Summary A standardised incremental exercise test was performed by 9 racehorses with idiopathic laryngeal hemiplegia (ILH), 1 horse with maxillary sinus cysts, 1 horse with epiglottic entrapment, 1 horse with a lesion on the vocal folds, and 1 horse with pharyngitis. Two of the horses with ILH were retested after laryngoplasty and ventriculectomy. The findings were compared with those from 20 normal racehorses. Heart rate, plasma lactate concentration, arterial blood gases, stride frequency, oxygen uptake (V̇o2) and carbon dioxide production were assessed during treadmill exercise on a +10% slope. The group of horses with ILH had significantly (P<0.01) lower peak V̇o2 values (136 ± 5 ml/kg/min) than did the normal group (154 ± 3 ml/klg/min). These values represent mean ± sem. Horses with ILH also had significantly higher (P<0.05) arterial carbon dioxide tensions (Paco2) at 10 m/s and lower speeds at a heart rate of 200 bpm (V200) than the normal group. The horse with maxillary sinus cysts had higher Paco2 tension at 10 m/s than normal, and abnormal values for several cardiorespiratory and metabolic indices. Horses with vocal fold lesions, aryepiglottic entrapment and pharyngitis had arterial blood gas and cardiorespiratory indices that were similar to those of normal horses. One horse which underwent corrective surgery for ILH showed improvements in arterial blood gases and cardiorespiratory indices during exercise, while the other horse had values which were the same as, or worse than, values before surgery. We conclude that the measurement of arterial blood gases and cardiorespiratory indices during treadmill exercise is useful in determining the effect on exercise capacity of various upper airway abnormalities in racehorses.

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Opinion statement Purpose of review With established immunosuppressant treatment regimens for anti-neutrophil cytoplasm antibody-associated vasculitides (AAV), prognosis has significantly improved. The mainstay of treatment still comprises high-dose corticosteroids and cyclophosphamide for severe forms, although rituximab is being increasingly utilised instead of cyclophosphamide as induction therapy. AAV patients experience an excess of infections, malignancies and cardiovascular events as compared to the general population, which is a combination of the systemic inflammatory process associated with vasculitis and the adverse events from treatment. Recent findings Successful therapy should focus on suppressing disease activity and minimising treatment-related toxicity. Infection is the largest contributor to morbidity and mortality in the first year of treatment, and annual pneumococcal and influenza vaccinations, Pneumocystis jiroveci prophylaxis and tuberculosis (TB) and Hepatitis B virus screening are advised. Patients on high-dose corticosteroid treatment should have regular blood sugar monitoring, a FRAX assessment with vitamin D and calcium supplementation, consideration of prophylaxis for gastric ulcers and a cardiovascular risk assessment. Patients who are treated with cyclophosphamide could also receive MESNA to reduce the risk of chemical cystitis. Cyclophosphamide, methotrexate and azathioprine all require blood monitoring schedules due to the risk of bone marrow suppression, liver and renal toxicity. Hypogammaglobulinaemia is a recognised risk of rituximab treatment. Patients of reproductive age need to be counselled on the infertility risks with cyclophosphamide and the teratogenicity associated with it, methotrexate and mycophenolate mofetil. Summary A greater focus on identifying clinical and biological markers that will help identify those patients at greatest risk of relapse, e.g. GPA and PR3-ANCA specificity, from those patients at greatest risk of toxicity, e.g. increasing age and declining GFR, is required to allow treatment to be tailored accordingly.