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ClinSci 2 Exam 2 > Lower Airway Inflammation > Flashcards

Lower Airway Inflammation Flashcards

1
Q

mild to moderate equine asthma

A

inflammatory airway disease

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2
Q

severe equine asthma

A

recurrent airway obstruction “heaves”

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3
Q

signalment of mild-moderate equine asthma

A

generally younger horses, but can see in older

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4
Q

signalment of severe equine asthma

A

older horses >7 yrs

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5
Q

clinical presentation of the mildest case of equine asthma

A

exercise intolerance

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6
Q

clinical presentation of inflammatory airway disease

A
  • exercise intolerance
  • prolonged recovery
  • occasional cough: problem is horses often “cough” normally and owners may not recognize they are coughing
    maybe nasal dc
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7
Q

presentation of recurrent airway obstruction: mild disease

A

clinical signs become more prominent
- exercise intolerance
- prolonged recovery
- occasional cough
maybe nasal dc- tends to be mucoid and can be very minimal and more severe after exercise

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8
Q

presentation of recurrent airway obstruction: severe disease

A
  • expiratory dyspnea
  • “heave line”
  • coughing
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9
Q

horses have a high/low threshold for coughing

A

high, often will have inflammatory changes that go along with the signs; it takes longer for a horse to be at the point that they cough than humans do

these horses have increased respiratory signs in general

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10
Q

when do owners often notice worse respiratory signs in horses?

A

during hot/humid times: they temperature regulate some thru nose, and owners will notice the difference in their horse during these times. longer recovery, breathing harder, etc

brain should immediately go to resp disease and mild/moderate equine asthma!

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11
Q

heaves is a hypersensitivity to

A

IgE mediated (type 1) hypersensitivity to inhaled antigens

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12
Q

what is the only respiratory disease that we actually know what the cause is

A

heaves: type 1 hypersensitivity (IgE mediated) to inhaled antigens

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13
Q

classic form of heaves

A

more severe signs when it is indoors exposed to bedding and hay dust. more mold associated than pollen

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14
Q

is equine asthma/RAO lower or upper airway obstruction?

A

lower airway obstruction
trying hard to expel the air after inhalation

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15
Q

what are the 3 reasons for the lower airway obstruction with RAO?

A
  1. mucous production
  2. neutrophil accumulation
  3. brochoconstriction: narrowing the lumen

typically there is goblet cell hyperplasia, so often these horses have increased mucous secretion

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16
Q

why do horses with RAO get bronchoconstriction?

A
  • smooth muscle contraction stimulated by inflammatory mediators and autonomic NS
  • hyperresponsive to nonspecific stimuli: cold air, road dust, etc - hard to control dust!
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17
Q

cytological evaluation with RAO

A
  • normal: <5%
  • RAO: 50-70%
  • positively correlated to hypoxia, pulmonary function, airway hyperreactivity
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18
Q

in equine asthma, what inflammatory cell accumulates? (hallmark feature)

A

neutrophils!! non degenerate neutrophil

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19
Q

you have a horse that is breathing hard, increased resp effort and coughing a lot. you do cytology on a tracheal wash and you see a lot of degenerate neutrophils. is this asthma?

A

no- asthma has non-degenerative neutrophils. if you see degenerative neutrophils, would diagnose it as some sort of infection.

why you want to get a cleannnn wash: if you cause degenerative neutrophils would be giving a horse the wrong diagnosis

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20
Q

pathophysiology of IAD (inflammatory airway disease)

A
  • unclear etiology
  • dust? positive correlation to stabling
  • viral?
  • bacterial?
  • most likely multiple etiologies
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21
Q

what are the 3 forms of IAD?

A
  1. eosinophilic
  2. mixed
  3. mast cell
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22
Q

eosinophilic IAD

A

5-40% eosinophils

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23
Q

mixed IAD

A
  • neutrophilia: >10% but less than the 25% that would send you to severe equine asthma
  • lymphocytosis
  • monocytosis
24
Q

mast cell IAD

A

> 2% mast cells
hypothesized that this form is the precursor for horses to develop severe equine asthma

