Managing Asthma in Horses

0:00Hi everyone and welcome to Ask the Horse Live. I'm your host, Haley Peffer, Digital Managing Editor at thehorse.com. Managing horses with asthma starts with controlling the horse's exposure to airborne irritants, particularly dust and mold from hay and bedding. Lot of fine turnout schedules, improving barn ventilation and adjusting feeding practices can improve affected horses clinical science. If you suspect your horse might have asthma, work with your veterinarian to develop a management and treatment plan. This event is sponsored by Kentucky Performance Products. To answer your questions tonight, we are joined by expert panelists, Dr. Kelsey Hart of the University of Georgia and Dr. Kate Hepworth of North Carolina State University. Welcome to both of you. Thanks, Haley. Happy to be here. Dr. Hart, can you start by telling us a little bit about your background? Sure. I am originally from New England, New York, and grew up riding hunter jumpers, and dressage, and pony club,

1:05and all that up there. I went to vet school at Cornell and then came to the University of Georgia in 2004 to do a one-year internship in large animal medicine and surgery. I was only supposed to be here for a year, and I've actually never left, so I stayed on at UGA to do a large animal internal medicine residency and a PhD in physiology. Then as I was finishing up, faculty positioned opened up, and I was lucky enough to join the faculty here at the vet school, and I've been here ever since. Both of our kids were born in Georgia, and we have a little farm here. I was horseless briefly for the last year or so, but I have a new fold that's going to be coming to our farm later this year, so I'm excited for that. Awesome. Thank you. Dr. Hepworth, can you tell us a little bit about your background? Yeah, absolutely. I was actually born in the UK,

2:07but mostly Gropan and Dianna, which is very different than the UK, I went to Purdue for vet school in undergrad, and then, unlike Dr. Hart, I've bounced around the country a whole lot, so I spent a year in Florida for an internship, and then I did my residency at Iowa State, and then my husband is a veterinarian as well. So after I finished my residency, he got to do his residency, so we moved to New Jersey, so I actually spent four or five years doing ambulatory practice, and then decided I would like to get back to academia, so then we moved down to North Carolina, so I've been at NT State for about seven years now, and just had a baby a year, almost a year ago, not quite, so we're exploring that, but I'm, I'm horseless. I'm in that brief stint of being horseless that Dr. Hart mentioned. I had a horse, I grew up doing kind of quarter horse and 4-H things, and had the horse that I did 4-H with until she was 35, but unfortunately I had to put her down about two

3:07years ago, so I'm currently horseless, but hopefully we won't stay that way for too long. Before we begin to answer in questions, I want to remind everyone of our Ask the Horse Live format. We're starting with questions that were submitted during registration. If you're listening live and would like to submit a question, please do so via the chat window. We'll do our best to get to as many of your questions as possible. If you're listening to the podcast recording of this event, and would like to join us live in the future, please visit the horse.com slash Ask the Horse Live to register for notifications, and with that we're going to jump in, so our first question is for you Dr. Hart from Olivia in New Jersey, who asks if you can explain what asthma is in horses and what causes it. That is a great question to start off with. asthma is termed an allergic lower airway disease, so what that means is the lungs, the lower part of the respiratory tract, responds in a way it shouldn't to allergens in the environment. Some horses have asthma signs

4:12that are triggered by grass or pollen or certain types of hay, other horses that can be dust, things like that. But essentially when they're exposed to these in a horse without asthma, it doesn't bother them unless it's very, very severe, dust storm type issue. But in a horse with asthma, their body sees those environmental allergens and responds by a couple of different pathologic processes in the lungs. There's what we call broncospasm, meaning the airway is sort of spasm and tighten, and it can make it hard for the horse to inhale an exhale. And then there's inflammation in the airway where the immune system is sort of overactive in terms of how it's responding to these allergens, causing a lot of mucus and inflammation in the airway. And together, that can make it really hard for the horse to breathe, particularly if it's trying to do any kind of exercise. As to what causes it, we don't really know. There are certainly probably genetic predispositions

5:18to asthma and horses just like in people, but it's not a specific gene that we can target. Chronic irritation to the airway might sort of trigger that as well. But if we could figure out what triggers allergies and asthma and horses, I would really like to know because I have pretty terrible allergies, and so does my daughter, where the rest of our family doesn't. So there's factors that we, we don't understand still, and there's a lot of active research in that area to date. Dr. Hepworth, Becky and Oklahoma wants to know what the early signs of equine asthma are. Dr. Hart, do you want to jump in? It looks like we can't hear Dr. Hepworth. Oh, I wonder if it was my obvious. Oh, I'm so sorry. I just realized. I'm so sorry. I have the mute button. I will not do that again.

