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Simões J, Tilley P. Decision Making in Severe Equine Asthma-Diagnosis and Monitoring. Animals (Basel) 2023; 13:3872. [PMID: 38136909 PMCID: PMC10740644 DOI: 10.3390/ani13243872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Decision making consists of gathering quality data in order to correctly assess a situation and determine the best course of action. This process is a fundamental part of medicine and is what enables practitioners to accurately diagnose diseases and select appropriate treatment protocols. Despite severe equine asthma (SEA) being a highly prevalent lower respiratory disease amongst equids, clinicians still struggle with the optimization of routine diagnostic procedures. The use of several ancillary diagnostic tests has been reported for disease identification and monitoring, but many are only suitable for research purposes or lack practicality for everyday use. The aim of this paper is to assist the equine veterinarian in the process of decision making associated with managing SEA-affected patients. This review will focus on disease diagnosis and monitoring, while also presenting a flow-chart which includes the basic data that the clinician must obtain in order to accurately identify severely asthmatic horses in their everyday routine practice. It is important to note that European and American board-certified specialists on equine internal medicine can provide assistance in the diagnosis and treatment plan of SEA-affected horses.
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Affiliation(s)
- Joana Simões
- Equine Health and Welfare Academic Division, Faculty of Veterinary Medicine, Lusófona University, Campo Grande 376, 1749-024 Lisbon, Portugal
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4Animals), Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
| | - Paula Tilley
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal;
- Associate Laboratory for Animal and Veterinary Sciences (AL4Animals), Faculty of Veterinary Medicine, University of Lisbon, 1300-477 Lisbon, Portugal
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Westermann CM, de Bie AG, Olave C, de Grauw JC, Teske E, Couetil LL. Effect of Lavage Solution Type on Bronchoalveolar Lavage Fluid Cytology in Clinically Healthy Horses. Animals (Basel) 2023; 13:2637. [PMID: 37627428 PMCID: PMC10451886 DOI: 10.3390/ani13162637] [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: 07/14/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Equine bronchoalveolar lavage (BAL) is usually performed with 250-500 mL of isotonic saline at pH 5.5. The acidic pH of saline may cause an increase in airway neutrophil count 48 h after BAL. Other isotonic solutions such as Ringer's solution, phosphate-buffered saline (PBS) or Plasma-Lyte 148® have a neutral pH of 7.4 and might be a better choice for BAL by not provoking inflammation and the influx of neutrophils into airways. BAL was performed in four healthy horses in four different lung lobes using four different solutions in a randomized crossover design. In each lobe, BAL was performed twice with a 48 h interval using 250 mL of solution. Automated total nucleated cell counts (TNCs) were recorded, and differential cell counts in lavage fluid were determined by two investigators blinded to treatments. The mean volume of BAL fluid retrieved was 51 ± 14%. The mean neutrophil percentage (%N) increased from 1.5 ± 0.9% to 14.7 ± 9.6% at 48 h (p < 0.001) but was not significantly affected by the solution used or the lung lobe sampled. In conclusion, in this study, the influx of neutrophils into airways after BAL was independent of the type of isotonic solution used and the lung lobe sampled. Saline remains an appropriate solution for BAL in horses.
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Affiliation(s)
- Cornélie M. Westermann
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM Utrecht, The Netherlands
| | - Annelieke G. de Bie
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM Utrecht, The Netherlands
- Dierenkliniek de Vijfsprong, Vijfsprongweg 28, 6733 JJ Wekerom, The Netherlands
| | - Carla Olave
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Janny C. de Grauw
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM Utrecht, The Netherlands
- Department of Clinical Sciences and Services, Royal Veterinary College, London AL9 7TA, UK
| | - Erik Teske
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584 CM Utrecht, The Netherlands
| | - Laurent L. Couetil
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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Lee GKC, Beeler-Marfisi J, Viel L, Piché É, Kang H, Sears W, Bienzle D. Bronchial brush cytology, endobronchial biopsy, and SALSA immunohistochemistry in severe equine asthma. Vet Pathol 2021; 59:100-111. [PMID: 34903109 PMCID: PMC8679176 DOI: 10.1177/03009858211048635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Horses with severe equine asthma (SEA), also known as heaves and recurrent airway
obstruction, have persistent neutrophilic inflammation of the lower airways.
