Decision Making in Severe Equine Asthma—Diagnosis and Monitoring

Abstract

Decision making consists of gathering quality data in order to correctly assess a situation and determine the best course of action. This process is a fundamental part of medicine and is what enables practitioners to accurately diagnose diseases and select appropriate treatment protocols. Despite severe equine asthma (SEA) being a highly prevalent lower respiratory disease amongst equids, clinicians still struggle with the optimization of routine diagnostic procedures. The use of several ancillary diagnostic tests has been reported for disease identification and monitoring, but many are only suitable for research purposes or lack practicality for everyday use. The aim of this paper is to assist the equine veterinarian in the process of decision making associated with managing SEA-affected patients. This review will focus on disease diagnosis and monitoring, while also presenting a flow-chart which includes the basic data that the clinician must obtain in order to accurately identify severely asthmatic horses in their everyday routine practice. It is important to note that European and American board-certified specialists on equine internal medicine can provide assistance in the diagnosis and treatment plan of SEA-affected horses.

Immunoproteomics enable broad identification of new Aspergillus fumigatus antigens in severe equine asthma

“…Due to the nature of the present study, it was not possible to analyze bronchoalveolar lavage cytology or perform lung function testing and respiratory endoscopy on healthy horses matched with asthmatic horses. Therefore, it cannot be fully excluded that horses with mild, subclinical asthma could have been categorized as healthy according to their history (HOARSI) and clinical presentation, while these parameters are highly reliable in detecting SEA ( 2 , 5 , 60 ).…”

Equine Asthma Does Not Affect Circulating Myostatin Concentrations in Horses

“…This disease causes significant losses in the use of horses in various sports and work disciplines [ 2 ]. Nowadays, the diagnosis of EA is most often based on clinical signs, examination results, and treatment response due to the lack of conclusive and relatively quick diagnostic tests [ 3 , 4 , 5 ]. Recently, in human medicine, asthma and asthma-like diseases have been recognized as complex and heterogeneous disorders characterized by airway obstruction and chronic inflammation, resulting in progressive airway muscle damage [ 6 ].…”

DataSheet_1.pdf

“…BALF mast cells 5 (%) 0.7 (0-3. Clinical signs as main criteria for group classification: Sum of scores for nasal discharge, nasal flare, cough, respiratory rate, abdominal lift, auscultation at rest, and after rebreathing (28, 56-58); one HE horse had an elevated score based on malformation of its upper airways and resulting clinical signs.…”

“…MEA presents with mastocytic, eosinophilic, or mild neutrophilic inflammation in BALF, while SEA is usually characterized by severe neutrophilic inflammation (1). Even though diagnostic criteria and phenotypes of EA are well defined, underlying pathological mechanisms remain incompletely understood (4,5). To date, there is no curative treatment available, and therapy is mostly focused on hay dust avoidance and symptomatic approaches including corticosteroid application to ameliorate dyspnea (2).…”

“…Inhalation of (hay) dust triggers exacerbation of clinical signs in EA within 1 to 5 days (5)(6)(7)(8). In addition, small airborne provoking agents such as mites, pollen, or mold have been described to cause increased clinical signs (4,7).…”