapeutic approaches in the horse, it would appear appropriate to further investigate the allergic (Th‐2) and non‐allergic (non‐Th‐2) phenotypes of equine asthma. Further research is required to more fully determine the potential clinical utility of phenotype classification.

An observational study of environmental exposures, airway cytology, and performance in racing thoroughbreds

Background

Mild equine asthma is presumed to arise in response to environmental exposures but the relative impact of differing inflammatory phenotypes upon performance are largely unexplored.

Hypotheses: Airway inflammation negatively affects performance and cytological phenotype varies with environmental exposure.

Animals

Thoroughbred racehorses in active training and racing.

Methods

Thoroughbreds were recruited 24‐48 hours before racing. Each horse was eligible for re‐enrollment with each race entry. Within one hour of race completion, physical examination, respiratory endoscopy, and BAL were performed. Respirable and inhalable dust, respirable endotoxin, and respirable β‐glucan exposures were measured at the breathing zone within one week after racing. Controlling for age, trainer, and pulmonary hemorrhage, the relationship between performance, bronchoalveolar lavage fluid (BALF) cytology, and measures of exposure were modeled.

Results

Performance and BALF data were collected on 64 individual horses from 8 stables for a total of 98 race performances and 79 dust exposure assessments. Evidence of mild equine asthma was found in 80% (78/98) of BALF samples from 52/64 horses. For each percent increase in BALF mast cell and neutrophil proportions, speed figures were reduced by 2.9 (P = .012) and 1.4 (P = .046) points, respectively. Respirable dust concentration was associated with BALF neutrophil proportions (P = .015). Bronchoalveolar lavage fluid mast cell proportions were only associated with respirable β‐glucan exposures (P = .030).

Conclusions and Clinical Importance: Mild equine asthma is common in racing horses and negatively impacts performance. The data support that respirable, rather than inhalable, dust exposure measures are pertinent to equine airway health.

Effect of ionization, bedding, and feeding on air quality in a horse stable

BACKGROUND

Organic dust is associated with Equine asthma. Ionization should reduce airborne dust levels.

OBJECTIVES

To determine the effect of ionization of air, type of bedding, and feed on the levels of airborne dust, endotoxin, and fungal colonies in horse stables.

ANIMALS

24 healthy University-owned horses occupied the stables.

METHODS

A randomized controlled cross-over study. Four units with 6 stables were equipped with an ionization installation (25 VA, 5000 Volt Direct Current). Horses were kept either on wood shavings and fed haylage (2 units), or on straw and fed dry hay (2 units). Measurements were performed with and without activated ionization, during daytime and nighttime, repeatedly over the course of a week and repeatedly during 4-6 weeks. Statistical analysis was performed using a mixed effect model with Akaike's Information Criterion for model reduction and 95% profile (log) likelihood confidence intervals (CI).

RESULTS

Ionization did not alter concentrations of dust, endotoxin, or fungi, fewer. In the units with straw and hay, the concentration of dust, endotoxin, and fungi (difference in logarithmic mean 1.92 (95%CI 1.71-2.12); 2.86 (95%CI 2.59-3.14); 1.75 (95%CI 1.13-2.36)) were significantly higher compared to wood shavings and haylage.

CONCLUSIONS AND CLINICAL IMPORTANCE

The installation of a negative air-ionizer in the horse stable did not reduce concentrations of dust, endotoxin, and viable fungal spores. The substantial effect of low dust bedding and feed is confirmed.

A comparison of unheated loose housing with stables on the respiratory health of weaned-foals in cold winter conditions: an observational field-study

Background

Newly weaned horses in Finland are often moved to unheated loose housing systems in which the weanlings have free access to a paddock and a shelter. This practice is considered to be good for the development of young horses. The daily temperatures can stay below − 20 °C in Finland for several consecutive weeks during the winter season. However, the effect of unheated housing in a cold climatic environment on the respiratory health of weanlings under field conditions has not been studied before. This investigation was an observational field-study comprising 60 weanlings among 11 different voluntary participant rearing farms in Finland. Weanlings were either kept in unheated loose housing systems (n = 36) or in stables (n = 24) and were clinically examined on two separate occasions 58 days apart in cold winter conditions.

Results

The odds of clinical respiratory disease were lower in the older foals (log_e days); OR = 0.009, P = 0.044). The plasma fibrinogen concentration was higher when the available space (m²/weanling) in the sleeping hall was smaller (P = 0.014) and it was lower when the sleeping hall was not insulated (P = 0.010). The plasma fibrinogen concentrations at the second examination were lower with a body condition score above 3 (P = 0.070). Standardbreds kept in loose housing systems had a lower body condition score than Finnhorses or Standardbreds kept in stables at both examinations (P = 0.026 and P = 0.007, respectively). Haemoglobin level was lower in weanlings in loose housing systems compared to their counterparts at the first examination (P = 0.037). Finnhorses had higher white blood cell count than Standardbreds at first (P = 0.002) and at the second examination (P = 0.001).