6:25Yeah, so a lot of times the early signs that people complain about the most are exercise intolerance or poor performance. So it may be that a horse that usually recovered very quickly after exercise, you know, seems like they take a little bit longer to have the respiratory rate come back to normal, or some horses may just cough a little bit at the beginning of a workout, or they may cough a couple times during exercise, or they, you know, if it's like a barrel horse or a race horse, they may just not be as fast as they usually where they may get winded more easily. And then sometimes a lot of the ones that I see, you know, people will often say they have a history of maybe the horse they thought had allergies the summer before, you know, they maybe had a bit of nasal discharge and occasionally coughed, and a lot of that's actually asthma. And then as it progresses, you know, with the severe type asthma, it can become more progressive, and then we may see horses that are actually starting to cough and have an increased respiratory rate, you know, breathing really hard, they may develop that heat line where we see that sort of

7:27line of muscles around the edges of the ribs. And those are sort of some of the later signs. To hurt Julie and Michigan wants to know if allergy shots could help a horse with asthma. That is another great question. And the short answer is maybe, but there's not a lot of solid data to say yes or no on that one. The really important mainstays of therapy for asthma in horses is two things to deal with the inflammation and the bronchospasm. And that's steroids usually to decrease the inflammation and bronchodilators to help open up the airway. And that's the same way that we treat asthma and people and cats. However, if it's an allergic problem that's starting this process, a lot of owners ask, you know, can allergy shots help my horse? My own daughter is going through allergy shots right now. And there's pretty decent data in people that for certain kinds

8:32of allergies, it can be helpful. We lack that really solid scientific evidence for allergy shots in horses with asthma. But the idea with behind them is that by sort of continually exposing the immune system to low doses of the things that the horses allergic to through these shots, eventually you teach the immune system to stop overreacting to it and to be more tolerant of it. In my practice, and I'd be interested if Dr. Hupworth has a different opinion on this, it's certainly not the first line treatment that I go to for asthma because it doesn't work very quickly. It can take years to tell the immune system to calm down with allergy shots for any type of allergy. And usually when a horse is having an asthmatic crisis, we need a quicker treatment. So it's something that I might add on for some horses that are struggling to be controlled

9:33with the mainstays of therapy or for horses that are athletes and can't always compete at certain levels or in certain events on some of the steroid treatments, the bronchodilators that are the mainstays of asthma therapy. So I think the summary of my answer would be yes allergy shots might help sometimes, but they don't help quickly. And we don't have strong scientific evidence to say that they help every horse. Yeah, I think I would agree. I'm not particularly prone to suggesting them. I think so much of the management of asthma horses is changing their environment and getting rid of the triggers because the allergy shots take so long, the problem is so many of the triggers for horses are things you can't easily get rid of. So things like, hey, dust and fungus. So the allergy shots can be difficult. I think there is some upcoming research looking at some of the drugs that they use in dogs with skin allergies, not necessarily the immunotherapy, but

10:37other drugs that they use for dogs that have adipier, you know, really bad itchy skin that may have some benefits. So I think there's probably a place for it, but agree there isn't that much research yet to support it. And I don't think that it's very likely they will replace, you know, steroids, bronchodilators and management changes. Dr. Hepworth, Sophia in Texas asked if some horses are more prone to asthma than others. I think that's a little bit of a multifaceted question. So there is some thought, you know, and some, I was actually reviewing it today. And surprise like there's some pretty old research, like from the early 90s and 80s that suggests there is potentially a heritable or, you know, potentially a genetic component to asthma, much like there isn't people. That being said, there's not been a specific mutation identified, at least not to my knowledge. So it's not

11:38something where you can sort of screen a full and say, is this full going to get asthma by a genetic test? You know, there's definitely a certain environmental scenarios like wildfires that we would briefly talking about before the podcast started or really dusty environments that may make it so that more horses, if they're prone to it or more likely to be reactive, are going to show signs in certain environments. But you know, I would say asthma really, the horses I see with asthma, any breed can have asthma. Certain horses, I think, horses that tend to be over conditioned, maybe some of their clinical signs like respiratory distress when it gets really hot or just they don't recover as well can be compounded if they're not necessarily in as good a body condition score and not as fit. But I see it in all types of horses. Dr. Hart, Arlene and Florida wants to know what management changes owners can make for horses with asthma. This is such an important question. And Dr. Hepworth alluded to this already.

