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Barton AK, Gehlen H. [Remodeling in equine asthma - Effects of antigen avoidance and pharmacological therapy]. Tierarztl Prax Ausg G Grosstiere Nutztiere 2021; 49:320-325. [PMID: 34470055 DOI: 10.1055/a-1581-6231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The term remodeling describes the process resulting in a tissue that is structurally and architecturally altered compared to its healthy counterpart. At least in severe equine asthma, this occurs mainly, but not exclusively, as a consequence of neutrophilic airway inflammation and is characterized by hypertrophy of the smooth muscle layers in airway and arterial walls as well as fibrosis of the bronchial walls and pulmonary interstitial tissue. To date, much less is known for mild to moderate equine asthma. For a long time it was assumed that these processes are irreversible, and at least for the remodeling of airway smooth muscle this is valid until today. In contrast, remodeling of the extracellular matrix disappears almost completely following long-term remission in consequence to strict antigen avoidance and environmental improvement as well as after glucocorticoid therapy. The remodeling of the arterial vasculature is also reversible following at least 12 months of antigen avoidance and bronchodilatory therapy, but not by inhaled glucocorticoids alone. Although not proven to date, the mild to moderate forms with a good prognosis for complete recovery may be a progenitor for severe equine asthma, in which lung function is restricted even during disease remission despite the absence of obvious clinical signs. Early diagnosis and therapy are, therefore, essential for the management of equine asthma prior to the development of irreversible remodeling, in particular of the bronchial smooth muscle. Antigen avoidance is of highest importance, and should be supported by glucocorticoids and bronchodilators.
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Affiliation(s)
- Ann Kristin Barton
- Klinik für Pferde, allgemeine Chirurgie und Radiologie, Freie Universität Berlin
| | - Heidrun Gehlen
- Klinik für Pferde, allgemeine Chirurgie und Radiologie, Freie Universität Berlin
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Mainguy-Seers S, Lavoie JP. Glucocorticoid treatment in horses with asthma: A narrative review. J Vet Intern Med 2021; 35:2045-2057. [PMID: 34085342 PMCID: PMC8295667 DOI: 10.1111/jvim.16189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/13/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Sophie Mainguy-Seers
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Jean-Pierre Lavoie
- Faculty of Veterinary Medicine, Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, Quebec, Canada
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Pirie RS, Mueller HW, Engel O, Albrecht B, von Salis-Soglio M. Inhaled ciclesonide is efficacious and well tolerated in the treatment of severe equine asthma in a large prospective European clinical trial. Equine Vet J 2021; 53:1094-1104. [PMID: 33403727 PMCID: PMC8518630 DOI: 10.1111/evj.13419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/22/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023]
Abstract
Background Ciclesonide is a glucocorticoid prodrug, already registered for human use. Due to its mode of action and inhaled route of administration, it was considered an appropriate treatment option for horses with severe equine asthma. Although the efficacy of inhaled ciclesonide has been demonstrated in horses with asthma exacerbations under controlled mouldy hay challenge conditions, it has not yet been reported under field conditions. Objectives To assess the effectiveness and safety of inhaled ciclesonide for the treatment of severe equine asthma. Study design Prospective, multicentre, placebo‐controlled, randomised, double‐blinded study. Methods Two‐hundred and twenty‐four client‐owned horses with severe equine asthma were randomised (1:1 ratio) to receive either ciclesonide inhalation (343 µg/actuation) solution or placebo (0 µg/actuation). Treatments (placebo or ciclesonide) were administered with a nonpressurised Soft Mist™ inhaler specifically developed for horses (Aservo® EquiHaler®) at doses of 8 actuations twice daily for the first 5 days and 12 actuations once daily for the following 5 days. Primary outcome was a success/failure analysis with the a priori definition of treatment success as a 30% or greater reduction in weighted clinical score (WCS) between Day 0 and Day 10 (±1). Results The treatment success rate (as defined above) in ciclesonide‐treated horses was 73.4% (80/109) after 10 (±1) days of treatment, being significantly higher than in the placebo group with 43.2% (48/111; P < 0.0001). Few systemic and local adverse events of ciclesonide were observed. Main limitations The severity of clinical signs of severe equine asthma varies over time; despite the prohibition of environmental management changes during the study, a placebo effect was also identified. This potentially contributed, in part, to the clinical improvement observed in the ciclesonide‐treated group. Conclusions Ciclesonide inhalation solution administered by the Aservo® EquiHaler® effectively reduced severity of clinical signs in a majority of horses with severe equine asthma and was well tolerated.