Conclusions

Keeping weanling horses in cold loose housing systems does not seem to increase the occurrence of respiratory disease, but special attention should be focused on ventilation, air quality and feeding-practices. Our field study data suggest it might be advantageous to keep Standardbred foals born late in the season in a stable over the Finnish winter.

Effect of Dexamethasone and Fluticasone on Airway Hyperresponsiveness in Horses With Inflammatory Airway Disease

Background

Airway hyperresponsiveness (AWHR), expressed as hypersensitivity (PC₇₅R_L) or hyperreactivity (slope of the histamine dose‐response curve), is a feature of inflammatory airway disease (IAD) or mild equine asthma in horses. Glucocorticoids are used empirically to treat IAD.

Objectives

To determine whether dexamethasone (DEX) (0.05 mg/kg IM q24h) and inhaled fluticasone (FLUT) (3,000 μg q12h) administered by inhalation are effective in decreasing AWHR, lung inflammation, and clinical signs in horses with IAD.

Methods

A randomized crossover study design was used. Eight horses with IAD were assigned to a treatment group with either DEX or FLUT. Measured outcomes included lung mechanics during bronchoprovocative challenges, bronchoalveolar lavage fluid (BALF) cytology, and scoring of clinical signs during exercise.

Results

Dexamethasone and FLUT abolished the increase in R_L by 75% at any histamine bronchoprovocative dose in all horses after the first week of treatment. However, after 2 weeks of FLUT treatment, 1 horse redeveloped hypersensitivity. There was a significant decrease in the number of lymphocytes after treatment with both DEX and FLUT (P = .039 for both) but no significant differences in other BALF cell types or total cell counts (P > .05). There was no difference in the scoring of the clinical signs during each treatment and washout period (P > .05).

Conclusions and Clinical Importance

Both DEX and FLUT treatments significantly inhibit airway hypersensitivity and hyperreactivity in horses with IAD. There are no significant effects on the clinical signs or the number of inflammatory cells (except lymphocytes) in BALF. The treatments have no residual effect 3 weeks after discontinuation.

Inflammatory Airway Disease of Horses--Revised Consensus Statement

The purpose of this manuscript is to revise and update the previous consensus statement on inflammatory airway disease (IAD) in horses. Since 2007, a large number of scientific articles have been published on the topic and these new findings have led to a significant evolution of our understanding of IAD.

Update on noninfectious inflammatory diseases of the lower airway

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.

Investigating the link between particulate exposure and airway inflammation in the horse

Inhalant exposure to airborne irritants commonly encountered in horse stables is implicated in the pathogenesis of inflammatory airway disease (IAD) and recurrent airway obstruction (RAO), non‐infectious, inflammatory pulmonary disorders that impact the health and performance of horses across all equine disciplines. IAD and RAO have overlapping clinical, cytological, and functional manifestations of the pulmonary response to organic dust and noxious gases encountered in the barn environment. Study of these diseases has provided important but incomplete understanding of the effect of air quality upon the respiratory health of horses. In this review, the principles of particulate exposure assessment, including health‐related aerosol size fractions and size‐selective sampling, the factors influencing air quality in equine environments, and the effect of air quality on the equine respiratory tract are discussed. The objective of this review is to provide the reader with a summary of the most common chronic inflammatory airway diseases in the horse and the principles of air sampling that are essential to the planning, interpretation, and assessment of equine respiratory health‐related exposure studies.

Airborne particulates (PM10) and tracheal mucus: A case-control study at an American Thoroughbred racetrack

REASONS FOR PERFORMING STUDY

Particle mapping within stalls has demonstrated a relationship between particulate concentrations and visible accumulations of tracheal mucus. However, measurement of breathing zone particulate concentrations, which is the most accurate way to measure exposure, has not been performed to determine the relationship between exposures and accumulations of tracheal mucus sufficient to affect performance.

OBJECTIVES

To compare breathing zone particulate exposures between horses with tracheal mucus scores (MS) previously demonstrated to affect performance (MS≥2) and those without (MS = 0) visible tracheal mucus.

STUDY DESIGN

Case-control study.

