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Hansen S, Otten ND, Nissen SD, Carstensen H, Hopster-Iversen C, Fjeldborg J, Staun SH, Fenner M, Hesselkilde EM, Buhl R. Atrial fibrillation as a risk factor for exercise-induced pulmonary haemorrhage following a standardised exercise test. Equine Vet J 2024; 56:552-561. [PMID: 37654233 DOI: 10.1111/evj.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) has been proposed as a risk factor for exercise-induced pulmonary haemorrhage (EIPH) due to increased pressure in the left atrium. OBJECTIVE To evaluate if AF was associated with EIPH following a standardised exercise test (SET) to fatigue. STUDY DESIGN Two-arm controlled experiment. METHODS Ten untrained Standardbred mares mean (standard deviation [SD]) age 6 (2) years performed a SET on the treadmill in sinus rhythm (SR) (SET1) and 25-44 days after induction of self-sustained AF (SET2). AF was induced by tachypacing using a pacing device. Endoscopy, including tracheal wash and bronchoalveolar lavage (BAL), was performed 48-72 h before and 24 h after the two SETs. In addition, endoscopic grading of tracheal blood was performed 2 h after each SET. RESULTS After SET1, none of the horses showed blood in the trachea, and two horses showed erythrophagocytosis. Following SET2, two horses had grade 1 blood in the trachea and free erythrocytes and erythrophagocytosis in the BAL, while another two horses had erythrophagocytosis in the BAL. In SET2, the overall performance on the treadmill was decreased with a lower maximum velocity (SET1 10.3 ± 0.8 m/s vs. SET2 8.9 ± 0.9 m/s, p = 0.004), a higher heart rate (284 ± 21 vs. 221 ± 18 bpm, p = 0.003) and more abnormal QRS complexes (p < 0.001) compared with SET1. CONCLUSIONS Two horses showed signs of EIPH, resulting in visible blood in the trachea, when exercising in AF compared with SR. However, a possible link between EIPH, pulmonary pressure and AF needs to be further elucidated.
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Affiliation(s)
- Sanni Hansen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Nina D Otten
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Sarah D Nissen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Helena Carstensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Charlotte Hopster-Iversen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Julie Fjeldborg
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Sophie H Staun
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Merle Fenner
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Eva M Hesselkilde
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Taastrup, Denmark
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2
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Shawaf T. Jugular venous thrombosis as a risk factor for exercise-induced pulmonary hemorrhage in thoroughbred racehorses. Open Vet J 2024; 14:1111-1116. [PMID: 38938431 PMCID: PMC11199763 DOI: 10.5455/ovj.2024.v14.i5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/04/2024] [Indexed: 06/29/2024] Open
Abstract
Background Exercise-induced pulmonary hemorrhage (EIPH) is one of the most commonly diagnosed disorders in racehorses. Many EIPH risk factors such as breed, age, high or low environmental temperature, and distance of the race have been studied in racehorses. Aim The aim of this study was to study the relationship between EIPH and the presence of jugular vein thrombose in racehorses. Methods Forty-eight thoroughbred racehorses randomly selected from animals with exercise intolerance due to respiratory disorders were enrolled in the present study. Clinical and tracheobronchoscopy examinations were done for EIPH grading. In addition, both jugular veins were examined using ultrasonography for vein thrombosis. Results It was noted during endoscopy that many cases suffered from laryngeal paralysis, and we were not able to assess the degree of laryngeal paralysis under sedation. About 40% of horses with exercise intolerance suffered from EIPH of varying degrees. Most cases of jugular vein thrombosis were of the chronic type, as local heat and pain were not observed. About 42% of the exercise-intolerant horses had jugular vein thrombose with most jugular vein thrombosis on the left side. Combined jugular veins thrombose and EIPH were found in about 25% of exercise intolerance horses, while 17% showed jugular vein thrombose without EIPH, and 41% showed no EIPH with the absence of jugular vein thrombose. Conclusion The present study revealed that jugular vein thrombosis may cause disorders-associated damage to the vessels and anatomical structures close to it, such as the trachea causing EIPH.
