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

Glucocorticoid treatment in horses with asthma: A narrative review

Despite substantial research efforts to improve the treatment and outcome of horses with asthma, glucocorticoids (GC) remain the cornerstone of drug treatment of this prevalent disease. The high efficacy of GC to relieve airway obstruction explains their extensive use despite potential deleterious effects. However, much is yet to be uncovered concerning GC use in horses with asthma, including the comparative efficacy of the different drugs, the determination of minimal effective doses and the mechanisms underlying their variable modulation of airway inflammation. The objectives of this structured review were to report and compare the plethora of effects of the various GC used in asthmatic horses with a focus on impact on lung function, airway inflammation, and bronchial remodeling. Adverse effects are also briefly described, with an emphasis on those that have been specifically reported in horses with asthma. Ultimately, we aimed to highlight gaps in the literature and to identify future research areas.

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.

Heaves, an asthma-like disease of horses

Animal models have been developed to investigate specific components of asthmatic airway inflammation, hyper-responsiveness or remodelling. However, all of these aspects are rarely observed in the same animal. Heaves is a naturally occurring disease of horses that combines these features. It is characterized by stable dust-induced inflammation, bronchospasm and remodelling. The evaluation of horses during well-controlled natural antigen exposure and avoidance in experimental settings allows the study of disease mechanisms in the asymptomatic and symptomatic stages, an approach rarely feasible in humans. Also, the disease can be followed over several years to observe the cumulative effect of repeated episodes of clinical exacerbation or to evaluate long-term treatment, contrasting most murine asthma models. This model has shown complex gene and environment interactions, the involvement of both innate and adaptive responses to inflammation, and the contribution of bronchospasm and tissue remodelling to airway obstruction, all occurring in a natural setting. Similarities with the human asthmatic airways are well described and the model is currently being used to evaluate airway remodelling and its reversibility in ways that are not possible in people for ethical reasons. Tools including antibodies, recombinant proteins or gene arrays, as well as methods for sampling tissues and assessing lung function in the horse are constantly evolving to facilitate the study of this animal model. Research perspectives that can be relevant to asthma include the role of neutrophils in airway inflammation and their response to corticosteroids, systemic response to pulmonary inflammation, and maintaining athletic capacities with early intervention.

Non-skeletal scintigraphy of the horse: indications and validity

Gamma scintigraphy is an established imaging modality in the horse and is principally utilised to investigate skeletal disease using bone-seeking radiopharmaceuticals. However, depending on the radiopharmaceutical and imaging sequence, scintigraphy can be used to investigate disease in virtually any organ system. In this article the indications and validity of scintigraphy as a clinical diagnostic tool to investigate non-skeletal disease in the horse are reviewed. These indications include: investigation of dental disease, identification of inflammatory foci, vascular lesions, muscle and tendon pathology, assessment of physiological function of the lungs, gastrointestinal tract and other organs. Some of the techniques described for use in the horse have not been validated fully and as a result non-skeletal scintigraphy requires further investigation and validation using well-designed prospective studies. Such information can be used by clinicians to make informed decisions regarding the clinical and economic issues associated with a specific scintigraphic technique and may help when interpreting the results.

Energetic cost of breathing, body composition, and pulmonary function in horses with recurrent airway obstruction

This study was conducted to determine whether horses with naturally occurring, severe chronic recurrent airway obstruction (RAO) 1) have a greater resting energy expenditure (REE) than control horses, 2) suffer body mass depletion, and 3) have significantly decreased REE after bronchodilation and, therefore, also 4) whether increased work of breathing contributes to the cachexia seen in some horses with RAO. Six RAO horses and six control horses underwent indirect calorimetric measures of REE and pulmonary function testing using the esophageal balloon-pneumotachograph method before and after treatment with ipratropium bromide, a parasympatholytic bronchodilator agent, at 4-h intervals for a 24-h period. Body condition scoring was performed, and an estimate of fat mass was determined via B-mode ultrasonography. O2 and CO2 fractions, respiratory airflow, respiratory rate, and pleural pressure changes were recorded, and O2 consumption, CO2 production, REE, pulmonary resistance, dynamic elastance, and tidal volume were calculated. In addition, we performed lung function testing and calorimetry both before and after sedation in two control horses. RAO horses had significantly lower body condition scores (2.8 ± 1.0 vs. 6.4 ± 1.2) and significantly greater O2 consumption than controls (4.93 ± 1.30 vs. 2.93 ± 0.70 ml·kg−1·min−1). After bronchodilation, there was no significant difference in O2 consumption between RAO horses and controls, although there remained evidence of residual airway obstruction. There was a strong correlation between O2 consumption and indexes of airway obstruction. Xylazine sedation was not associated with changes in pulmonary function but did result in markedly decreased REE in controls.