Cytologic evaluation of bronchoalveolar lavage (BAL) fluid is commonly used to
confirm the clinical diagnosis of SEA. However, the utility of microscopic
assessment of bronchial brushings, endobronchial biopsies, and
immunohistochemical detection of disease-associated biomarkers for the diagnosis
of SEA remain poorly characterized. Salivary scavenger and agglutinin (SALSA)
has anti-inflammatory properties and downregulated gene expression in SEA;
therefore, it was investigated as a tissue biomarker for airway and systemic
inflammation. Six asthmatic and 6 non-asthmatic horses were exposed to an
inhaled challenge. Before and after challenge, samples of BAL fluid, bronchial
brushing, and endobronchial biopsy were collected. Location of SALSA in biopsies
was determined, and immunohistochemical label intensity was computed using image
analysis software. Serum amyloid A (SAA) was measured to assess systemic
inflammation. After challenge, neutrophil proportions were significantly higher
in asthmatic versus non-asthmatic horses in BAL fluid (least squares means, 95%
confidence interval: 80.9%, 57.2% to 93.1%, vs 3.6%, 1.1% to 10.7%) and in brush
cytology slides (39.5%, 7.7% to 83.6%, vs 0.2%, 0% to 2.3%), illustrating the
potential of brush cytology as an alternate modality to BAL for assessing
intraluminal inflammation. Bronchial histopathologic findings and intensity of
SALSA immunolabeling in surface and glandular epithelium were similar in
asthmatic and non-asthmatic horses, indicating limited changes in bronchial
tissue from the inhaled challenge. Increases in SAA indicated systemic
inflammation, but SALSA immunolabeling did not change significantly.
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Affiliation(s)
| | | | | | - Érica Piché
- University of Guelph, Guelph, Ontario, Canada
| | - Heng Kang
- University of Guelph, Guelph, Ontario, Canada
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Barton AK, Schulze T, Doherr MG, Gehlen H. Influence of bronchoalveolar lavage on thoracic radiography in the horse. J Vet Sci 2018; 19:563-569. [PMID: 29486534 PMCID: PMC6070596 DOI: 10.4142/jvs.2018.19.4.563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
Bronchoalveolar lavage (BAL) and thoracic radiography are routinely performed diagnostic procedures. We hypothesized that BAL increases the interstitial opacity of caudoventral and caudodorsal thoracic radiographs. Fifty-three horses, including 8 clinic owned and 45 from a referral hospital population, were classified as healthy controls (n = 12), severe equine asthma (recurrent airway obstruction, n = 12) or mild-to-moderate equine asthma (inflammatory airway disease, n = 21) based on the results of a clinical scoring system. Eight were excluded due to different diagnoses and poor image quality. Four randomized thoracic radiographs of each horse were scored by two blinded observers, who were also asked to identify the image as obtained before or after a BAL procedure. In severe equine asthma, the chance (adjusted odds) of misinterpretation of the correct imaging time was approximately 5 times higher than in controls (odds ratio [OR] = 5.373, p = 0.028). The chance of misinterpretation was approximately 4 times lower in caudodorsal images than in caudoventral projections (OR = 0.241, p = 0.004). Identification of the correct imaging time was highly correlated with an increase in interstitial opacity (OR = 9.976, p < 0.0001). In conclusion, we recommend performing BAL after thoracic radiography to avoid possible misinterpretation.
