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Exercise Induced Pulmonary Hemorrhage Stephen M. Reed, DVM Dip ACVIM Rood and Riddle Equine Hospital Lexington, Kentucky.

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Presentation on theme: "Exercise Induced Pulmonary Hemorrhage Stephen M. Reed, DVM Dip ACVIM Rood and Riddle Equine Hospital Lexington, Kentucky."— Presentation transcript:

1 Exercise Induced Pulmonary Hemorrhage Stephen M. Reed, DVM Dip ACVIM Rood and Riddle Equine Hospital Lexington, Kentucky

2 Disorders of the Respiratory System are: Disorders of the Respiratory System are: The second most common limiting factor for the athletic performance of horses The second most common limiting factor for the athletic performance of horses Often result in major economic losses for owners Often result in major economic losses for owners Many horses are lost for performance or must be retired Many horses are lost for performance or must be retired

3 EIPH EIPH occurs in Thoroughbreds, Quarter Horses and Standardbreds EIPH occurs in Thoroughbreds, Quarter Horses and Standardbreds During sprint racing During sprint racing Also observed in other high performance non-racing equine athletes e.g. Also observed in other high performance non-racing equine athletes e.g. Barrel, Cutting, Reining, Roping Barrel, Cutting, Reining, Roping Polo Polo Cross-country and 3-day event Cross-country and 3-day event Show jumping and Hunter-jumper Show jumping and Hunter-jumper Steeplechase Steeplechase And even draft horses And even draft horses

4 Exercise Induced Pulmonary Hemorrhage Dr. Robinson has defined EIPH Dr. Robinson has defined EIPH Explained how it occurs Explained how it occurs Described important pre-disposing and/or coexisting conditions Described important pre-disposing and/or coexisting conditions Shared a great deal about both the underlying mechanisms responsible for the development of this problem and described how it might impact performance horses Shared a great deal about both the underlying mechanisms responsible for the development of this problem and described how it might impact performance horses My task is to discuss available treatment options along with how and why these might be effective in treatment of EIPH My task is to discuss available treatment options along with how and why these might be effective in treatment of EIPH

5 PREVENTION AND TREATMENT OF EIPH Exercise-induced pulmonary hemorrhage (EIPH) is a major health concern and cause of poor performance in the equine athleteExercise-induced pulmonary hemorrhage (EIPH) is a major health concern and cause of poor performance in the equine athlete Many therapeutic and management interventions have been tried, but few have proven efficacy in treating EIPHMany therapeutic and management interventions have been tried, but few have proven efficacy in treating EIPH

6 Most Evidence for Treatment of EIPH Furosemide and Flair Nasal Strip Furosemide and Flair Nasal Strip Currently being used to treat EIPH based on evidence that these decrease but do not prevent EIPH Currently being used to treat EIPH based on evidence that these decrease but do not prevent EIPH Sweeney et al 1984( in Eq Exercise Physiology) Sweeney et al 1984( in Eq Exercise Physiology) Goer et al 2001 (Equine vet J 33, 577-584) Goer et al 2001 (Equine vet J 33, 577-584) Kindig et al 2001 (J Appl Phys 91, 1396-1400) Kindig et al 2001 (J Appl Phys 91, 1396-1400) Zawadzkas et al 2006 (Eq vet J supp 36, 291-293) Zawadzkas et al 2006 (Eq vet J supp 36, 291-293) Epp et al 2009 (J Eq Vet Sci 29, 527-532) Epp et al 2009 (J Eq Vet Sci 29, 527-532) Hinchcliff et al 2009 (JAVMA 235, 76-82) Hinchcliff et al 2009 (JAVMA 235, 76-82)

7 Treatment of EIPH Furosemide, a high-loop diuretic, decreases plasma volume, cardiac output and pulmonary vascular pressures reducing EIPH up to 50% (Kindig et al. 2001a). Furosemide, a high-loop diuretic, decreases plasma volume, cardiac output and pulmonary vascular pressures reducing EIPH up to 50% (Kindig et al. 2001a). The Flair nasal strip decreases EIPH a similar amount by preventing nasal passage narrowing on inspiration thereby lowering airway resistance (Poole et al. 2000; Geor et al. 2001; Kindig et al. 2001a; Holcombe et al. 2002). The Flair nasal strip decreases EIPH a similar amount by preventing nasal passage narrowing on inspiration thereby lowering airway resistance (Poole et al. 2000; Geor et al. 2001; Kindig et al. 2001a; Holcombe et al. 2002).