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

OBJECTIVE

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

ANIMALS

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

PROCEDURE

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

RESULTS

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

CONCLUSIONS AND CLINICAL RELEVANCE

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

Exercise-induced pulmonary perfusion redistribution in heaves

This study aimed to compare exercise-induced pulmonary perfusion redistribution in healthy vs. 'heavey' horses using scintigraphy, a minimally invasive technique. Six healthy (A) and 5 'heavey' horses in remission (B(I)) and during clinical signs of disease (B(II)) were investigated. Dimensions of the exercising pulmonary perfusion (QE) images were expressed in percent of the resting perfusion (QR) images. Computed QE to QR ratios (QE/QR) images enabled the definition of the region more perfused at exercise than at rest (R1). In all groups, exercise induced a major enlargement of the Q image but a larger increase of the lung height was found in 'heavey' horses. Compared to A, 'heavey' horses showed a larger R1 region with a significantly higher QE/QR. Location of R1 pointed out the dorsal lung region as a major site of pulmonary perfusion redistribution for all groups. This work demonstrated (1) the feasibility of using scintigraphy for studying exercise-induced pulmonary perfusion redistribution; (2) perfusion redistribution to the dorsal lung with exercise and (3) an intensified redistribution in 'heavey' horses, either clinically affected or not.

Comparison of deposition images obtained by use of an ultrafine 99m-technetium-labeled carbon dry aerosol with ventilation images obtained by use of 81m-krypton gas for evaluation of pulmonary dysfunction in calves

OBJECTIVE

To characterize the accuracy of an ultrafine 99m-technetium-labeled carbon dry aerosol for use in assessment of regional ventilation in calves with pulmonary dysfunction.

ANIMALS

7 Belgian White and Blue calves.

PROCEDURE

The ultrafine aerosol was assessed by comparing deposition (D) images with ventilation (V) images obtained by use of 81 m-krypton (81mKr) gas via D-to-V ratio (D:V) image analysis in calves during spontaneous breathing (SB) and during experimentally induced pulmonary dysfunction (ePD).

RESULTS

Mismatching index (LrTot) calculated on the D:V images revealed a good match (LrTot, 0.96 +/- 0.01) between D and V distribution patterns in calves during SB. Calculation of the ultrafine aerosol penetration index relative to 81mKr (PIRel) revealed preferential distribution of the ultrafine aerosol in lung parenchyma (PIRel, 1.13 +/- 0.11). In ePD, heterogeneity in the D:V distribution was observed (LrTot, 0.78 +/- 0.10) as a result of ultrafine aerosol particles impaction in airways as indicated by PIRel (0.66 +/- 0.16) and a proportion of pixels more radioactive in D images, compared with V images, that was located in the central part of the lung (475 +/- 77% in ePD vs 32.8 +/- 5.7% in SB). However, this central deposition did not prevent visual examination of the entire ventilated lung.

CONCLUSIONS AND CLINICAL RELEVANCE

The ultrafine aerosol appears suitable for use in examination of ventilated parts of lungs of cattle, even those with impaired pulmonary function. However, airway impaction of ultrafine aerosol particles impedes the quantification of regional ventilation in cattle with abnormal lung function.

Comparison between radioactive aerosol, technegas and krypton for ventilation imaging in healthy calves

The use of lung scintigraphy in calves necessitates the validation of a ventilation (V) imaging agent compatible with clinical applications. This study aimed at defining the value of an inhaled radioactive aerosol (99mTc-DTPA) and a 'pseudogas' (Technegas) in the assessment of regional V in healthy conscious calves by comparing 99mTc-DTPA and Technegas deposition (D) images to V(V) images obtained from the steady-state inhalation of the short half-life krypton 81 (81mKr) gas. Images were compared by analysis of radioactivity distribution in computer-generated regions of interest within the right lung and D to V ratio images were generated in order to highlight areas of mismatching between 99mTc-DTPA or Technegas and 81mKr distributions. Results of this analysis showed that the 99mTc-DTPA aerosol droplets were unable to reach the lung parenchyma because of significant particle impaction in the major conducting airways. Better definition of the ventilated lung was obtained when using Technegas because of minimal deposition in conducting airways. Furthermore, the Technegas and 81mKr distribution patterns were highly equivalent.