12:46The management changes are really the most critical part of dealing with these horses with asthma. And really the crux of the issue is trying to reduce exposure to the allergens that trigger the horses' asthmatic episodes. And as Dr. Hepworth said so eloquently already, it can be really hard to do. I don't know any barn that doesn't have some degree of destiny. If any horse on the property is eating, hey, there's going to be some hay dust. And then there's horses that are allergic to things in the environment, like different kinds of tree or grass pollen, that's just impossible to avoid. So a little bit is getting to know your horse and understanding what triggers it. A lot of horses are triggered by hay and hay dust. So for those animals, it can mean eliminating hay from their diet. You might feed a pelleted feed, soaked out the cube, something like that,

13:46or even some low-dust chopped hay products, things like that. But taking them off of hay. Some horses do okay, staying on hay as long as the hay is steamed or moistened so that there's no dust in it. Other horses are not bothered by hay and they have issues more in the summer, the sort of summer pasture associated asthma. And those horses need to be removed from whatever pasture is triggering it. So sometimes it's changing to a different pasture, coming into a arena turnout instead of a grass pasture. Other times when the horses are triggered by sort of everything that's outside, it's getting them in the barn more. We're sort of accustomed to thinking, okay, well the barn can be a dusty place. Let's put the horse outside more. And for a lot of horses with asthma, that can be beneficial, keeping them out of the barn period or keeping them out of the barn in particular when

14:48you're throwing hay down or cleaning stalls, sweeping, blowing the aisle. But then there's the subset of horses that are actually triggered worse by the pasture and they do better when they're in the barn. So the first sort of management change that's so important is understanding when is your horse assigned so worse? Is it the spring when there's certain kinds of pollen out? Is it the middle of the summer when there's certain kinds of grass out or is it in the winter when you're feeding various kinds of hay and then avoiding that? In other horses, finding specific triggers like certain types of feed can sometimes be done by allergy testing through skin testing ideally or there are some serum tests out there but they can give conflicting results on the blood tests. So in rare cases, it's not so much just managing dust exposure, grass, hay exposure, it's managing exposure to certain types of feed that might trigger a horse. But again, I think the

15:52mainstays are, get them out of the environment that triggers them, minimize the dust in their life in every way, shape or form. I'd love to jump in for just a second to Dr. Hard explained all of that beautifully but there there's a study that I like to tell a lot of our best students but also most of my clients about now that was a while ago that compared horses that had had management changes to reduce the dust and the triggers in their environment compared horses that were treated that way for asthma or those that were treated with just steroids or those that were treated with management changes and drugs and the horses that were treated with drugs alone did the worst. So it's really important that horses have these management changes because no amount of prescription medication will control a lot of these horses if the management changes haven't been made. I think that's such an important point. Thank you for bringing that up and the medications sometimes

16:52are not cheap. So if you're wanting to minimize them is definitely in your favor. Dr. Hepworth, Connie in Texas, asks if Regent can affect a horse's chances of developing or struggling with asthma. Absolutely and I think Dr. Hard already touched on a lot of this. I think Regent can definitely affect the types of asthma that we see and can also affect when a horse shows the signs if they're prone to it. I don't know that the Regent specifically makes them more prone to developing it but for example in certain parts of the country mine especially I'd love to know Dr. Hard since you're sort of close to me. We see I would say more asthma in the summer when it's really really hot and humid and we see a lot of the summer pastures associated asthma so we see a lot of the horses that really struggle when there's a lot of pollen around when it's really really humid. I've had some horses that the only way we could get their asthma controlled was by having the client

17:55move them. So sometimes we've had horses move up north with a new owner and they're totally fine whereas they could barely breathe at all without a lot of medication in the south. Whereas horses in the north you know are much more likely to really struggle with asthma in the winter when they're in barns that are more closed up because it's freezing cold and it's dusty and there's a lot of ammonia things like that. So I think the Regent may have an effect on when they show their signs and when they're the most triggered. We also see in my area a different subset in the cell types so we look at different cells when we're trying to diagnose asthma and the inflammatory cells that I see in my region now is a lot of mass cells which are more of an allergic type immune cell as opposed to when I practiced in different parts of the country. I saw neutrophils which are more of an inflammatory immune cell so it's interesting to me and I don't know what type you usually see and that might be getting in the weeds a little bit but those who asthma's are the same.

18:56Yeah I think that's such an excellent way to state it and I think our case distribution here in Georgia is not that different than yours at North Carolina but I'll give you an interesting anecdote. So one of the reasons that I've been whorseless for the last few years is because my horse moved from down here in Georgia up to of St. New York with a friend of mine and partly we moved him because I have children that are very busy and I was spending a lot of time driving them to soccer games and cross country races and art shows and not riding my horse but partly we moved him up there because he had pretty severe asthma down here and was really struggling exactly like Dr. Hepworth said in the in the summer months especially and he lives outside up in New York now and ETA up there and does great and really is on no medication so for him so far an environmental change

19:58has been really beneficial we'll see if he becomes sensitive to things in of St. New York now as well but I think it's the horse plus the environment that plays a role in those things and it's hard to predict. That's super interesting thank you. Dr. Hart Sheryl in Alberta asks if a runny nose is significant in a horse with a history of asthma that is now controlled. A good question I would say yes and it can be it can mean that there's again inflammation mucus sort of pus in the airway from a flare-up of the asthma but it can come from a lot of other places in the horse's respiratory tract from the sinuses something like that the back of the throat so a runny nose is always something that you're going to want to get your vet out there to look at and letting them know that the horse