8 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76-82) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76-82) Study was randomized, placebo-controlled, crossover field trial Study was randomized, placebo-controlled, crossover field trial Conducted in South Africa at a racing venue Conducted in South Africa at a racing venue Horses assigned to fields of 9 to 16 horses Horses assigned to fields of 9 to 16 horses Raced twice one week apart once on Lasix and once with saline control Raced twice one week apart once on Lasix and once with saline control Other factors were identical (surface, jockey, length, etc.) Other factors were identical (surface, jockey, length, etc.) After the race all horses were returned to the parade ring, tack removed and a tracheobronchoscopic examination was performed After the race all horses were returned to the parade ring, tack removed and a tracheobronchoscopic examination was performed

9 Most Evidence for Treatment of EIPH Furosemide Furosemide Hinchcliff et al 2009 (JAVMA 235, 76-82) Hinchcliff et al 2009 (JAVMA 235, 76-82) A total of 328 horses were nominated A total of 328 horses were nominated 193 were enrolled in the study by a professional handicapper 193 were enrolled in the study by a professional handicapper 155 competed in both races, 12 in only the 1 st race and 26 did not compete 155 competed in both races, 12 in only the 1 st race and 26 did not compete Horses from 40 stables Horses from 40 stables Only three horses were unable to be scoped after racing Only three horses were unable to be scoped after racing Horses were scoped approximately 42 minutes after racing Horses were scoped approximately 42 minutes after racing

10 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76-82 ) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76-82 ) Scores for endoscopic severity for EIPH were less severe after furosemide with no 3 or 4 Scores for endoscopic severity for EIPH were less severe after furosemide with no 3 or 4 Scores for endoscopic severity for EIPH ranged from 1 to 4 in horses after saline Scores for endoscopic severity for EIPH ranged from 1 to 4 in horses after saline FOR THE 152 HORSES SCOPED AFTER BOTH RACES 57% HAD EIPH >/= 1 WITH FUROSEMIDE AND NONE WAS A GRADE 3 TO 4 WHILE 79% HAD EIPH AFTER SALINE FOR THE 152 HORSES SCOPED AFTER BOTH RACES 57% HAD EIPH >/= 1 WITH FUROSEMIDE AND NONE WAS A GRADE 3 TO 4 WHILE 79% HAD EIPH AFTER SALINE

11 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) OVERALL (67.5%) OF THE HORSES THAT HAD EIPH AFTER SALINE HAD A REDUCTION OF EIPH SEVERITY SCORE OF AT LEAST 1 GRADE WHEN TREATED WITH FUROSEMIDE OVERALL (67.5%) OF THE HORSES THAT HAD EIPH AFTER SALINE HAD A REDUCTION OF EIPH SEVERITY SCORE OF AT LEAST 1 GRADE WHEN TREATED WITH FUROSEMIDE

12 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) AGE, GENDER, DISTANCE RACED AND TREATMENT SEQUENCE DID NOT HAVE AN EFFECT ON EIPH AGE, GENDER, DISTANCE RACED AND TREATMENT SEQUENCE DID NOT HAVE AN EFFECT ON EIPH MEAN WEIGHT LOSS WAS 12.7 Kg +/- 0.33Kg WITH LASIX AND 5.4Kg +/- 0.28 Kg WITH SALINE MEAN WEIGHT LOSS WAS 12.7 Kg +/- 0.33Kg WITH LASIX AND 5.4Kg +/- 0.28 Kg WITH SALINE

13 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) RESULTS OF THIS STUDY INDICATED THAT PRERACE ADMINISTRATION OF FUROSEMIDE DECREASED THE INCIDENCE AND SEVERITY OF EIPH IN THOROUGHBREDS RACING UNDER TYPICAL CONDITIONS IN SOUTH AFRICA RESULTS OF THIS STUDY INDICATED THAT PRERACE ADMINISTRATION OF FUROSEMIDE DECREASED THE INCIDENCE AND SEVERITY OF EIPH IN THOROUGHBREDS RACING UNDER TYPICAL CONDITIONS IN SOUTH AFRICA

14 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Strengths of the study: Strengths of the study: Large number of horses Large number of horses Standard race conditions Standard race conditions Horses used were in an at risk group Horses used were in an at risk group Statistical methods used made it unlikely results were due to confounding factors Statistical methods used made it unlikely results were due to confounding factors

15 Most Evidence for Treatment of EIPH Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Furosemide Hinchcliff et al 2009 (JAVMA 235, 76- 82) Some remaining questions: Some remaining questions: Did not identify an association between weight lost and prevention of EIPH Did not identify an association between weight lost and prevention of EIPH Crossover period was adequate to find no lasix in saline group Crossover period was adequate to find no lasix in saline group Furosemide is reported to reduce mucociliary clearance in humans and bronchodilation in ponies with recurrent airway obstruction Furosemide is reported to reduce mucociliary clearance in humans and bronchodilation in ponies with recurrent airway obstruction