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Affiliation(s)
- Ann K Barton
- Equine Clinic for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Thorben Schulze
- Equine Clinic for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Marcus G Doherr
- Institute for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
| | - Heidrun Gehlen
- Equine Clinic for Veterinary Epidemiology & Biostatistics, Freie Universitaet Berlin, 14163 Berlin, Germany
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Calzetta L, Rogliani P, Page C, Roncada P, Pistocchini E, Soggiu A, Piras C, Urbani A, Matera MG. Clinical effect of corticosteroids in asthma-affected horses: A quantitative synthesis. Equine Vet J 2018; 50:594-601. [PMID: 29393535 DOI: 10.1111/evj.12815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 01/10/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are limited findings from low-powered studies based on few number of subjects with equine asthma. Furthermore, no studies have been performed to assess a meaningful clinically detectable impact of corticosteroids in equine asthma. OBJECTIVES To assess and compare the clinical effect of inhaled and systemic corticosteroids in equine asthma and identify a quantitative clinical score suitable to assess the Minimal Important Difference (MID), expressed as the Minimally Clinically Detectable Difference (MCDD). STUDY DESIGN Pair-wise and network meta-analysis. METHODS Literature searches for studies on corticosteroid therapy in equine asthma were performed. The risk of publication bias was assessed by Funnel plots and Egger's test. The effect on changes in clinical scores vs. control was analysed via random-effects models and Bayesian networks. RESULTS Corticosteroids significantly improved the clinical condition (Standardised Mean Difference: -1.52, 95% CrI -2.07 to -0.98; P<0.001 vs. control). No difference was detected between inhaled and systemic corticosteroids with regard to the changes in clinical scores (Relative Effect: 0.08, 95% CrI -1.45 to 1.32; P = 0.8). An Improved clinically Detectable Equine Asthma Scoring System (IDEASS) indicated that corticosteroids improved the clinical condition of asthmatic horses by 30% compared with controls (IDEASS value: -2.36, 95% CI -3.39 to -1.33; P<0.001). A one-point change in IDEASS represented the MCDD in equine asthma. MAIN LIMITATIONS Moderate quality of evidence for systemic corticosteroids. CONCLUSIONS Inhaled corticosteroids are effective in improving the clinical condition of horses with equine asthma and prevent exacerbations. Systemic corticosteroids should be used only in selected cases with symptomatic airway hyperresponsiveness during exacerbation. IDEASS requires further validation but may represent a suitable approach to rank the level of asthma severity and assess the clinical effect of pharmacotherapy in horses with equine asthma.
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Affiliation(s)
- L Calzetta
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - P Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - C Page
- The Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK
| | - P Roncada
- Istituto Sperimentale Italiano "Lazzaro Spallanzani", Milan, Italy
| | | | - A Soggiu
- Dipartimento di Medicina Veterinaria, University of Milan, Milan, Italy
| | - C Piras
- Dipartimento di Medicina Veterinaria, University of Milan, Milan, Italy
| | - A Urbani
- Istituto di Biochimica e Biochimica Clinica, Università Cattolica, Rome, Italy
| | - M G Matera
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Koblinger K, Hecker K, Nicol J, Wasko A, Fernandez N, Léguillette R. Bronchial collapse during bronchoalveolar lavage in horses is an indicator of lung inflammation. Equine Vet J 2013; 46:50-5. [PMID: 23662631 DOI: 10.1111/evj.12096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 04/07/2013] [Indexed: 11/27/2022]
Abstract
REASONS FOR PERFORMING STUDY The bronchoalveolar lavage (BAL) procedure can return variable volumes of fluid, possibly depending on the presence of bronchial collapse during fluid aspiration and on the severity of lung inflammation. OBJECTIVES We tested the hypothesis that horses with bronchial collapse during BAL are at higher risk of having severe lung inflammation. STUDY DESIGN Prospective field study. METHODS Bronchial collapse was graded using a new simple scoring method (0, 1 or 2) during a standardised BAL procedure in the field on 131 horses with normal, mild/moderate or severe lower airway inflammation on cytology of BAL fluid. RESULTS Of the 131 horses, 37 (28%), 55 (42%) and 39 (30%) horses had bronchial collapse scores of 0, 1 and 2, respectively. There was a difference in collapse scores between all the BAL inflammation categories (P<0.001). Severe collapse had a positive predictive value of 0.95 for both mild/moderate and severe BAL inflammation, with a prevalence of 63% and 20%, respectively. The BAL fluid return volume in the horses with severe collapse scores was lower than volumes in the partial (score 1/2) and no collapse (score 0/2) groups (P<0.001). The BAL fluid volume was negatively correlated with BAL neutrophil percentage (P<0.001). CONCLUSIONS Airway collapse during BAL is associated with airway inflammation and neutrophilia. POTENTIAL RELEVANCE During a standardised BAL procedure, clinicians can expect lung inflammation in horses that have bronchial collapse and bronchial collapse in horses with lung inflammation. Lung inflammation may be a contributing factor in the mechanism of bronchial collapse during BAL in horses.