21:02has asthma is important because it might be something that they want to investigate a little further to say okay well maybe he seems controlled at rest but maybe there is inflammation still going on in the airway that we need to look for look for some of those inflammatory cell types that Dr. Hepworth was talking about. Now if it's just a very mild clear nasal discharge on a cold day or every now and then that may not be a big deal but still worth having your vet out to investigate any kind of nasal discharge in your horse whether they've had asthma before or not. Dr. Hepworth Kristen in Kentucky asks if fungal infections can play a role in chronic airway inflammation in horses? That's a good question so thankfully fungal infections in the airway are not very common the lower airway I should take that back I can sometimes happen in the upper airway

22:05but a true fungal infection in the lower airway or in the lungs would be considered a fungal pneumonia and thankfully that's not something we see very often and when it does happen it tends to be in horses that are somehow immune suppressed you know they may be on really high doses of steroids for a very very long time or older horses with uncontrolled cushions or PPID things like that but those horses with fungal infections in the lower airways tend to be very very very ill they lose a lot of weight and just look very sickly which some asthma horses can obviously lose some weight while they're working really hard to breathe but they generally don't look as sick as a horse with a fungal infection funguses becomes involved in asthma because fungal spores often are in the hay and in the environment so they can absolutely be one of those allergens that the horse reacts to but most of the time in asthma horses when we find fungus in an airway sample it's more considered

23:09just an environmental contaminant as opposed to actually having colonized and caused an infection Dr. Hart we have a question from Adam in our live audience who he would like to know what's the difference between mild or moderate and severe equine asthma based on the clinical signs and respiratory function oh that's a great question and I suspect both of us may have something to say here that might just be the rest of the podcast I know that I think there's been papers written on this by a lot of smart people so I'll try to give us a sink dancer and then I'll let Dr. Hart jump in so mild, moderate asthma these horses tend to not have respiratory signs at rest they're not doing much coughing they're not having an increased respiratory radar effort at rest but they may do some of the things like Dr. Hart was mentioning where they might cough at the

24:14beginning of exercise or they may be a little slow to recover maybe they're not just performing at exactly the level you want them to but you're not sure why these horses have mild to moderate degrees of inflammation in the airway so when we sample the lower airway through a procedure called a bronco alveolar lavage or BAL they have in evidence of increased inflammation but not to a very severe degree so when we count the immune cells in there it's sort of a lower number than in a severe case the severe asthma courses have clinical signs at rest coughing things like that when they're just standing around increased respiratory rate and effort obviously is much more common there that's what often what the owner will notice and when we sample the airway there's more substantial degrees of inflammation various cell types can be involved but there's a

25:17lot of inflammatory cells in there there's also different types of pulmonary function testing that can be done and there's kind of parameters for calling it based on that but that probably is beyond a question that Adam was asking yeah I think that was a very good explanation of it I think the thing that I will add is that it's not necessarily a spectrum so not every horse with mild moderate then develop severe asthma some horses with mild moderate asthma can basically be resolved and never develop the severe a lot of the naming of this disease has changed a lot even you know in the past 20 years I think asthma has probably had three or four different names in my career yeah in my career say I'm like all the things we learn now are not the names that I learned when I was a student or even when I was a resident I think yeah so you know historically we

26:19talked about asthma as heaves or and then it became recurrent airway obstruction sometimes people say COPD and then for a while there was sort of the subset where there was recurrent airway obstruction and inflammatory airway disease and now if you're familiar with those names inflammatory airway disease was the sort of subset of horses that now we call mild mild moderate asthma where they don't have signs at rest they tend to be younger horses sometimes they're the resources the younger performance horses whereas the recurrent airway obstruction most of the things that were written about that really now translate to the severe equine asthma so in a couple more years if we repeat a podcast I'm sure that the name will be something different but asthma does seem to be have to stuck around for a little while now at least yeah I think it's a better name it sort of encompasses all of the different ways it can present but I think you just summarize my 22 years in practice with that I think mine too it's the same with that theory they've all changed too oh seriously

27:30Dr. Hart Lindy and England asked if a young horse with severe asthma can have a career as a sport horse oh that's a tough one so again I think the answer is yes and maybe yes but in this case they can but it requires really really diligent management as Dr. Hupurtha said tends to be milder moderate disease in the younger horses ideally but they definitely can present a severe asthma and if mild moderate asthma is not managed appropriately there can be sort of chronic damage to the lungs that can impair that horse's lung capacity over time so there are plenty of athletic horses that I've worked with in my career that we've diagnosed with asthma and how they're managed and how well the triggers that set that particular horse off can be avoided