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Affiliation(s)
- Robert Scott Pirie
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Veterinary Centre, Roslin, UK
| | | | - Odilo Engel
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim, Germany
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Klier J, Bartl C, Geuder S, Geh KJ, Reese S, Goehring LS, Winter G, Gehlen H. Immunomodulatory asthma therapy in the equine animal model: A dose-response study and evaluation of a long-term effect. Immun Inflamm Dis 2019; 7:130-149. [PMID: 31141308 PMCID: PMC6688086 DOI: 10.1002/iid3.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Equine asthma represents a naturally occurring animal model for human allergic neutrophilic asthma. Inhalative nanoparticle-bound cytosine-phosphate-guanosine (CpG-GNP) immunotherapy, independent of specific allergens, has already shown promising clinical and immunological results in previous studies and offers the possibility to treat the underlying cause of the disease. This study analyses the relationship between dose and response, and evaluates a possible long-term effect. METHODS In the prospective, randomised, double-blind clinical field study, 29 horses suffering from equine asthma received 10 inhalation treatments with either 187.5 µg CpG-GNP (CpG single dose [CpGsd]; n = 11), 375 µg CpG-GNP double dose (CpG double dose [CpGdd]; n = 9) (q48h for 20 days) or 1600 µg beclomethasone (n = 9) (q24h for 10 days). Each horse was examined three times: before the treatment (I), immediately after the 10 inhalations (II), and 8 weeks after the final inhalation (III). The three groups were compared according to clinical and laboratory parameters. The study examined the sustainability of the long-term effect of the treatment after 8 weeks, as well as the tolerability of the formula as a double dose. RESULTS The CpGsd resulted in a significant improvement in 82% of the parameters, the CpGdd in 72%. In the long-term evaluation, the CpGsd showed a significant improvement in 100% of the parameters in comparison to the initial values, the CpGdd in 67%. On the immunological level, the bronchoalveolar lavage revealed a significant reduction of IL-4, IL-8, and interferon-γ. CONCLUSION Both CpG groups displayed significant improvements in clinical and laboratory parameters, especially regarding the long-term effect of CpGsd. Doubling the CpG dose did not result in any improvement in comparison to the original single dose. On the immunological level, an anti-inflammatory, as well as an immunomodulatory effect, apart from a Th2-dominated immune response, could be observed. This immunomodulatory inhalation treatment could indicate a new possibility for human allergic asthma therapy.
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Affiliation(s)
- John Klier
- Centre for Clinical Veterinary Medicine, Equine ClinicLudwig‐Maximilians‐UniversityMunichGermany
| | - Carolin Bartl
- Centre for Clinical Veterinary Medicine, Equine ClinicLudwig‐Maximilians‐UniversityMunichGermany
- Department of Veterinary Medicine, Equine Clinic, Surgery and RadiologyFree University of BerlinBerlinGermany
| | - Sabine Geuder
- Centre for Clinical Veterinary Medicine, Equine ClinicLudwig‐Maximilians‐UniversityMunichGermany
| | - Katharina J. Geh
- Department of Pharmacy, Pharmaceutical Technology and BiopharmaceuticsLudwig‐Maximilians‐UniversityMunichGermany
| | - Sven Reese
- Department of Veterinary Medicine, Equine Clinic, Surgery and RadiologyFree University of BerlinBerlinGermany
| | - Lutz S. Goehring
- Centre for Clinical Veterinary Medicine, Equine ClinicLudwig‐Maximilians‐UniversityMunichGermany
| | - Gerhard Winter
- Department of Pharmacy, Pharmaceutical Technology and BiopharmaceuticsLudwig‐Maximilians‐UniversityMunichGermany
| | - Heidrun Gehlen
- Department of Veterinary Medicine, Equine Clinic, Surgery and RadiologyFree University of BerlinBerlinGermany
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Lavoie JP, Bullone M, Rodrigues N, Germim P, Albrecht B, von Salis-Soglio M. Effect of different doses of inhaled ciclesonide on lung function, clinical signs related to airflow limitation and serum cortisol levels in horses with experimentally induced mild to severe airway obstruction. Equine Vet J 2019; 51:779-786. [PMID: 30854685 PMCID: PMC7379559 DOI: 10.1111/evj.13093] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 03/02/2019] [Indexed: 12/20/2022]
Abstract
