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Internal medicine (equine) > Lower respiratory disease in individuals (Yr 4) > Flashcards

Lower respiratory disease in individuals (Yr 4) Flashcards

1
Q

what are the two names for the different severities of equine asthma?

A

mild… inflammatory airway disease
severe… recurrent airway obstruction (heaves)

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2
Q

what can cause asthma?

A

inhalation of allergens (mild, bacteria, dust, gas…)
how horse responds to allergens

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3
Q

what is happens once allergens are inhaled to cause asthma?

A

triggers inflammatory mediator release…
mucus production
increased blood flow and vascular permeability
cell accumulation/activation
neural reflex mechanism (parasympathetic)
increased airway smooth muscle tone (bronchoconstriction)

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4
Q

what causes the respiratory noise heard with asthma?

A

bronchoconstriction (creates a wheeze)

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5
Q

what contributes to the narrowing airways associated with equine asthma?

A

mucosal hyperplasia, inflammation, oedema
increased inflammatory cells
decreased mucociliary escalator and mucous production
(fibrosis in chronic cases)

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6
Q

when do horses typically present with mild asthma?

A

young horses
signs of poor performance, coughing at exercise
often improve/resolve with treatment

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7
Q

what are the factors of chronic asthma that lead to airway remodelling?

A

smooth muscle hypertrophy
peribronchiolar fibrosis
epithelial cell hyperplasia
mucus plugging

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8
Q

what are the clinical signs of asthma?

A

exercise intolerance
cough, nostril flare, nasal discharge, tachypnoea
heave lines (forced expiration)
very severe - respiratory distress and weight loss

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9
Q

does asthma cause an inspiratory or expiratory noise?

A

expiratory wheeze (respiratory tract collapses when breathing out)

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10
Q

how can suspected equine asthma be diagnosed?

A

endoscopy of upper airway (increased mucous)
BAL - airway cytology (mild increase in neutrophils/eosinophils)

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11
Q

how can the mucous be graded on endoscopy of equine asthma?

A

0-5
0 - no mucous
5 - river of mucous

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12
Q

is tracheal aspirate or bronchoalveolar lavage better for asthma diagnosis?

A

BAL

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13
Q

what result on tracheal aspirate would be associated with the horse having asthma?

A

neutrophils >40%

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14
Q

what is done on bronchoalveolar lavage to diagnose equine asthma?

A

count cells, if >25% are neutrophils it indicates asthma (the severity of the increase correlates with grade of asthma)

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15
Q

what are the three main treatment options for equine asthma?

A

environmental control
corticosteroids
bronchodilators

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16
Q

what is the best treatment for asthma flares (short term treatment)?

A

bronchodilator

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17
Q

what is the environmental control used for asthma?

A

reduce respirable particles (dust, mould, fungi, grass…)
ventilation and time outside
feed - soak hay, turn out to pasture, pelleted feeds
low dust bedding - paper, rubber mats, cardboard
turn out during/around mucking out

18
Q

what is the main treatment used for inflammation associated with equine asthma?

A

corticosteroids

19
Q

how do corticosteroids help to control asthma?

A

reduce cell accumulation/activation
reduce vascular changes
reduce bronchoconstriction (inhibit cytokines, histamine, prostaglandin release)

20
Q

how can corticosteroids be given for asthma?

A

systemic
inhaled

21
Q

what systemic corticosteroids are available for asthma?

A

prednisolone
dexamethasone (stronger)

22
Q

what inhaled corticosteroids are available for asthma treatment?

A

ciclesonide
beclomethasone dipropionate
nebulised dexamethasone

23
Q

what is the benefit of inhaled corticosteroid for asthma treatment?

A

targets specific area so there are less side affects associated with their use

24
Q

what are the two types of bronchodilators available for asthma treatment?

A

beta2 adrenergic agonists (sympathetic)
muscarinic antagonists (parasympathetic)

25
Q

what are the indications for using bronchodilators in equine asthma cases?

A

emergency therapy in flare ups
before other inhaled medications
before exercise
(don’t use a sole therapy)

26
Q

what is the most common bronchodilator used?

A

clenbuterol
(salbutamol)

27
Q

what is the mode of action of clenbuterol?

A

beta2 adrenergic agonist

28
Q

why can’t beta2 agonists be used long term as bronchodilators?

A

the receptors become down-regulated and tolerance is built up against them

29
Q

what are muscarinic antagonists used for bronchodilation in asthma cases?

A

atropine
buscopan
ipratropium bromide (inhaled)

30
Q

what are some extra therapies that might be useful in equine asthma cases?

A

mucolytics
rest
disodium cromoglycate
antioxidants

31
Q

what causes bronchopneumonia/pleuropneumonia?

A

secondary infections from opportunistic pathogens

32
Q

what factors predispose horses to bronchopneumonia/pleuropneumonia?

A

transport
inhalation (anaesthesia, reflux, choke, dysphagia…)
viral URT disease
exercise induced pulmonary haemorrhage

33
Q

what is the main site for bronchopneumonia/pleuropneumonia in the lungs?

A

right ventral lung lobes

34
Q

how are bronchopneumonias diagnosed?

A

clinical signs - dyspnoea, tachypnoea, pyrexia, dull, increase HR
adventitious lung sounds
tracheal aspirate - degenerative neutrophils and culture

35
Q

how are pleuropneumonias diagnosed?

A

clinical signs
reduced lung sounds ventrally
very painful (abducted elbows, short shallow breaths)
thoracocentesis

36
Q

what are the three stages of pleuropneumonia?

A

acute exudative - inflammation of lung/pleura
fibrinopurulent - bacteria invade, fibrin deposits
organisational

37
Q

what is done to treat bronchopneumonia/pleuropneumonia?

A

broad spectrum antibiotics (penicillin, gentamicin)
anti-inflammatory (meloxicam)
drain/support drainage
supportive therapy

38
Q

what is a specific part of the history in equine lungworm?

A

they have to graze with donkeys

39
Q

how is equine lungworm treated?

A

ivermectin

40
Q

what causes equine multinodular pulmonary fibrosis?

A

equine herpes virus 5 (EHV-5)

41
Q

what is the prognosis for equine multinodular pulmonary fibrosis?

A

guarded/poor

42
Q
A

Internal medicine (equine) (22 decks)

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