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Affiliation(s)
- Turke Shawaf
- Department of Clinical Sciences, College of Veterinary Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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3
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Massie S, Bayly W, Ohmura H, Takahashi Y, Mukai K, Léguillette R. Field-training in young two-year-old thoroughbreds: investigating cardiorespiratory adaptations and the presence of exercise induced pulmonary hemorrhage. BMC Vet Res 2024; 20:159. [PMID: 38671428 PMCID: PMC11046817 DOI: 10.1186/s12917-024-03997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Comparatively little is known regarding the initial cardiorespiratory response of young racehorses to training. The objectives were to compare physiological parameters before and after introductory training and determine whether young Thoroughbreds show endoscopic signs of exercise-induced pulmonary hemorrhage (EIPH). Ten Thoroughbreds (20-23 months) underwent 12-weeks of introductory training, including weekly speed sessions. Two 600 m high-speed exercise tests (HSET) were performed following weeks 4 and 12 while wearing a validated ergospirometry facemask. Peak oxygen consumption (V̇O2pk) and ventilatory parameters (tidal volume, VT; peak inspiratory and expiratory flow, PkV̇I, PkV̇E; respiratory frequency, Rf; minute ventilation, V̇E) were measured. The ventilatory equivalent of oxygen (V̇E/V̇O2) and the aerobic and anaerobic contributions to energy production were calculated. Maximal heart rate (HRmax) and HR at maximal speed (HRVmax) were determined. Post-exercise hematocrit, plasma ammonia and blood lactate were measured. Evidence of EIPH was investigated via tracheobronchoscopy post-exercise. Results were compared (paired t-test, P < 0.05). RESULTS Horses were faster following training (P < 0.001) and V̇O2pk increased 28 ml/(kg total mass.min) (28 ± 16%; P < 0.001). Ventilatory (V̇E, P = 0.0015; Rf, P < 0.001; PkV̇I, P < 0.001; PkV̇E, P < 0.001) and cardiovascular parameters (HRmax, P = 0.03; HRVmax, P = 0.04) increased. The increase in V̇E was due to greater Rf, but not VT. V̇E/V̇O2 was lower (26 ± 3.6 vs 23 ± 3.7; P = 0.02), indicating improved ventilatory efficiency. Anaerobic contribution to total energy production increased from 15.6 ± 6.1% to 18.5 ± 6.3% (P = 0.02). Post-exercise hematocrit (P < 0.001), plasma ammonia (P = 0.03) and blood lactate (P = 0.001) increased following training. Horses showed no signs of EIPH. CONCLUSIONS Young two-year-old Thoroughbreds responded well to introductory training without developing tracheobronchoscopic evidence of EIPH.