Background Inhaled corticosteroids are effective for the treatment of equine asthma but they induce cortisol suppression with potential side effects. Objectives To study the efficacy of ciclesonide, an inhaled corticosteroid with an improved safety profile, on lung function, clinical signs related to airway obstruction, and serum cortisol levels in asthmatic horses exposed to a mouldy hay challenge. Study design Cross‐over placebo controlled, blinded, randomised experiment. Methods Sixteen horses were enrolled in three subsequent dose‐titration studies (8 horses/study) to investigate the effects of inhaled ciclesonide administered for 2 weeks at doses ranging from 450 to 2700 μg twice daily or 3712.5 μg once daily. Systemic dexamethasone (0.066 mg/kg per os) was our positive control. A placebo group was also studied. Lung function and clinical scores were blindly performed before and after 7 and 14 days of treatment. Serum cortisol was measured before and after 3, 5, 7, 10, 14 days of treatment as well as 3 and 7 days post treatment. Results After 7 days, dexamethasone induced a significant reduction in pulmonary resistance (from 2.5 ± 0.6 at day 0 to 1.1 ± 0.7 cm H2O/L/s), pulmonary elastance (5.0 ± 2.6 to 1.2 ± 1.0 cm H2O/L), and of the weighted clinical score (14.8 ± 4.7 to 8.0 ± 4.4). Similarly, ciclesonide 1687.5 μg twice daily significantly improved pulmonary resistance (2.7 ± 1.1 to 1.6 ± 0.8 cm H2O/L/s), pulmonary elastance (5.2 ± 3.1 to 2.2 ± 1.3 cm H2O/L), and weighted clinical score (13 ± 2.9 to 10.8 ± 4.2). Serum cortisol suppression (<50 nmol/L) systematically occurred with dexamethasone from day 3 of treatment up to day 3 post treatment, but not with ciclesonide at any tested doses. Placebo did not exert any significant beneficial effect. Main limitations Experimentally induced asthma exacerbations in horses might respond differently to treatment than naturally occurring exacerbations. Conclusions Inhaled ciclesonide is an effective treatment for horses with equine asthma. Serum cortisol was unaffected by treatment.
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Affiliation(s)
- J-P Lavoie
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - M Bullone
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - N Rodrigues
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - P Germim
- Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - B Albrecht
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
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Lavoie JP, Leclere M, Rodrigues N, Lemos KR, Bourzac C, Lefebvre-Lavoie J, Beauchamp G, Albrecht B. Efficacy of inhaled budesonide for the treatment of severe equine asthma. Equine Vet J 2018; 51:401-407. [PMID: 30203854 PMCID: PMC6585971 DOI: 10.1111/evj.13018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 09/06/2018] [Indexed: 01/22/2023]
Abstract
Background Corticosteroids are the most potent drugs for the control of severe equine asthma, but adverse effects limit their chronic systemic administration. Inhaled medications allow for drug delivery directly into the airways, reducing the harmful effects of these drugs. Objectives To evaluate the efficacy of inhaled budesonide specifically formulated for the equine use and administered by a novel inhalation device in horses with severe asthma. Study design Experimental studies in horses with naturally occurring asthma with cross‐over, randomised, blinded experimental designs. Methods In Study 1, budesonide (1800 μg twice daily) administered using a novel Respimat® based inhaler was compared to i.v. dexamethasone (0.04 mg/kg). In Study 2, 3 doses of budesonide (450, 900, and 1800 μg) were compared to oral dexamethasone (0.066 mg/kg). Lung function, bronchoalveolar fluid cytology (Study 1), CBC, serum chemistry, and serum cortisol and adrenocorticotropic hormone (ACTH) values were evaluated. Results In Study 1, there was a marked and significant improvement in the lung function of all horses treated with budesonide and dexamethasone. Neutrophil percentages in bronchoalveolar fluid decreased in all horses treated with dexamethasone and in four of six horses treated with budesonide. Serum cortisol and blood ACTH concentrations decreased with both treatments. In Study 2, there was a significant improvement in the lung function with all dosages of budesonide, and the effects of higher dosages were comparable to those of dexamethasone. Dexamethasone and budesonide at the two higher dosages induced a significant decrease of cortisol concentrations. Main limitations The Respimat® based inhaler is not currently commercially available. Conclusions Administration of budesonide with the Respimat® based inhaler provided dose‐dependent relief of airway obstruction in horses with severe asthma, but also a suppression of serum cortisol.
