Randomized, controlled study of inhaled fluticasone propionate, oral administration of prednisone, and environmental management of horses with recurrent airway obstruction

Abstract

Environmental management is the most important factor in the treatment of horses with RAO. Early treatment with inhaled fluticasone can help accelerate recovery of horses with severe RAO.

Inflammatory Airway Disease of Horses—Revised Consensus Statement

“…One study found that long‐term dexamethasone and fluticasone treatment did not reverse the airway neutrophilia when RAO horses are kept indoors and exposed to hay even after 6–7 months 6. Other studies showed an additive effect on clinical signs, airway neutrophilia, and inflammatory cytokines in RAO horses when combining corticosteroid treatment with measures to improve air quality 6, 115, 116…”

“…It is thought that the risks of developing adverse effects associated with this treatment might be increased compared to inhaled corticosteroids,118 although the evidence is weak. Inhaled beclomethasone and fluticasone can be administered by metered dose inhaler via specialized delivery devices 115, 119, 120, 121. However, a fluticasone propionate metabolite was observed in the blood and urine when the drug was administered by inhalation at therapeutic doses,122 and adrenal suppression was detected after administration of beclomethasone dipropionate by inhalation 118…”

Inflammatory Airway Disease of Horses

“…These medications are administered by metered dose inhaler via specialized delivery devices and they have proven to be clinically effective in horses with RAO with diminished risk of systemic adverse effects. 51,52 Anecdotal evidence suggest that the same drugs are beneficial for the treatment of IAD and dosages are usually lower that for RAO therapy.…”

Fluticasone Propionate Aerosol is More Effective for Prevention than Treatment of Recurrent Airway Obstruction

“…One of the most widely used drugs is fluticasone propionate (FP), which also is recommended for the management of recurrent airway obstruction (RAO) and inflammatory airway disease in horses. In RAO‐affected horses, FP (2 mg twice daily for 3 weeks) improves lung function, and a similar dose administered for 2 weeks enhances the improvement in lung function caused by environmental management alone 2,3 . There are no published papers either on the shorter‐term effects of FP in RAO‐affected horses or on the effectiveness of FP for prevention of exacerbations of RAO.…”