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Affiliation(s)
- Shannon Massie
- Faculty of Veterinary Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Warwick Bayly
- College of Veterinary Medicine, Washington State University, Grimes Way, Pullman, WA, 99164, USA
| | - Hajime Ohmura
- Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke-shi, Tochigi, 329-0412, Japan
| | - Yuji Takahashi
- Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke-shi, Tochigi, 329-0412, Japan
| | - Kazutaka Mukai
- Equine Research Institute, Japan Racing Association, 1400-4, Shiba, Shimotsuke-shi, Tochigi, 329-0412, Japan
| | - Renaud Léguillette
- Faculty of Veterinary Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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4
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Shoemaker S, Wang Y, Sellon D, Gold J, Fisher A, Bagshaw J, Leguillette R, Sanz M, Bayly W. Prevalence and severity of exercise-induced pulmonary hemorrhage in 2-year-old Thoroughbred racehorses and its relationship to performance. J Vet Intern Med 2024; 38:1167-1176. [PMID: 38363079 PMCID: PMC10937470 DOI: 10.1111/jvim.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Little has been reported regarding the prevalence and severity of exercise-induced pulmonary hemorrhage (EIPH) in 2-year-old Thoroughbred racehorses. OBJECTIVES Evaluate EIPH prevalence and severity and its association with performance, speed index, furosemide administration, race distance, and track surface. ANIMALS A total of 830 2-year-old Thoroughbreds. METHODS Prospective blinded observational study. Videoendoscopy was performed 30 to 60 minutes postrace at 15 American racetracks. Three blinded observers independently assigned an EIPH grade (0-4) to each video, and prevalence and severity of EIPH were determined. Relationships of EIPH grade to performance, speed index, race distance, track surface, and prerace administration of furosemide were evaluated using Pearson's chi-squared test for categorical variables and analysis of variance (ANOVA) for numerical variables. Multivariable logistic regression assessed relationships between EIPH prevalence and severity, respectively, and the aforementioned independent variables. A P < .05 was considered significant. RESULTS A total of 1071 tracheoendoscopies were recorded. The EIPH prevalence was 74% and for EIPH grade ≥3 was 8%. Speed index (P = .02) and finishing place (P = .004) were lower with EIPH ≥3. The EIPH prevalence and severity were lower at 2 tracks where postrace tracheoendoscopy was mandatory rather than voluntary (P < .001). Probability of observing EIPH was negatively associated with speed index (P = .01) at tracks where postrace tracheoendoscopy was mandatory. Prerace furosemide administration decreased the probability of EIPH occurrence (P = .007) and severity (P = .01) where study participation was voluntary. CONCLUSIONS AND CLINICAL IMPORTANCE Prevalence and severity of EIPH in 2-year-old racehorses were consistent with that of older racehorses. An EIPH grade ≥3 was associated with decreased performance. Prerace furosemide administration was associated with a decreased likelihood, but not severity, of EIPH at most tracks.
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Affiliation(s)
- Sierra Shoemaker
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Yuan Wang
- Center for Interdisciplinary Statistical Education and ResearchWashington State UniversityPullmanWashingtonUSA
| | - Debra Sellon
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Jenifer Gold
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Allison Fisher
- Center for Interdisciplinary Statistical Education and ResearchWashington State UniversityPullmanWashingtonUSA
| | - Julia Bagshaw
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Renaud Leguillette
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Macarena Sanz
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
| | - Warwick Bayly
- Department of Veterinary Clinical SciencesWashington State UniversityPullmanWashingtonUSA
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5
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Barbazanges P, Richard EA, Lemonnier LC, Wouters CP, Toquet MP, Couroucé A. Cytological diagnosis of exercise-induced pulmonary haemorrhage: Comparison of tracheal wash and bronchoalveolar lavage in standardbred racehorses. Vet Rec 2024; 194:e3826. [PMID: 38291664 DOI: 10.1002/vetr.3826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Cytology of airway samples is sensitive for diagnosis of exercise-induced pulmonary haemorrhage (EIPH), but the association between tracheal wash (TW) and bronchoalveolar lavage fluid (BALF) is unknown. The objective of this study was to determine whether diagnosis of EIPH, using haemosiderophages/macrophages (H/M) ratio, differs when based on TW or BALF. METHODS A prospective cross-sectional study was conducted on 102 standardbred horses in training. TW and BALF were collected concomitantly from all horses at rest (at least 24 hours after their last training or race), and their H/M ratios were calculated. Spearman's correlation, Cohen's kappa and Gwet's coefficient tests were performed to evaluate the association between TW and BALF samples. RESULTS With BALF, 21 horses met the cytological inclusion criteria for an EIPH diagnosis from individual and/or pooled samples. With TW, 20 horses had occasional (H/M < 10%) haemosiderophages, and nine, one and three horses had small (10%-25%), moderate (25%-50%) and large (>50%) proportions, respectively. Poor correlations and inconsistent concordances between TW and BALF were found for H/M ratio. LIMITATIONS Limitations include the use of a single staining method and the absence of a total haemosiderin score. CONCLUSION No association between TW and BALF was found for the cytological diagnosis of EIPH. Based on H/M ratio, BALF remains the sample type of choice for cytological diagnosis of EIPH.