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Affiliation(s)
- J P Lavoie
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - M Leclere
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - N Rodrigues
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - K R Lemos
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - C Bourzac
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - J Lefebvre-Lavoie
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - G Beauchamp
- Department of Veterinary Biomedicine, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - B Albrecht
- Boehringer Ingelheim Vetmedica GmbH, Ingelheim am Rhein, Germany
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Leclere M. Corticosteroids and Immune Suppressive Therapies in Horses. Vet Clin North Am Equine Pract 2017; 33:17-27. [PMID: 28325178 DOI: 10.1016/j.cveq.2016.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Immune suppressive therapies target exaggerated and deleterious responses of the immune system. Triggered by exogenous or endogenous factors, these improper responses can lead to immune or inflammatory manifestations, such as urticaria, equine asthma, or autoimmune and immune-mediated diseases. Glucocorticoids are the most commonly used immune suppressive drugs and the only ones supported by robust evidence of clinical efficacy in equine medicine. In some conditions, combining glucocorticoids with other pharmacologic and nonpharmacologic treatments, such as azathioprine, antihistamine, bronchodilators, environmental management, or desensitization, can help to decrease dosages and associated side effects.
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Affiliation(s)
- Mathilde Leclere
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, 3200 Sicotte, St-Hyacinthe, Quebec J2S 7C6, Canada.
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Abstract
This article discusses the benefits and limitations of inhalation therapy in horses. Inhalation drug therapy delivers the drug directly to the airways, thereby achieving maximal drug concentrations at the target site. Inhalation therapy has the additional advantage of decreasing systemic side effects. Inhalation therapy in horses is delivered by the use of nebulizers or pressured metered dose inhalers. It also requires the use of a muzzle or nasal mask in horses. Drugs most commonly delivered through inhalation drug therapy in horses include bronchodilators, antiinflammatories, and antimicrobials.
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Affiliation(s)
- Mandy L Cha
- Kulshan Veterinary Hospital, 8880 Benson Rd, Lynden, WA 98264, USA
| | - Lais R R Costa
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
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Pulmonary Remodeling in Equine Asthma: What Do We Know about Mediators of Inflammation in the Horse? Mediators Inflamm 2016; 2016:5693205. [PMID: 28053371 PMCID: PMC5174180 DOI: 10.1155/2016/5693205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 12/31/2022] Open
Abstract
Equine inflammatory airway disease (IAD) and recurrent airway obstruction (RAO) represent a spectrum of chronic inflammatory disease of the airways in horses resembling human asthma in many aspects. Therefore, both are now described as severity grades of equine asthma. Increasing evidence in horses and humans suggests that local pulmonary inflammation is influenced by systemic inflammatory processes and the other way around. Inflammation, coagulation, and fibrinolysis as well as extracellular remodeling show close interactions. Cytology of bronchoalveolar lavage fluid and tracheal wash is commonly used to evaluate the severity of local inflammation in the lung. Other mediators of inflammation, like interleukins involved in the chemotaxis of neutrophils, have been studied. Chronic obstructive pneumopathies lead to remodeling of bronchial walls and lung parenchyma, ultimately causing fibrosis. Matrix metalloproteinases (MMPs) are discussed as the most important proteolytic enzymes during remodeling in human medicine and increasing evidence exists for the horse as well. A systemic involvement has been shown for severe equine asthma by increased acute phase proteins like serum amyloid A and haptoglobin in peripheral blood during exacerbation. Studies focusing on these and further possible inflammatory markers for chronic respiratory disease in the horse are discussed in this review of the literature.
