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Y4 EQ - Cardio-Respiratory > Lower respiratory tract conditions affecting the individual horse > Flashcards

Lower respiratory tract conditions affecting the individual horse Flashcards

1
Q

Name 3 common causes of lower respiratory tract disease in adult horses

A

Recurrent airway obstruction/’heaves’
Inflammatory airway disease
Viral and bacterial infections

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2
Q

Name 3 fairly common causes of lower respiratory tract disease in adult horses

A

Exercise Induced Pulmonary Haemorrhage (EIPH)
Pleuropneumonia
Aspiration pneumonia

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3
Q

Name the uncommon causes of lower respiratory tract disease in adult horses

A
  • Pulmonary abscess
  • Lungworm
  • Tracheal stenosis/collapse
  • Interstitial pneumonia
  • Pulmonary nodular fibrosis
  • Neoplasia
  • African Horse Sickness or other exotic diseases
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4
Q

Equine asthma is made up of which 2 conditions?

A

Recurrent airway obstruction/heaves
Inflammatory airway disease

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5
Q

Of the two conditions that cause equine asthma which one induces mild asthma and which induces severe asthma?

A

Inflammatory airway disease = mild/moderate
Recurrent airway obstruction = severe

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6
Q

List some causes of allergic asthma

A
  • Moulds
  • Bacteria / endotoxin
  • Mites
  • Plant debris
  • Inorganic dust
  • Noxious gases
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7
Q

Describe the pathophysiology of equine asthma

A

Primary insult -> inflammatory mediator release ->
- Airway smooth muscle tone
- Increased blood flow and vascular permeability
- Cell accumulation and activation
- Antibacterial activity
- Mucus production
- Neural reflex mechanisms

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8
Q

When dust, spore, gases, etc get into the airway, describe the 2 mechanisms which lead to bronchoconstriction

A
  • Inflammation increases the activity of muscarinic receptors which cause peribronchiolar smooth muscle contraction
  • Inflammation decreases activity of B2 adrenergic receptors which reduced bronchodilation
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9
Q

List the consequences of narrowing airways

A
  • Mucosal hyperplasia/inflammatory infiltrate
  • Goblet cell, increase mucus production
  • Decreased mucociliary escalator
  • Increased inflammatory cells
  • Chronic -> fibrosis
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10
Q

Describe the typical clinical presentation of mild/moderate equine asthma - age, signs, history, etc

A
  • Usually young to middle ages
  • Occasional coughing
  • Poor performance
  • No increased respiratory effort at rest
  • Often improve spontaneously
  • History of exposure to a stable environment
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11
Q

Describe the typical clinical presentation of severe equine asthma - age, signs, history, etc

A
  • Older than 7yo
  • Regular/frequent coughing, exercise intolerant
  • Increased respiratory effort at rest
  • Lasts weeks/months before diagnosis
  • Cant be cured but signs can be controlled
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12
Q

Describe the pathogenesis of chronic asthma

A
  • Smooth muscle hypertrophy
  • Peribronchiolar fibrosis
  • Epithelial cell hyperplasia
  • Mucus plugging
    –> airway remodelling
    –> Progressive impairment of lung function
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13
Q

Describe how increased respiratory effort in severe equine asthma presents on clinical exam

A
  • Flared nostrils when breathing
  • Expiratory +/- inspiratory wheeze
  • Forced expiration -> biphasic expiratory effort = “Heaves”
  • “Heave line”
  • Severe cases - respiratory disease and weight loss
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14
Q

How is equine asthma diagnosed?

A
  • Compatible clinical signs
  • Endoscopy (resting or dynamic)
  • Airway cytology
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15
Q

Describe the findings seen on endoscopy in cases of equine asthma

A

Excess mucus in tracheobronchial tree

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16
Q

Describe the findings seen on airway cytology in cases of equine asthma

A

Mild increases in neutrophils, eosinophils

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17
Q

Neutrophils above …% on tracheal cytology = inflammation

A

40

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18
Q

What would be seen on tracheal cytology to indicate a bacterial infection?

A

Lots of intracellular bacteria + degenerate neutrophils

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19
Q

How many cells need to be counted on a BAL to determine that qualitative cytology?

A

200

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20
Q

Neutrophils above …% on BAL cytology = abnormal

A

25
Severe asthma = greater increase
Mild/mod asthma = milder increase

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21
Q

When should you suspect other DDx for cases of ‘equine asthma’ based on your finding?

A
  • Clinical signs at rest in < 7 years old
  • ‘Sick’ (Dull / anorexic / pyrexic / weight loss)
  • Diagnostic tests don’t show lower airway inflammation
  • Lack of response to therapy
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22
Q

Describe the pyramid of asthma management

A

Short term - Bronchodilators
Mid term - Corticosteroids
Long term - Environmental control

23
Q

What are the aims of environmental control for asthma management?