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Affiliation(s)
- Pauline Barbazanges
- Department of Equine Internal Medicine, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Eric A Richard
- LABÉO (Frank Duncombe), Caen, France
- Université de Caen Normandie, BIOTARGEN UR7450, Caen, France
| | - Louise C Lemonnier
- Department of Equine Internal Medicine, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Clovis P Wouters
- Department of Functional Sciences, Faculty of Veterinary Medicine, Pharmacology and Toxicology, Fundamental and Applied Research for Animals & Health, University of Liège, Liège, Belgium
| | - Marie-Pierre Toquet
- LABÉO (Frank Duncombe), Caen, France
- Université de Caen Normandie, BIOTARGEN UR7450, Caen, France
| | - Anne Couroucé
- Department of Equine Internal Medicine, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
- Université de Caen Normandie, BIOTARGEN UR7450, Caen, France
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6
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Dumont R, Touzet C, Gomes E, Le Boedec K. Treatment of recurrent hunting-associated respiratory distress episodes in 2 dogs. J Vet Intern Med 2023; 37:2514-2519. [PMID: 37878243 PMCID: PMC10658495 DOI: 10.1111/jvim.16665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 12/08/2022] [Indexed: 10/26/2023] Open
Abstract
Noncardiogenic pulmonary edema (NCPE) in hunting dogs is an uncommon and poorly described condition for which no preventive treatment is available. Two dogs were presented for recurrent respiratory distress strictly associated with hunting activities. Diagnosis was based on bilateral, symmetrical, interstitial-to-alveolar pattern in the caudodorsal lung fields on thoracic radiographs, exclusion of other causes, and spontaneous clinical and radiographic improvement. Considering that the pathogenesis of exercise-induced NCPE likely involves α- and β-adrenergic overstimulation, treatment with sympathetic blockers was used in both dogs. The first dog no longer showed respiratory signs during hunting activities. However, treatment failed to prevent respiratory distress in the other dog. Based on the large number of red blood cells in the bronchoalveolar lavage fluid of the second dog, exercise-induced pulmonary hemorrhage was suspected, as described in racing horses. The loop diuretic furosemide successfully prevented further hunting-associated respiratory distress episodes in this dog.
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Affiliation(s)
- Renaud Dumont
- Internal Medicine UnitCentre Hospitalier Vétérinaire Frégis43, Av. Aristide Briand, 94110 ArcueilFrance
| | - Chloé Touzet
- Diagnosis Imaging UnitCentre Hospitalier Vétérinaire Frégis43, Av. Aristide Briand, 94110 ArcueilFrance
| | - Eymeric Gomes
- Diagnosis Imaging UnitCentre Hospitalier Vétérinaire Frégis43, Av. Aristide Briand, 94110 ArcueilFrance
| | - Kevin Le Boedec
- Internal Medicine UnitCentre Hospitalier Vétérinaire Frégis43, Av. Aristide Briand, 94110 ArcueilFrance
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7
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Bertram CA, Marzahl C, Bartel A, Stayt J, Bonsembiante F, Beeler-Marfisi J, Barton AK, Brocca G, Gelain ME, Gläsel A, du Preez K, Weiler K, Weissenbacher-Lang C, Breininger K, Aubreville M, Maier A, Klopfleisch R, Hill J. Cytologic scoring of equine exercise-induced pulmonary hemorrhage: Performance of human experts and a deep learning-based algorithm. Vet Pathol 2023; 60:75-85. [PMID: 36384369 PMCID: PMC9827485 DOI: 10.1177/03009858221137582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Exercise-induced pulmonary hemorrhage (EIPH) is a relevant respiratory disease in sport horses, which can be diagnosed by examination of bronchoalveolar lavage fluid (BALF) cells using the total hemosiderin score (THS). The aim of this study was to evaluate the diagnostic accuracy and reproducibility of annotators and to validate a deep learning-based algorithm for the THS. Digitized cytological specimens stained for iron were prepared from 52 equine BALF samples. Ten annotators produced a THS for each slide according to published methods. The reference methods for comparing annotator's and algorithmic performance included a ground truth dataset, the mean annotators' THSs, and chemical iron measurements. Results of the study showed that annotators had marked interobserver variability of the THS, which was mostly due to a systematic error between annotators in grading the intracytoplasmatic hemosiderin content of individual macrophages. Regarding overall measurement error between the annotators, 87.7% of the variance could be reduced by using standardized grades based on the ground truth. The algorithm was highly consistent with the ground truth in assigning hemosiderin grades. Compared with the ground truth THS, annotators had an accuracy of diagnosing EIPH (THS of < or ≥ 75) of 75.7%, whereas, the algorithm had an accuracy of 92.3% with no relevant differences in correlation with chemical iron measurements. The results show that deep learning-based algorithms are useful for improving reproducibility and routine applicability of the THS. For THS by experts, a diagnostic uncertainty interval of 40 to 110 is proposed. THSs within this interval have insufficient reproducibility regarding the EIPH diagnosis.