METHODS

We endoscopically examined 649 Thoroughbred racehorses over 7 months and selected 113 age-matched cases and controls based on the presence (MS≥2) or absence (MS = 0) of tracheal mucus, respectively. Inflammatory cell numbers in tracheal lavage were also determined. Breathing zone monitors recorded particulate exposure during 3 time periods (mid-day, evening and overnight). Total recording time averaged 17.5 h/horse.

RESULTS

The overall prevalence of MS≥2 in the observed stables was 23%. Breathing zone particular matter (PM10) concentrations were very similar to previously reported ambient concentrations. During the evening and overnight, cases had significantly higher breathing zone PM10 concentrations and neutrophil counts than controls. Inflammatory cell counts were associated with average PM10 concentrations throughout the day.

CONCLUSIONS

Breathing zone particulate concentrations are associated with MS≥2 and inflammatory cell numbers. If breathing zone particulate exposures are predominantly influenced by ambient PM concentrations, racing stable management practices to reduce particle exposures should greatly reduce the prevalence of tracheal mucus.

Age effects on blood gas, spirometry, airway reactivity, and bronchoalveolar lavage fluid cytology in clinically healthy horses

Background

Despite the increasing number of geriatric horses attended by veterinarians, there is a lack of understanding of aging‐related changes on the respiratory system of horses.

Objective

To identify aging‐related changes on the respiratory function and bronchoalveolar lavage fluid (BALF) cytology of horses.

Animals

Fifteen healthy young adult (2–11 years) and 16 healthy aged (≥20 years) horses.

Methods

The respiratory system was examined by measurement of arterial blood gases (ABG), use of respiratory inductive plethysmography (RIP) for assessment of breathing pattern and ventilatory parameters, histamine bronchoprovocation, and BALF cytology.

Results

No significant differences were detected with regard to values obtained by ABG or bronchoprovocation of young adult and aged healthy horses. In aged horses, there were significant differences in mean ± SD of the following parameters when compared to young horses: prolonged expiratory time (Te) measured by RIP (3.9 ± 1.5 s versus 3.0 ± 0.6 s), decreased percentage of alveolar macrophages (40.6 ± 11.3% versus 53.5 ± 9.6%), and increased percentage of lymphocytes (53.4 ± 9.5% versus 43.9 ± 11.0%). No correlations between airway reactivity and ventilatory parameters, ABG, or BALF cytology were found in this asymptomatic population.

Conclusions

These results suggest that aging does not cause changes in the results obtained by ABG, most RIP‐derived variables, and bronchoprovocation in the horse. A decreased percentage of macrophage and an increased percentage of lymphocytes in the BALF cytology may be expected in the asymptomatic geriatric horse and may be a result of aging.

Infectious risk factors and clinical indicators for tracheal mucus in British National Hunt racehorses

REASONS FOR PERFORMING STUDY

Many studies of respiratory disease in racehorses have focused on a combination of increased tracheal mucus and airway neutrophilia. Examination of each component separately should provide further insight into this condition.

OBJECTIVES

To identify infectious risk factors for endoscopically visible tracheal mucus in National Hunt racehorses.

STUDY DESIGN

A 2 year prospective longitudinal study.

METHODS

Monthly quantitative bacteriological examinations of tracheal wash samples and viral serological examinations were conducted. Risk factors for 'small amounts of mucus' (mucus score = 1/3) and 'increased mucus' (score ≥2/3) were identified.

RESULTS

There were increased odds of small amounts of mucus when both Streptococcus zooepidemicus and nonhaemolytic streptococci (NHS) were isolated (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.5-4.6; P<0.001) but not when either species was isolated in the absence of the other. Increased odds of increased mucus were associated with the isolation of either S. zooepidemicus (OR 5.6; 95% CI 1.2-25.9; P = 0.03) or NHS (OR 3.7; 95% CI 1.2-11.6; P = 0.02), with an increased effect when both were isolated together (OR 12.5; 95% CI 3.7-41.6; P<0.001). Approximately 6-fold increased odds of small amounts of mucus were associated with the first 3 months in training (OR 6.3; 95% CI 2.0-19.4; P<0.001) and 3-fold increased odds of increased mucus associated with the first 6 months in training (OR 2.9; 95% CI 1.3-6.4; P = 0.01). Coughing at exercise and increased serous nasal discharge were specific but insensitive indicators of increased mucus.

CONCLUSIONS

Associations with S. zooepidemicus corroborate previous research, but an independent effect of NHS has not previously been reported. The possibility that there are individual pathogenic species within this group should be considered. Further work is required to identify S. zooepidemicus subtypes and NHS species associated with disease. Closer monitoring of the respiratory health of horses entering training for the first time is likely to be valuable.

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.