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Mora Pereira M, Groover E, Wooldridge A, Caldwell F. Review of glucocorticoid therapy in horses. Part 2: Clinical use of systemic glucocorticoids in horses. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M. Mora Pereira
- J. T. Vaughan Large Animal Teaching Hospital; Auburn University; Alabama USA
| | - E. Groover
- J. T. Vaughan Large Animal Teaching Hospital; Auburn University; Alabama USA
| | - A. Wooldridge
- J. T. Vaughan Large Animal Teaching Hospital; Auburn University; Alabama USA
| | - F. Caldwell
- J. T. Vaughan Large Animal Teaching Hospital; Auburn University; Alabama USA
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Cuming RS, Groover ES, Wooldridge AA, Caldwell FJ. Review of glucocorticoid therapy in horses. Part 1: Pharmacology. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R. S. Cuming
- J. T. Vaughan Large Animal Teaching Hospital Auburn University Alabama USA
| | - E. S. Groover
- J. T. Vaughan Large Animal Teaching Hospital Auburn University Alabama USA
| | - A. A. Wooldridge
- J. T. Vaughan Large Animal Teaching Hospital Auburn University Alabama USA
| | - F. J. Caldwell
- J. T. Vaughan Large Animal Teaching Hospital Auburn University Alabama USA
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Ivester KM, Couëtil LL. Management of chronic airway inflammation in the horse: A systematic review. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12238] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- K. M. Ivester
- College of Veterinary Medicine; Veterinary Clinical Sciences; Purdue University; West Lafayette Indiana USA
| | - L. L. Couëtil
- College of Veterinary Medicine; Veterinary Clinical Sciences; Purdue University; West Lafayette Indiana USA
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Pirie RS. Recurrent airway obstruction: a review. Equine Vet J 2014; 46:276-88. [PMID: 24164473 DOI: 10.1111/evj.12204] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/05/2013] [Indexed: 12/01/2022]
Abstract
Recurrent airway obstruction is a widely recognised airway disorder, characterised by hypersensitivity-mediated neutrophilic airway inflammation and lower airway obstruction in a subpopulation of horses when exposed to suboptimal environments high in airborne organic dust. Over the past decade, numerous studies have further advanced our understanding of different aspects of the disease. These include clarification of the important inhaled airborne agents responsible for disease induction, improving our understanding of the underlying genetic basis of disease susceptibility and unveiling the fundamental immunological mechanisms leading to establishment of the classic disease phenotype. This review, as well as giving a clinical overview of recurrent airway obstruction, summarises much of the work in these areas that have culminated in a more thorough understanding of this debilitating disease.
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Affiliation(s)
- R S Pirie
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Roslin, Midlothian, UK
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Dauvillier J, Felippe MJB, Lunn DP, Lavoie-Lamoureux A, Leclère M, Beauchamp G, Lavoie JP. Effect of long-term fluticasone treatment on immune function in horses with heaves. J Vet Intern Med 2011; 25:549-57. [PMID: 21488960 DOI: 10.1111/j.1939-1676.2011.0717.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Corticosteroids currently are the most effective pharmacological treatment available to control heaves in horses. Systemically administered corticosteroids have been shown to alter immune response in horses, humans, and other species. Aerosolized administration theoretically minimizes systemic adverse effects, but the effect of inhaled corticosteroids on immune function has not been evaluated in horses. OBJECTIVES To evaluate the effects of prolonged administration of inhaled fluticasone on the immune system of heaves-affected horses. ANIMALS Heaves-affected horses were treated with inhaled fluticasone (n = 5) for 11 months or received environmental modifications only (n = 5). METHODS Prospective analysis. Clinical parameters and CBC, lymphocyte subpopulations and function, and circulating neutrophil gene expression were sequentially measured. Primary and anamnestic immune responses also were evaluated by measuring antigen-specific antibodies in response to vaccination with bovine viral antigen and tetanus toxoid, respectively. RESULTS No clinical adverse effects were observed and no differences in immune function were detected between treated and untreated horses. CONCLUSIONS AND CLINICAL IMPORTANCE The treatment of heaves-affected horses with inhaled fluticasone at therapeutic dosages for 11 months has no significant detectable effect on innate and adaptive (both humoral and cell-mediated) immune parameters studied. These results suggest that prolonged administration of fluticasone would not compromise the systemic immune response to pathogens nor vaccination in adult horses.
