Non-infectious Respiratory Disease 2 Flashcards
What type of anti-inflammatory drug is not effective for equine asthma?
NSAIDs
What are some systemic corticosteroids used for asthma?
Dexamethasone (PO)
Prednisolone (PO)
Which steroids can be inhaled?
Fluticasone and Ciclesonide
When should you use systemic therapy?
Severe Airway disease
-Switch to oral later
-Cheaper
-Less labor and equipment
-Effects all of immune response, makes them more suseptible to infection and heavy parasite load/skin disease
-Increase risk of laminitis
What are some inhaled meathods?
Flexineb and equihaler
-nebulizers
-Mild to moderate horses
-Ciclesonide - inactive, activated in lung when reach airway epithelium
What are some advantages of inhaled therapy? Disadvantages?
Advantage: local effect - rapidly degraded when enters blood, minimal side effect, best for long term maintenance
More expensive, labor and equipment intense
What is treatment of asthma based on?
Severity of clinical signs
-Mild - change environment first
-Fails to respond then more changes
-Mild- severe - IV corticosteroid and oral bronchodilator (clenbuterol)
When do you stop a corticosteroid?
Low dose and no evidence of clinical signs returning, Enviromental modification in place
Recheck BAL - confirm airway inflammation resolved (No neutrophilic inflammation) - recheck every 3 weeks
Always taper
When maintaining remission what is critical?
Client Education
-Ask about nasal discharge, cough, temp, other horses affected, change in management
-Recommend changes in environment
-Can reproscribe for time of year
What are some additional considerations for equine asthma horses?
Weight loss - untreated
Poor Response - Bronchial malacia (Bronchiectasis) - melting bronchi
What does IAD stand for?
Inflammatory Airway Disease
What are some other names for IAD?
Small airway inflammatory disease, lower respiratory tract inflammation, small airway disease, noninfectious airway disease, bronchiolitis, allergic airway disease
What is the common signalment for IAD?
Young 2–3-year-old racehorses, no history of recurrence or seasonality
What are some clinical signs of IAD and what does it look like on cytology?
Persistent, intermittent cough, nasal discharge, tracheal mucus
5-205 neutrophils in BAL, mainly nondegenerative
No response antibiotic
Reversible if caught early
Where does inflammation and injury occur?
-Injury to airway epithelium
-Decreased clearance and accumulation of debris
-Vicious cycle
What occurs in the IAD Cycle?
Epithelial injury -> mucociliary disruption -> Accumulation mucus and debris-> persistence epithelial inflammation and injury -> more mucociliary damage -> accumulate mucus and debris _> epithelial damage
Does bacteria play a role in IAD?
Not typically - if bacteria secondary to decreased mucous clearance
How do you diagnose IAD?
Signalment, breed, history
Signs: Cough, mucus, exercise intolerance
How can you sample for IAD?
Tracheal Wash
or
Bronchoalveolar Lavage (Preferred for IAD) - sample right dorsal diaphrgmatic lung lobe (lower airway better indicator disease status)
What does the typical inflammation from cytology of IAD look like?
Neutrophils, mast cell, eosinophil - less bacteria
(Hint at allergy)
What is the most important part of treatment of IAD?
Enviromental management - barn, turnout, medicate if not better with prednisolone
What is EIPH?
Exercise Induced Pulmonary Hemorrhage
What are factors that increase the risk of epistaxis?
Racing
Steeplechase
Older (2-4 or 9-10)
Female
What is the pathophysiology that causes EIPH?
Extreme negative pressure in alveoli of exercising horse and extreme positive pressure due to increase blood flow = increased transmural pressure on capillary = bust
Hemorrhage = inflammation
Inflammation = neo-vascularization
New vessel rupture = cycle start over