25
how do you diagnose a horse with severe equine asthma?
increased respiratory effort, heave line, can see severe disease. often history as well with mild/moderate: likely need to get more information as well as consider other organ systems: resp tract, cardio dz, musculoskeletal dz
26
what body systems should you be concerned about with a horse that has exercise intolerance?
resp tract, cardio dz, musculoskeletal dz
27
hematology and biochem with equine asthma/airway dz?
usually no change, even in severe cases. horse may have a mature neutrophilia: stress leukogram. don't want to misdiagnose it as bronchopneumonia!
28
why might you see neutrophilia in a horse with airway dz?
stress leukogram
29
T/F: asthma cases will often have a mature neutrophilia
false- there should be no change. if seeing this, likely is stress leukogram
30
radiographs with asthma/airway dz?
no, skip. often don't have a prominent bronchial pattern esp in the mild cases rads will be normal
31
how to approach CBC and radiographs
if it walks like a duck and quacks like a duck, don't run them if the horse comes in and something bothers you- history, auscultation, cytology weird, then do these additional diagnostics. just to rule out that nothing is being missed not used for diagnosing the primary problem but used to diagnose something else. ESPECIALLY if a horse you treated comes back and treatment failed. need to do diagnostics to see what you are missing
32
endoscopy with asthma/airway dz?
often unrewarding. fluid accumulation is a common, yet unspecific finding. doesn't tell you what the disease is. can maybe tell you how severe the disease is but usually don't pursue it
33
bronchoscopy with asthma/resp dz?
can see change with a hyperreactive bronchi. again tells you something is abnormal, but don't pursue unless lavaging. extra information useful for those weird/unique cases
34
when do you use BAL?
in most cases tubing is shoved up nose and into trachea until tube gets wedged in lungs = have no idea where the tube ends up sitting!! used for a disease process that you think is homogenously affecting all of the lung. otherwise it is luck if you end up in the true diseased part or not. for equine asthma these diseases affect the whole lung pretty similarly.
34
tracheal wash vs BAL
BAL; cells and secretions from the distal smaller airways. in most cases tubing is shoved up nose and into trachea until tube gets wedged in lungs = have no idea where the tube ends up sitting!! used for a disease process that you think is homogenously affecting all of the lung. otherwise it is luck if you end up in the true diseased part or not. for equine asthma these diseases affect the whole lung pretty similarly. Tracheal wash: non-homogenous sample of cells + debris from anywhere in teh distal airways. superior for focal diseas and culture
35
what is the preferred way to make a diagnosis for equine asthma?
BAL: quality of cells is way superior than what you pull during a tracheal wash
36
why is a tracheal wash cytology not as good as BAL?
the trachea is the sewer of the lungs: good place to find a focal disease process in one specific site of the trachea as cells have made their way up there but: inflamm cells get pooled from all those places, so gives a combined sample, but the journey of the cells to the trachea cause them to be old, sad and unhappy. when taking a tracheal wash sample, will see majority neutrophils, but often these cells look degenerative!!! in a BAL they do not look degeneartive tends to be more heterogenous with cell distribution bc mucous traps cells: if all the neutrophils are clumped together it makes it hard to come up with a good differential
36
will you see degenerate or non degenerate neutrophils on a tracheal wash?
degenerate cells. they may be dead from their journey up to the trachea
37
will you see degenerate or non degenerate neutrophils on a BAL?
non-degenerate cells
38
what is a better test, tracheal wash or BAL?
BAL
39
what test is superior for small airway cytology?
BAL
40
what test is superior for focal disease and culture?
tracheal wash
41
what is the goal of environmental management of equine asthma?
minimize exposure to mold, dust, and endotoxins!! most important sources are hay and bedding remove bedding, put mats in the stall, shavings rather than straw, soak the hay to reduce dusk exposure or switch to an alternative feed: complete feed that is less dusty
42
what is the major trigger of equine asthma?
hay and bedding
43
ideally, where would you have horses with equine asthma?
maintained as pasture so they are not exposed to a stall, bedding, etc. if super sensitive, would feed pelleted feed supplement
44
summer pasture associated recurrent airway obstruction
form of equine asthma summer pasture associated: pasture is worse way to manage these asthma cases! need to differentiate between horses based on order of appearance, frequency, etc. the horse with indoor allergies are a lot more common. but there are the occasional ones you need to differenitate
45
how can you differentiate summer pasture associated recurrent airway obstruction from inside- caused horse asthma?
see seasonality with the summer pasture cases: have more clinical signs during the summer. may have very specific signs during the summer where you have one specific thing that is flowering or blooming ^ in the dry west, may see the summer form occurring because things are blooming, growing etc causing signs and it takes until winter for things to cover the pollen and allergens. not uncommon to see clinical signs in the fall and winter bc pollen counts will still be high classic form: stabilized in the winter inside and have more clinical signs inside in the winter.
46
why might you still see asthma signs during the fall and winter?
in the dry west, may see the summer form occurring because things are blooming, growing etc causing signs and it takes until winter for things to cover the pollen and allergens. not uncommon to see clinical signs in the fall and winter bc pollen counts will still be high
47
environmental management of equine asthma
- dust exposure is not a steady state!! - stall cleaning, feeding, eating can all trigger: may need to move the horse away from these - once road dust subsides, then maybe it isn't a problem. but if near a big road, that is a problem the road dust is not the thing that triggers the inflammation
48
medical therapy for equine asthma typically consists of
corticosteroids bronchodilators
48
choice of txt for equine asthma depends on
- severity of signs - cytological results - financial means - owner compliance
49
systemic administration of corticosteroids
- more powerful than inhaled - greater risk of systemic complications: laminitis, infection
50
aerosolized delivery of corticosteroids
- short acting - no prolonged benefit
51
systemic administration of bronchodilators
- greater risk of adverse effects: excitation, tachycardia, sweating
52
aerosolized delivery of bronchodilators
- more powerful than systemic - expensive
53
other treatments of equine asthma
- mast cell stabilizers: sodium cromoglycate - antihistamines - NSAIDS - singulair: expensive all of these are ineffective!

ClinSci 2 Exam 2 (11 decks)

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