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Affiliation(s)
- J Dauvillier
- Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada
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ABRAHAM G, ALLERSMEIER M, GOTTSCHALK J, SCHUSSER GF, HOPPEN HO, UNGEMACH FR. Effects of dermal dexamethasone application on ACTH and both basal and ACTH-stimulated cortisol concentration in normal horses. J Vet Pharmacol Ther 2009; 32:379-87. [DOI: 10.1111/j.1365-2885.2008.01054.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cohn LA, DeClue AE, Cohen RL, Reinero CR. Effects of fluticasone propionate dosage in an experimental model of feline asthma. J Feline Med Surg 2009; 12:91-6. [PMID: 19647461 DOI: 10.1016/j.jfms.2009.05.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2009] [Indexed: 12/11/2022]
Abstract
Cats with inflammatory bronchial disease are usually treated with glucocorticoid (GC) drugs to reduce airway inflammation. Inhalant GC delivery can preserve airway effects while systemic effects are minimized. An appropriate dosage regimen for inhaled GC in cats has not been investigated. A blinded, randomized, cross-over study design was used to investigate the ability of three different dosages of the inhalant GC fluticasone propionate delivered by metered dose inhaler to ameliorate eosinophilic airway inflammation in cats with experimentally induced allergic airway inflammation. Further, suppression of the hypothalamic-pituitary-adrenal axis (HPAA) at each dose was assessed. Fluticasone administered at dosages of 44, 110, or 220 microg q 12h reduced airway eosinophilia by 74%, 82%, or 81%, respectively (no difference). None of the dose regimens tested caused HPAA suppression. We conclude that a twice daily dosage of 44 microg fluticasone should be evaluated for the management of cats with naturally occurring inflammatory bronchial disease.
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Affiliation(s)
- Leah A Cohn
- University of Missouri, College of Veterinary Medicine, Department of Veterinary Medicine and Surgery, Columbia, MO, USA.
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Modern techniques for the determination of anabolic–androgenic steroid doping in the horse. Bioanalysis 2009; 1:785-803. [DOI: 10.4155/bio.09.52] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Control of the use of performance-affecting substances in the horse is critical to the integrity of a wide range of equine sports, with major implications for both animal welfare and revenue streams. One class of medications enjoying particular public notoriety is the anabolic–androgenic steroid group, as highlighted by the recent ‘Big Brown’ affair and Congressional inquiries into the use of steroids in professional sports, including horse racing, in the USA. This review examines the latest developments pertaining to the analytical detection of these substances in equine biological samples and the supporting regulatory environment. Consideration is given to the full variety of sample matrices available, together with modern sample preparative approaches and instrumental techniques. Issues concerning the regulation of endogenous steroids, including thresholds where applicable, are also discussed.
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Sojka J, Jedra U, Hester N, Jackson LP, Juarez A. Topical Dexamethasone and Dimethyl Sulfoxide Solutions Do Not Result in Detectable Blood Levels of Dexamethasone. J Equine Vet Sci 2008. [DOI: 10.1016/j.jevs.2008.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Couëtil LL, Hoffman AM, Hodgson J, Buechner-Maxwell V, Viel L, Wood JL, Lavoie JP. Inflammatory Airway Disease of Horses. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb02975.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Couëtil LL, Art T, Moffarts B, Becker M, Mélotte D, Jaspar F, Bureau F, Lekeux P. Effect of Beclomethasone Dipropionate and Dexamethasone Isonicotinate on Lung Function, Bronchoalveolar Lavage Fluid Cytology, and Transcription Factor Expression in Airways of Horses with Recurrent Airway Obstruction. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb02875.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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