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Affiliation(s)
- Christof A. Bertram
- University of Veterinary Medicine
Vienna, Vienna, Austria
- Freie Universität Berlin, Berlin,
Germany
| | - Christian Marzahl
- Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany
- EUROIMMUN Medizinische Labordiagnostika
AG, Lübeck, Germany
| | - Alexander Bartel
- Freie Universität Berlin, Berlin,
Germany
- Alexander Bartel, Department of Veterinary
Medicine, Institute for Veterinary Epidemiology and Biostatistics, Freie
Universität Berlin, Koenigsweg 67, Berlin, 14163 Berlin, Germany.
| | - Jason Stayt
- Novavet Diagnostics, Bayswater, Western
Australia
| | | | | | | | | | | | - Agnes Gläsel
- Justus-Liebig-Universität Giessen,
Giessen, Germany
| | | | | | | | | | | | - Andreas Maier
- Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany
| | | | - Jenny Hill
- Novavet Diagnostics, Bayswater, Western
Australia
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8
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Minuto J, Bedenice D, Ceresia M, Zaghloul I, Böhlke M, Mazan MR. Clinical effects and pharmacokinetics of nebulized lidocaine in healthy horses. Front Vet Sci 2022; 9:984108. [PMID: 36187809 PMCID: PMC9521615 DOI: 10.3389/fvets.2022.984108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nebulized lidocaine appears promising as a novel corticosteroid-sparing therapeutic for equine asthma, but its safety and pharmacokinetic behavior have yet to be confirmed. Objective To describe the effect of nebulized lidocaine on upper airway sensitivity, lung mechanics, and lower respiratory cellular response of healthy horses, as well as delivery of lidocaine to lower airways, and its subsequent absorption, clearance, and duration of detectability. Animals Six healthy university- and client-owned horses with normal physical examination and serum amyloid A, and no history of respiratory disease within 6 months. Methods Prospective, descriptive study evaluating the immediate effects of 1 mg/kg 4% preservative-free lidocaine following nebulization with the Flexineb®. Prior to and following nebulization, horses were assessed using upper airway endoscopy, bronchoalveolar lavage, and pulmonary function testing with esophageal balloon/pneumotachography and histamine bronchoprovocation. Additionally, blood and urine were collected at predetermined times following single-dose intravenous and nebulized lidocaine administration for pharmacokinetic analysis. Results Upper airway sensitivity was unchanged following lidocaine nebulization, and no laryngospasm or excessive salivation was noted. Lidocaine nebulization (1 mg/kg) resulted in a mean epithelial lining fluid concentration of 9.63 ± 5.05 μg/mL, and a bioavailability of 29.7 ± 7.76%. Lidocaine concentrations were higher in epithelial lining fluid than in systemic circulation (Cmax 149.23 ± 78.74 μg/L, CELF:Cmaxplasma 64.4, range 26.5–136.8). Serum and urine lidocaine levels remained detectable for 24 and 48 h, respectively, following nebulization of a single dose. Baseline spirometry, lung resistance and dynamic compliance, remained normal following lidocaine nebulization, with resistance decreasing post-nebulization. Compared to the pre-nebulization group, two additional horses were hyperresponsive following lidocaine nebulization. There was a significant increase in mean airway responsiveness post-lidocaine nebulization, based on lung resistance, but not dynamic compliance. One horse had BAL cytology consistent with airway inflammation both before and after lidocaine treatment. Conclusions Nebulized lidocaine was not associated with adverse effects on upper airway sensitivity or BAL cytology. While baseline lung resistance was unchanged, increased airway reactivity to histamine bronchoprovocation in the absence of clinical signs was seen in some horses following nebulization. Further research is necessary to evaluate drug delivery, adverse events, and efficacy in asthmatic horses.