28:34really has been what has dictated their ability to to go on and have a career as a sport horse I think it takes really excellent level management to control the environment and all the ways we've been talking about especially when you're traveling a lot flying on airplanes riding in trailers a lot it can be harder to control the environment at a show ground than it can be at your own barn certainly medical therapy plays a role in managing these horses as well but there's restrictions as to what you can use in various levels of competition so it's not in my feeling necessarily a diagnosis that's going to condemn that horse's athletic career but it is something that an owner would really need to be prepared to manage diligently and carefully as part of that horses sort of preparation for all of its athletic endeavors. Dr. Hepworth Karen in California wants to know if any supplements

29:42might help a horse with asthma. Yeah I think that's a good question a little bit maybe have a loaded question it's I think the horse world there's so many supplements available and you can ask five different people and they'll give you five different supplements that they think are great there's not always a ton of research behind some individual ones some have a lot of research some don't I think the one thing and I'd love Dr. Hartz and put on this as well the one thing that has kind of come forth in the recent few years as a supplement that may actually really help asthma as things can contain omega-3 fatty acids that seems to actually reduce some of the inflammation in the lower airways I suspect there's you know research going on on a number of other supplements to look at them and see how they may help but I think it's still the most important thing to focus on is the management changes and then add junk like prescription medication I don't think at this point that any supplement is going to be able to replace those things

30:47yeah I would agree wholeheartedly to that I think that there's a lot of supplements that have zero data out there in the equine world and there are some Perez-Mata courses that do have some data that suggests they might be helpful but I don't think any of them are helpful in the absence of excellent environmental management and medications for horses that have severe disease Dr. Hart darwin and north secoda asked if long-term steroid use as a treatment for asthma could be harmful to a horse yes for sure but so could uncontrolled asthma so steroids are wonderful medications they're the most potent anti-inflammatory agents we have and with that they come with some side effects so the idea with steroid use is that you want to use it as close to the site of inflammation

31:51as possible and as low a dose as possible and for a short a course as possible and that will give you the beneficial anti-inflammatory effects with the least side effects possible so for asthma the sort of ideal way to do it is to get the steroids directly into the airway through an inhaler through a nebulizer or something like that that is going to put the steroids right where the inflammation is and many of them are not absorbed much into the body that way if you have the dose right and the drug right so you don't end up with a lot of systemic side effects where the steroids might be affecting other parts of the body that you don't want them to affect however sometimes in really severe cases we do need to give steroids IV or intramuscularly or orally to horses with asthma or sometimes owners can't manage a nebulizer or an inhaler the horse won't tolerate it or the

32:54medications are expensive so we do use steroids and they have a really important place in asthma the goal is to use them when the inflammation is out of control taper the dose as much as you can to get it to the lowest dose that is helping control that horse's inflammation as you're doing these other very important environmental changes and then you'll find in most cases the horse can come off of steroids and be managed predominantly with careful environmental management there are some severe cases though where they need steroid use to control their inflammation and to help the horse be able to breathe long term for months or years or every year at a certain time of year when their signs are really bad that can be okay in a lot of horses again as long as we just continue to work with our vet and pay attention to the horse and continue to try to get them on as low a dose as

33:55possible you after have both Jane and Oregon as if horses with asthma typically do better in wet weather versus dry summer heat well first I wish that I had dry summer heat living down here in the southeast that's not something I'm familiar with um so I think that goes back to our discussion earlier on you know just the different environments I will say you know for example with very high levels of humidity a lot of horses do worse I don't know that I can necessarily comment on how how horses in your specific environment where it's more temperate and where you have like cooler wetter weather I would say I again only seem to see the big

34:57flares when it's hot and wet as opposed to hot and dry or wet you know wet and cooler to me I think it's more the temperature that makes a difference so I think the horses when it's cooler maybe do better I don't know Dr. Hart if you have a better answer on that or more more insight I haven't practiced anywhere where we have dry summer heat maybe there yeah I haven't either I think it's it's quite similar but I do think when it's very dry you certainly can have increased dust so again I think it depends on what irritation to the airway is happening it's been quite dry where we are right now and we have a dirt driveway that was just re-graded and it really needs to rain at my farm it's quite dusty right now and one of the horses the old retired horse that are how does struggle a little bit with asthma and she's having a little bit of a flare maybe triggered by a little bit more of the increased dust right now so I think there's lots of things in all the different weather conditions

36:05that can trigger different horses but the ones that are triggered by mold are going to do worse in the wet weather and the ones that are triggered by environmental dust more might do worse than the dry weather Dr. Hart Alexandra in our live audience asks if you've ever seen horses react poorly to allergy shots in particular has it ever caused their asthma to be worse that's a good question I have not personally seen that I've not treated a huge number of horses with allergy shots but in the ones that we have the most common thing that people will say is oh I just don't think it's helping and that's because I think if it does help it's very very slow I've not had a case where it seemed that the horse was getting worse with the allergy shots I don't know if Dr. Hart says had that experience but I haven't no I have not I think it would be the same thing that

