EIPH Flashcards
Does EIPH produce clinical signs ?
very low quality evidence of consistent clinical abnormalities in horses with EIPH
moderate quality of evidence that causes epistaxis
Does EIPH affect blood-gas exchange?
Very low quality evidence of an adverse effect of EIPH on arterial oxygen tension during exercise.
Very low quality evidence of an association between higher blood lactate concentrations and EIPH during strenuous exercise.
Is EIPH a cause of sudden death?
low quality evidence that EIPH is causally associated with sudden death in race horses
no evidence of increased risk of sudden death in horses with EIPH.
Does EIPH shorten the career of horses?
moderate quality evidence that EIPH Grade 1-3 is not associated with a shorter racing career of Thoroughbred horses.
moderate quality evidence that Thoroughbred horses with epistaxis or Grade 4 EIPH have shorter careers.
Is EIPH associated with inflammation in the lung?
low quality evidence that EIPH leads to inflammation in either the pulmonary parenchyma or airways.
very low quality evidence that inflammation causes EIPH
Does EIPH cause lesions in the lungs?
high quality evidence that some horses with EIPH have extensive and characteristic pulmonary lesions
What pulmonary lesions are seen with EIPH?
Gross lesions
Discoloration of the pleural surface: a consequence of hemosiderin accumulation that is accompanied by pleural and septal fibrosis and angiogenesis
underlying firm parenchyma that does not fully deflate in excised lungs.
Vascular lesions:
Remodelling of small pulmonary veins (100– 200 lm outer diameter)
accumulation of adventitial collagen and, in some vessels, smooth muscle hyperplasia.
vascular lumen is markedly decreased.
Electron microscopy are compatible with capillary stress failure consequent to high intravascular pressure
Breaks in the capillary endothelium and basement membrane,
interstitial and intra-alveolar accumulations of erythrocytes
interstitial oedema
Where in the lung are lesions seen in EIPH?
Caudodorsal
Is EIPH a progressive condition?
moderate quality evidence that EIPH is progressive and related to load of racing.
Does EIPH contribute to the pathogenesis of other disease?
No evidence that EIPH is associated with development of other lung diseases.
Is EIPH heritable?
no published evidence regarding the heritability of EIPH.
very low quality evidence of an association of pedigree with occurrence of epistaxis.
Is EIPH associated with the finishing position in a race?
moderate quality evidence that moderate to severe EIPH in Thoroughbred race horses is associated with increased likelihood of inferior finishing position in a race
Is EIPH associated with the finishing time in a race?
very low quality of evidence that EIPH in Standardbred racehorses is not associated with finishing time in a race.
Is EIPH associated with the distance a horse finishes behind the winning horse in a race?
moderate quality evidence that Thoroughbred racehorses with more severe EIPH finish farther behind the winning horse in a race.
Is EIPH associated with race earnings?
moderate evidence that severity of EIPH in Thoroughbred racehorses is negatively associated with a horse’s race earnings.
Is there a dose response relationship between the severity of EIPH and performance?
low quality evidence of a dose response relationship between severity of EIPH in Thoroughbred racehorses and severity of impaired performance.
Is EIPH associated with performance?
Moderate evidence is associated with: finishing position, distance behind winning horse, race earnings
Low evidence: dose response relationship between severity of EIPH and performance
Very low evidence: EIPH is not associated with finid=shing time.
Evidence for use of furosemide in EIPH
high quality that decreases severity and incidence (0.5-1mg/kg IV 4 hours before exercise)
Improvement demonstrated in: gross blood presence/absence, RBC in BALF, EIPH endoscopic grade
Does furosemide affect pulmonary vascular pressure?
moderate quality evidence based on treadmill exercse. Pulmonary arterial/wedge pressures and transmural pressures reduced.
Evidence for aminocaproic acid?
Very low quality that affects severity- 2 RCT, small numbers and indirectness.
Evidence for bronchodilators
very low quality evidence that affects
Evidence for corticosteroids
Very low quality evidence that affects severity
Evidence for NSAIDs
Very low quality evidence
Evidence for pentoxyfilline
very low quality
Evidence for nasal strips
Low quality evidence: 4 small studies show decrease in postexercise BALF RBCs.
Evidence for other miscellaneous non-pharmacological treatments
Very low- herbal/ inhaled water vapour
No evidence for rest or water restriction
Does furosemide affect performance of horses running on the racetrack?
moderate quality evidence that furosemide administered IV 4 hours prior to racing is associated with improved racing outcomes in Thoroughbred and Standardbred racehorses
Does furosemide affect performance of horses running on a treadmill?
low quality evidence that furosemide administered IV 4 hours before treadmill exercise results in delayed onset of fatigue and improved energetic cost of locomotion.
How does sex/ age affected performance response to furosemide?
Benefits of furosemide administration were more marked in males up to 6 years old.
How does furosemide affect performance?
Unknown- no studies
What difference in performance was demonstrated in the largest study investigating the effect of furosemide on racetrack performance?
0.56-1.09s faster per mile. n=22589
Summarise current recommendations on the influence of EIPH
Is associated with pulmonary lesions and epistaxis. Poor evidence that has any further effect on health or wellbeing, but is considered a disease. Weak evidence that is progressive. Moderate evidence that is associated with decreased performance.
Summarise current recommendations for EIPH prophylaxis
high quality evidence for the use of furosemide, but weak recommendation for use due to affect on performance. No reccomendaton for any other pharmacological interventions.