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Affiliation(s)
- Jillian Minuto
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Daniela Bedenice
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Michelle Ceresia
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
- Department of Pharmacy Practice, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Iman Zaghloul
- Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Mark Böhlke
- Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Melissa R. Mazan
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
- *Correspondence: Melissa R. Mazan
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9
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Cascardo B, Bernardes C, de Souza GN, Silva KM, Pires NR, de Alencar NX, Lessa DAB. Diagnostic value of tracheal wash cytology for monitoring Exercise-Induced Pulmonary Haemorrhage in Thoroughbred racehorses. J Equine Vet Sci 2022; 118:104128. [DOI: 10.1016/j.jevs.2022.104128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
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10
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Validation of a Rapid Bronchoalveolar Lavage Fluid Colorimetric Evaluation for Assessing the Severity of Exercise-Induced Pulmonary Hemorrhage in Horses in Field Conditions. J Equine Vet Sci 2020; 95:103284. [PMID: 33276915 DOI: 10.1016/j.jevs.2020.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/22/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
Diagnosis and assessment of severity of exercise-induced pulmonary hemorrhage (EIPH) relies on postexercise visualization of fresh blood in the airways via tracheobronchoscopic examination (TBE) and/or counting erythrocytes in bronchoalveolar lavage fluid (BALFRBC). Determining the BALFRBC is more sensitive than TBE but its usefulness is hampered by the need to have BALFRBC counted at a laboratory. We explored the feasibility of evaluating the severity of EIPH by using a color chart comprised of five shades of red and matching those colors with the color of BALF immediately following collection. To validate the technique, sets of ten BALF samples with known BALFRBC numbers were created and randomly shown to two groups of 18 observers who independently matched the color of the BALF with one of the shades of red displayed on the screen of a smartphone. Interobserver and intra-observer agreements regarding colors were > 0.9. The utility of the color chart was further validated under field conditions at two barrel racing events where 63 BALF samples were collected from 21 horses and BALF color was graded independently by three observers. The number of BALFRBC in the 63 samples ranged from 25-1,100,000/μL. EIPH was diagnosed in 39 samples based on the detection of color, and all 5 colors were matched multiple times with BALF samples. Overall, the color of the BALF was related to the number of BALFRBC. Colorimetric evaluation of BALF represents a practical and reliable option for rapid postexercise assessment of the presence and severity of EIPH.