37:08they just they don't necessarily improve but I don't think it would make it worse after have worth the question from Sarah in the live audience who asks if nebulizers and inhalers help with coping with asthma and is that something that can be weaned off of eventually or is it best to keep them on these therapies long term I think the answer would be yes and no for every different horse I usually like to tell people that no two cases of asthma are the same so like Dr. Hart touched on you know some horses can do really well with only nebulized or inhaled therapies especially the corticosteroid sometimes bronchodilators which are drugs like albuterol that actually get rid of some of that spasming in the lower airways some horses require systemic you know oral or injectable corticosteroids whereas some will do okay with just the nebulizer the inhaled I've definitely had

38:09some cases where if they're really severe I can sort of get them under control initially by using the higher doses and the systemic steroids while the management changes sort of go to work removing some of the allergens and then after that sometimes the horse may need just occasional dosing with an inhaled medication it could be oh we know it's going to be really hot in him with this weekend or oh I'm gonna go to a show this weekend if these drugs are allowed obviously and then they might be able to nebulize them every case is different so every single horse I think has kind of a different threshold at what level of control they need from the medications but nebulizers and inhalers are great because as Dr. Hart said you know it puts the anti-inflammatory drug or the bronchodilator right where it needs to be in the lungs not all horses will tolerate them and there's definitely some pros and cons for some of those you have to buy sort of a fancy set up

39:09you know like the nebulizers themselves which can be kind of pricey but then the drugs that go in them may be cheaper whereas sometimes the drugs for the inhalers are more expensive but the apparatus is cheaper the other thing is not all horses will tolerate it some are great but for some of them you know for the nebulizers especially you have to leave this sort of apparatus on their face kind of like a hay bag only much heavier and louder and it has to stay there for you know 10 15 20 minutes and not all horses will tolerate it so I think it depends a lot on the horse a lot on the type of asthma and that horse's specific allergen triggers Dr. Hart Elena in our live audience wants to know what is the recommendation for medical management of an asthma course who also has PPID oh you just like picked all my favorite things to talk about in the end thank you I'm so glad this is your question now you just have to make it a full too somehow so it's funny because I was just talking with someone about this today and

40:16like Dr. Hepers said there's no two horses and no two cases that are the same in general in horses with endocrine disease so PPID or metabolic syndrome or a combination of the two where there might be a higher risk of laminitis or issues with insulin regulation we want to be careful with steroid use because steroid use while in a normal horse doesn't seem to cause laminitis in a horse that is prone to developing laminitis or insulin dysregulation because of its underlying hormonal problems like PPID there might be an increased risk of laminitis we know that steroids especially when they're given systemically to the horse can cause problems with insulin and we know the insulin can cause problems with laminitis so we're trying to avoid that cycle getting started

41:19natural is if you have an older horse that has PPID and has asthma you have to figure out a way to get steroids into them or figure out another way to control them and so and no we sound a little bit like a broken record but environmental management is even more critical in these cases because having to control asthma crisis or a flare-up with high doses of steroids is riskier in these horses so being very careful to figure out what triggers that horse and do everything you can to avoid it is vital and then in these cases if you are going to use steroids if you can't get them under control any other way I really try to stay away from systemic steroids in them these are ones where we're usually talking to the owner about the cost of a nebulizer the cost of inhaled meds to decrease the dose of steroids we need to put into the horse the other thing that I think we mentioned very briefly at the beginning of the talk but that is something

42:26that's possibly on the horizon or some other classes of drugs that might work to target allergies in a different way some of the drugs that are being used to control itchy dogs and adipi and things like that might be an area that could be beneficial in these horses yet but I would caution to say that they're expensive and we're really lacking solid data right now to say that those are any safer I wonder if Dr. Hepworth has any other thoughts but that's generally it short-course steroids as low dose as possible and I try to avoid giving them systemically if I can now I think the audience is lucky to have one of our endocrine gurus to give it to that talk I would like to know because I will often less so for the horses with PPI D but for the horses with metabolic syndrome we will often you know recommend at least doing some metabolic testing first to try the best of our abilities to get an idea of what their risk might be but it does

43:28become difficult because if again my Dr. Hart said like they do have to breathe so they do very fine balance you know and sometimes we have horses that if if some of their you know pre steroid blood testing you know or endocrine testing suggests that they might be a high risk of limonitis we might push harder with only management changes or inhaled versus systemic but a lot of lying to me you know they do have to breathe so sometimes you can't avoid it yeah I couldn't say it better that's exactly right test them if we don't know if we do know we try to avoid it but you can't avoid breathing so we've got to help them do that Dr. Hepworth Olivia in our live audience wants to know if you see obesity affecting horses with asthma and improvement with symptoms when the horse has an ideal body condition I think that is a nice