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Affiliation(s)
- K Koblinger
- Moore Equine Veterinary Center, Alberta, Canada
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Fernandez NJ, Hecker KG, Gilroy CV, Warren AL, Léguillette R. Reliability of 400-cell and 5-field leukocyte differential counts for equine bronchoalveolar lavage fluid. Vet Clin Pathol 2013; 42:92-8. [DOI: 10.1111/vcp.12013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nicole J Fernandez
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary; AB; Canada
| | - Kent G Hecker
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary; AB; Canada
| | - Cornelia V Gilroy
- Department of Pathology and Microbiology; Atlantic Veterinary College; University of Prince Edward Island; Charlottetown; PE; Canada
| | - Amy L Warren
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary; AB; Canada
| | - Renaud Léguillette
- Department of Veterinary Clinical and Diagnostic Sciences; Faculty of Veterinary Medicine; University of Calgary; Calgary; AB; Canada
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Koblinger K, Nicol J, McDonald K, Wasko A, Logie N, Weiss M, Léguillette R. Endoscopic Assessment of Airway Inflammation in Horses. J Vet Intern Med 2011; 25:1118-26. [DOI: 10.1111/j.1939-1676.2011.00788.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 03/21/2011] [Accepted: 07/15/2011] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - J. Nicol
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - K. McDonald
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - A. Wasko
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - N. Logie
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
| | - M. Weiss
- Faculty of Veterinary Medicine; University of Calgary; Calgary; AB
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Perkins G, Viel L, Wagner B, Hoffman A, Erb H, Ainsworth D. Histamine bronchoprovocation does not affect bronchoalveolar lavage fluid cytology, gene expression and protein concentrations of IL-4, IL-8 and IFN-γ. Vet Immunol Immunopathol 2008; 126:230-5. [DOI: 10.1016/j.vetimm.2008.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 07/11/2008] [Accepted: 07/16/2008] [Indexed: 11/30/2022]
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Hoffman AM. Bronchoalveolar lavage: sampling technique and guidelines for cytologic preparation and interpretation. Vet Clin North Am Equine Pract 2008; 24:423-35, vii-viii. [PMID: 18652963 DOI: 10.1016/j.cveq.2008.04.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Bronchoalveolar lavage (BAL) is a method for the recovery of respiratory secretions that line the peripheral airways and alveoli. Overall, BAL is considered very safe and sufficiently sensitive to detect inflammation at the cytologic level. The good correlation between BAL differential cell counts and exercise-induced hypoxemia or lactic acidosis, airway obstruction, or airway responsiveness attests to the relevance of BAL cytology to the structure and function of the equine airways. Thus, an important advantage of BAL over tracheal wash cytology is that BAL cytology relates well to the clinical signs and pathophysiologic consequences of inflammatory airway disease.
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Affiliation(s)
- Andrew M Hoffman
- Tufts University, Cummings School of Veterinary Medicine, 200 Westboro Road, North Grafton, MA 01539, USA.
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