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11
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Knych HK, Wilson WD, Vale A, Kass PH, Steffey EP, Jones JH, Arthur RM. Physiologic effects of furosemide in combination with water restriction when administered at 4 and 24 hours prior to high-intensity treadmill training. J Vet Pharmacol Ther 2020; 43:565-576. [PMID: 32483865 DOI: 10.1111/jvp.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
Although controversial, due to its reported effectiveness in attenuating bleeding associated with exercise-induced pulmonary hemorrhage (EIPH), furosemide is currently a permitted race day medication in most North American racing jurisdictions. The objective of this study was to assess the efficacy of furosemide in reducing the presence and severity of EIPH when administered 24 hr prior to strenuous treadmill exercise. Eight exercised Thoroughbred horses received saline or 250 mg of furosemide either 4 or 24 hr prior to high-speed treadmill exercise in a balanced 3-way cross-over design. Blood samples were collected for determination of furosemide, lactate, hemoglobin, blood gas, and electrolyte concentrations. Heart rate and pulmonary arterial pressure were measured throughout the run and endoscopic examination and bronchoalveolar lavage (BAL) performed. Horses were assigned an EIPH score and the number of red blood cells in BAL fluid determined. Although not significantly different, endoscopic EIPH scores were lower in the 4-hr versus the 24-hr and saline groups. RBC counts were not significantly different between the treatment groups. Pulmonary arterial pressures were significantly increased at higher speeds; however, there were no significant differences between dose groups when controlling for speed. A small sample size and unknown bleeding history warrant a larger-scale study.
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Affiliation(s)
- Heather K Knych
- K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA.,Department of Veterinary Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - W David Wilson
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Alina Vale
- Private Practitioner, San Diego, CA, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Eugene P Steffey
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - James H Jones
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Rick M Arthur
- School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
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Lopez Sanchez CM, Kogan C, Gold JR, Sellon DC, Bayly WM. Relationship between tracheobronchoscopic score and bronchoalveolar lavage red blood cell numbers in the diagnosis of exercise-induced pulmonary hemorrhage in horses. J Vet Intern Med 2019; 34:322-329. [PMID: 31880352 PMCID: PMC6979084 DOI: 10.1111/jvim.15676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background Exercise‐induced pulmonary hemorrhage (EIPH) is diagnosed and its severity assessed by post‐exercise tracheobronchoscopy, and enumeration of bronchoalveolar lavage fluid red blood cells (BALFRBC). Minimal information is available regarding the relationship of tracheobronchoscopy score to BALFRBC number. Objective Evaluate the relationship between BALFRBC number and tracheobronchoscopy scores and determine their diagnostic sensitivities. Animals Nine sedentary horses, 21 fit Thoroughbreds, 129 Barrel Racers. Methods Normal BALFRBC number and the effect of bronchoalveolar lavage (BAL) on it were evaluated by performing 2 BALs 24 hours apart in sedentary horses. Tracheobronchoscopy followed by BAL was performed 247 times on 150 horses after treadmill, racetrack, or barrel racing exercise. Lastly, a BALFRBC diagnostic threshold number that optimized the geometric mean of the sensitivity and precision (F1‐score) was determined using Bayesian analysis. Results No increase in BALFRBC occurred after the second BAL (mean ± SD, 304 ± 173/μL). Tracheobronchoscopy scores ranged from 0 (n = 112) to 4 (n = 4) and BALFRBC ranged from 102 to 4605268/μL. Spearman correlation between tracheobronchoscopy score and BALFRBC was weak (P < .001; rs = 0.42) with large ranges of BALFRBC associated with each tracheobronchoscopy score. The highest F1‐score occurred for a BALFRBC threshold number = 992/μL. Seventy‐five tracheobronchoscopy scores equaled 0 although BALFRBC number was ≥992/μL. Sensitivity of tracheobronchoscopy for diagnosing EIPH was poor (0.59; 95% confidence intervals [CI], 0.49‐0.68), compared to BALFRBC number ≥992/μL (0.93; 95% CI, 0.88‐0.96). Conclusions and Clinical Importance False negatives are common with tracheobronchoscopy. Follow‐up determination of BALFRBC may be indicated for tracheobronchoscopy scores = 0 before EIPH can be ruled out.
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Affiliation(s)
| | - Clark Kogan
- Center for Interdisciplinary Statistical Education and Research, Washington State University, Pullman, Washington
| | - Jenifer R Gold
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
| | - Debra C Sellon
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
| | - Warwick M Bayly
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
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