44:28kind of spin off from the conversation we were just having I think it might not necessarily directly affect their airway function but it does have an effect on what treatments you can use so horses that are obese are much more likely to be dysregulated as far as their insulin status and their endocrine status which means they're probably more likely to have adverse effects if they're given steroids the other side of that is you know just like in people when obesity is a component obviously the cardiovascular function isn't going to be as good and they're probably not going to breathe as well so you know yes I think trying to maintain an appropriate body weight is always the ideal for a number of reasons Dr. Hart Jane and in Missouri wants to know if respiratory problems are anywhere concerned in horses or if we just hear about them more now because our knowledge has expanded

45:31gosh I think maybe a little bit of both to be honest I mean I think all of us most of us on here have grown up with horses since we were little for sure and I certainly did and I remember horses I think then we were calling it heaves horses in the barn with heaves and having asthma type signs even as a kid but what I do think we are better at doing now is diagnosing the milder forms of asthma before the horses are really presenting with coughing and respiratory difficulties at rest when they're just standing around so I can see where it might seem that it's a newer or emerging disease I don't think it has I think we're just better at realizing that even mild inflammation in the airway can impact a horse's athletic ability and those are the ones that were sometimes we used to struggle to sort of figure out why is this horse not performing well I think we're better at finding the

46:36inflammation in the airway and realizing that asthma is probably playing a role in its issues. Dr. Hepworth Sarah in Florida asks how heat and humidity affect both working and non-working horses with asthma? Yeah I think we've touched on that a lot you know that it definitely does have an effect I think you know just like with people with asthma when it's really hot hot and dry or really hot and humid it can affect any of them and I think one of the added things in super hot environments you know like where Dr. Hart and I are both practicing some horses also stop sweating which makes it even harder I've had at least in the past few weeks a couple of horses that have asthma and the anti-droses so they're really struggling to breathe because they can't regulate their temperature when it's super hot and then they've also got the asthma component on top of it and those horses are really difficult to manage so I think it is important in those really hot and humid environments

47:39to make sure that asthma's not the only problem because sometimes when those horses come in and they're not sweating they do look very similar to a horse that's having an acute flare-up of asthma when they're in respiratory distress breathing really really hard so it is something to keep an eye on when you're you know working horses and living with horses in these really hot and humid areas to make sure that they actually are sweating because it's pretty common in at least some of these to see horses that lose the ability to sweat and that can exacerbate respiratory things. We've had so many of those here too in the last couple of weeks for those of you that aren't in the Southeast it's been really pretty impressive really 110 12 degree heat indexes the heat finally broke this weekend and I was about to pack up my car and move north so I'm glad I broke but those horses it's so really struggling yes I was actually managing a case exactly like the one I was just

48:39describing last week that we're like is it really her asthma is it because she's not sweating and it's 100 degrees it's hard to tell what what exactly was causing the issue probably both yes. Dr. Hart Amy in our live audience asks what the pros and cons are of nebulizing a horse before exercise if they have more mild asthma and are there benefits to nebulizing only with saline? Oh I will be interested to hear Dr. Hepworth's subunion on this too. I don't know that we have great data to say whether or not saline is beneficial or not. I think one theoretical way in my mind it could work is nebulizing with saline before exercise if there is a mucous in the airway it can thin the mucous a little bit and make it easier for the horse to sort of cough it up and breathe around it in terms of nebulizing before exercise with something else a bronco dilator certainly can be

49:45beneficial right it can open up the airway but a bronco dilator alone in a asthma of course that has a lot of inflammation in its airway doesn't always help on its own because you might just be opening up airways that are full of mucous and pus and can still be very hard for the horse to breathe. These bronco dilators drugs like albuterol and stuff can have effects on the heart and lungs together and so there can be some agitation and stuff that can happen so that's why there's restrictions on using these medications and competition in terms of timing and things like that. So it's sort of a it's a hard question to answer because it depends a little bit on what you're nebulizing with. I'd be interested to hear if Dr. Hafer has any interesting data to share more on saline alone versus other nebulization before exercise. The only one I haven't done any research on that specifically myself but there was a paper not too long ago where they were actually

50:51comparing nebulized alitacane which is a drug that may have the local anesthetic and they compared that to saline and I think in that particular study the horses with asthma actually did show mild improvement in the inflammation of their airway samples after the saline compared to the alitacane but I think it was a fairly small group but I think it probably needs more work so I suspect it maybe helps a little bit but I agree with what Dr. Hart said that if there's a lot of inflammation you know I suspect it's not going to be enough but again every horse is different and some horses you know some horses respond really well the things that you know we might think don't work that well so I think it it is a lot of trial and error. Dr. Hart, Alain and Connecticut wants to know if any other conditions or diseases might look like asthma in horses. Oh I think we had a really good segue to this question and I definitely think