A

Reduction of respirable particles including dust, moulds, fungi, endotoxins, gases
- Airflow, time outside ideal

24
Q

Compare the best and worst feeds for asthma management

A

Pasture = Best
Complete pelleted feed
Haylage
Soaked hay
Hay = worst

25
Q

Describe housing changes that can be implemented for asthma control

A
  • Turned out is best
  • Low dust bedding: cardboard, paper, fitted rubber matting
  • Take horse during/1 hour after mucking out
  • Not deep litter system
  • Maximise ventilation to stable
26
Q

Name the best drug for controlling asthma

A

Corticosteroids

27
Q

Describe the actions of corticosteroid which make them useful for controlling asthma

A
  • Reduce cell accumulation and activation
  • Reduce vascular changes
  • Reduce bronchoconstriction
28
Q

Which corticosteroids would be used systemically for asthma control?

A

Prednisolone (PO)
Dexamethasone (PO / IM/ IV)

29
Q

Which corticosteroids would be inhaled for asthma control?

A
  • Ciclesonide
  • Beclomethasone dipropionate
  • Fluticasone propionate
  • Budesonide
30
Q

Describe the timing of the effects of systemic dexamethasone for asthma treatment

A
  • Rapid effect
  • Maximal effect by day 7
  • Residual effects up to 7 days after stopping treatment
31
Q

What are the detection times for IV dexamethasone by the FEI and BHA?

A

FEI = 48 hrs
BHA = 120 hrs

32
Q

Describe the actions of bronchodilators on the nervous system

A

Activate the sympathetic NS or block the parasympathetic NS

33
Q

List the indications of bronchodilator use in equine asthma

A
  • Emergency ‘rescue’ therapy in flare ups
  • Before other inhaled medication
  • Before exercise
  • Diagnostic – do signs improve?
  • Do not use as sole therapy
34
Q

List the B2 agonist drugs for bronchodilation

A

Clenbuterol
Salbutamol
Salmeterol

35
Q

List the muscarinic antagonist drugs for bronchodilation

A
  • Atropine (single dose)
  • Buscopan (single dose)
  • Ipratropium bromide (inhaled)
36
Q

List the pros of inhalation therapy

A
  • Lower total dose
  • Rapid onset
  • Fewer systemic side effects
  • Shorter detection times
37
Q

List the cons of inhalation therapy

A

Expensive
Owner compliance
Distribution of drug if dyspnoeic

38
Q

What are spacers?

A

Provide a high local conc of an inhaled drug

39
Q

Bronchopneumonia/pleuropneumonia commonly occurs secondary to (5 options)?

A
  • Transport (‘Transit fever’)
  • Inhalation: Oesophageal choke, Gastric reflux, Pharyngeal dysphagia
  • General anaesthetic
  • Viral URT disease
  • Exercise induced Pulmonary Haemorrhage
40
Q

Bacterial colonisation of the lungs in bronchopneumonia / Pleuropneumonia affects which lung lobes the most?

A

Right ventral lobes most affected

41
Q

List the clinical signs of bronchopneumonia and how its diagnosed

A

Dyspnoea - tachypnoea
Systemic illness - Pyrexia, Depression, Increased HR, RR
Adventitious lung sounds
Cough
Tracheal aspirate - culture

42
Q

List the clinical signs of pleuropneumonia

A

Reduced lung sounds ventrally, dull on percussion
Ultrasonography
Thoracocentesis – reduced percussion where fluid is

43
Q

Name the 3 stages of pleuropneumonia

A
  • Active exudative stage
  • Fibrinopurulent stage
  • Organisational stage
44
Q

Describe the active exudative stage of pleuropneumonia

A

Inflammation of the lung and pleura – sterile protein rich pleural exudate

45
Q

Describe the fibrinopurulent stage of pleuropneumonia

A

Bacteria invade and multiply in the pleural fluid
Fibrin deposits on pleural surfaces
Lymphatic obstruction

46
Q

Describe the organisational stage of pleuropneumonia

A

Fibrin bridges stick the surfaces of the lung together

47
Q

How are bronchopneumonia/pleuropneumonia treated?

A
  • Broad spectrum antimicrobial therapy: Penicillin, Gentamicin, Metronidazole if complicated
  • Anti-inflammatory
  • Promote drainage
  • Monitor, supportive therapy
  • Pleuropneumonia: thoracic drainage
48
Q

Name the equine lungworm

A

Dictyocaulus arnfieldi

49
Q

What is the role of donkeys in equine lungworm?

A

Asymptomatic reservoir of infection for horses

50
Q

How is equine lungworm diagnosed?

A

Identification of worms in tracheal wash or BAL

51
Q

How is equine lungworm treated?

A

Ivermectin

52
Q

Equine Multinodular pulmonary fibrosis is caused by?

A

Equine herpes virus 5

53
Q

How is equine herpes virus 5 diagnosed?

A

Inclusion bodies may be detected on BAL or on lung biopsy tissues

54
Q

The most common adventitious respiratory sound cause by URT stenosis is?

A

Inspiratory wheeze

Y4 EQ - Cardio-Respiratory (6 decks)

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