51:52one that really masquerades as it is what we call anhydrosis or the inability to sweat or not being able to sweat enough. We see that so commonly in hot climates, hot and human climates all in the southeast and those horses sometimes present to us in the hospital on emergency for an asthmatic crisis because they're breathing so hard but they're just breathing hard to try and cool themselves because they can't sweat. When those horses have anhydrosis and asthma as we talked about then they're really struggling but anhydrosis alone can fool you and present like asthma because the horse is really working hard to breathe. The other conditions that can look like asthma are any other kind of problem in the lungs so pneumonia things like that a horse can be coughing and having trouble breathing and that's why it's so important to make sure that even if your horse has a history of asthma that your veterinarian is involved if it seems to be getting worse

52:55or if you're going to restart medication that it hasn't been on for a while because it could be a flare-up of asthma where it needs steroids but it also could be an infection in the lungs where steroids would suppress the immune system which is not what we want in an infection. That horse might need antibiotics instead and then the last condition that can sometimes look like asthma is when the horse's heart is having trouble. The heart and the lungs as we've talked about work really closely together to circulate blood and oxygen throughout the body and if the heart is not working properly the animal can end up with fluid in their lungs and that can make them act like they're having trouble breathing they can have nasal discharge that is sometimes fluid like and that can sometimes fool people into thinking the horse is struggling with asthma and really they have a heart problem. Dr. Hepworth, Debbie in our live audience asks if you have recommendations for managing a horse

54:01with both antidrosis and asthma. Oh yeah that's a great one. I do actually I think you know the big thing is that these horses with antidrosis you know there's a ton of ton of different remedies out there and unfortunately you know in our world the more treatments there are for something the less effective they generally are. So antidrosis is really tough you know keeping them inside with fans not working when it's super hot is really really important but of course if they have asthma keeping them inside with fans is not always the best. So I think you know finding finding an environment you know if you have a barn for example you have a horse that has antidrosis has to stay inside the barn making sure at least wherever that horse is stall is isn't on the edge of an arena isn't directly below a hay loft making sure that the barn isles don't get cleaned with a leaf floor. There are special shaving sometimes that can be used that are advertised as being lower

55:02in dust you know sometimes spraying the shavings down with water soaking the hay things like that can help but really keeping the horse cool while also trying to reduce the dust you know and again some of those horses might not be able to live their best life in these really high human environments because both antidrosis and asthma in a lot of horses will almost go away if the horse moves to a different climate obviously you don't want to sell our horses and that's not always the best option but for some really severe cases that sometimes is the only option. And I love if Dr. Hart has other recommendations I think there's tons of supplements out there there's the old adages of giving horses with antidrosis different cocktails literal cocktails you know that can potentially help but there's there's just not much evidence to support anything that truly has a direct effect. Yeah the only other thing I would add is sometimes these

56:06asthmatic and hydrotic horses that can't be in the barn I've had owners put like ceiling fans in their running shed outside and that and like kind of shut them in there during the day so they're getting kind of open air but they still have shade in a fan and that's been beneficial. The only other thing that I'll offer not with a huge amount of scientific evidence yet but with some good results from some of my colleagues this past summer has been there's an acupuncture protocol for helping with sweating that they have said has been really beneficial in their hands and we have a couple of horses in our researcher that our storeling was all these conditions that really did start sweating again after acupuncture. So again I don't have good science to support that yet but there may be something that people are going to be studying in the future and maybe some of your horses can be involved in those studies to help us figure it out.

57:12You've let us perfectly to our last question which is for Dr. Heffworth from Karen in Georgia who asks if complementary therapies or Eastern medicine could be used to treat horses with asthma in combination with traditional therapies. Yeah I may have to defer this one back to Dr. Hart since it sounds like some of her group at Georgia is working on some of these things. I'm not particularly well first in a lot of Eastern medicine I've definitely heard you know that acupuncture with EN hydrosis can help. I don't know that I've actually I'm just trying to wreck my brain I don't know that I have much experience with horses that have had acupuncture at least as a sole therapy and improved I think there's probably a decent number of horses that have acupuncture in addition to the other therapies but it's hard to say which one helps because every asthma horse has so many different components of management that it's hard to say which one helps. So Dr. Hart I'd love to know if you have input on other things that may help. Yeah and I don't for sure and I don't think for asthma alone that I am not trying to

58:17get an acupuncture so I don't want to be speaking out of turn but we have a number of clinicians here at EGA who are I don't think any of them are using acupuncture for horses with asthma alone but definitely for horses that are in hydrodics is where they're reaching for it. I don't think we have any data probably even in people that would suggest that these Eastern approaches or complimentary therapies are solidly convincing but I am a big believer in sort of holistic approaches as long as we're also doing the things that we know work like environmental management and things like that so I think it's certainly worth a try but there's not a lot of data out there and if you have limited resources to spend I would definitely direct them towards the other things that we've talked about tonight. Well that's all the time that we have for tonight but thank you Dr. Hart and Dr. Hepworth for joining me. Thanks very much. Thank you. And thank you to Kentucky Performance

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