16 Treatment of EIPH Diuretics other than Furosemide Diuretics other than Furosemide Effect of ethacrynic acid on the thick ascending limb of Henle's loop Maurice Burg and Nordica Green, Kidney International (1973) 4, 301– 308;1973. Effect of ethacrynic acid on the thick ascending limb of Henle's loop Maurice Burg and Nordica Green, Kidney International (1973) 4, 301– 308;1973. Redistribution of Renal Blood Flow Produced by Furosemide and Ethacrynic Acid AG. BIRTCH, RM. ZAKHEIM, LG. JONES, AC. BARGER., Circ Res 1967 Redistribution of Renal Blood Flow Produced by Furosemide and Ethacrynic Acid AG. BIRTCH, RM. ZAKHEIM, LG. JONES, AC. BARGER., Circ Res 1967

17 Exercise Induced Pulmonary Hemorrhage Effect of furosemide and furosemide – carbazochrome combination on exercise-induced pulmonary hemorrhage in Standardbred racehorses. Effect of furosemide and furosemide – carbazochrome combination on exercise-induced pulmonary hemorrhage in Standardbred racehorses. Can Vet J 2009;50:821–827 Cecilia I. Perez- Moreno, Laurent L. Couëtil, Suzanne M. Pratt, Hugo G. Ochoa-Acuña,Rose E. Raskin, Mark A. Russell Can Vet J 2009;50:821–827 Cecilia I. Perez- Moreno, Laurent L. Couëtil, Suzanne M. Pratt, Hugo G. Ochoa-Acuña,Rose E. Raskin, Mark A. Russell

18 Exercise Induced Pulmonary Hemorrhage Carbazochrome salicylate, also known as Kentucky Red Carbazochrome salicylate, also known as Kentucky Red Classified among hemostatic drugs as a capillary stabilizer Classified among hemostatic drugs as a capillary stabilizer It is used clinically for the treatment of hemorrhage due to capillary fragility in humans It is used clinically for the treatment of hemorrhage due to capillary fragility in humans The mechanism of action of carbazochrome is unknown The mechanism of action of carbazochrome is unknown

19 Exercise Induced Pulmonary Hemorrhage RESULTS : RESULTS : EIPH endoscopy scores were: EIPH endoscopy scores were: Placebo 1.56 Placebo 1.56 Furosemide 1.12 Furosemide 1.12 Furosemide – carbazochrome 1.0 Furosemide – carbazochrome 1.0 Weight loss over 4-hour period after treatment was: Weight loss over 4-hour period after treatment was: Placebo 9.4 kg Placebo 9.4 kg Furosemide 14.8 kg Furosemide 14.8 kg Furosemide–carbazochrome 13.8 kg Furosemide–carbazochrome 13.8 kg

20 Exercise Induced Pulmonary Hemorrhage In this study pre-exercise administration of furosemide or furosemide-carbazochrome combination did not affect the severity of pulmonary bleeding or the performance of horses that had a history of EIPH. In this study pre-exercise administration of furosemide or furosemide-carbazochrome combination did not affect the severity of pulmonary bleeding or the performance of horses that had a history of EIPH. Low number of Standardbred horses not under race conditions Low number of Standardbred horses not under race conditions

21 Exercise Induced Pulmonary Hemorrhage Effects of conjugated oestrogens and aminocaproic acid upon exercise-induced pulmonary haemorrhage (EIPH) TS Epp*, KL Edwards, DC Poole and HH Erickson Department of Anatomy and Physiology, Kansas State University, Manhattan, KS 66506, USA *Corresponding author: tepp@vet.ksu.edu Comparative Exercise Physiology 5(2); 95–103 TS Epp*, KL Edwards, DC Poole and HH Erickson Department of Anatomy and Physiology, Kansas State University, Manhattan, KS 66506, USA *Corresponding author: tepp@vet.ksu.edu Comparative Exercise Physiology 5(2); 95–103tepp@vet.ksu.edu

22 Why even try these medications? Aminocaproic acid and Premarin ACA used in an attempt to mitigate EIPH as a result of hypothesized transient coagulation deficiencies in exercising horses ACA used in an attempt to mitigate EIPH as a result of hypothesized transient coagulation deficiencies in exercising horses Antifibrinolytic treatments may result in increased stability/lifespan of the clot and control of numerous causes of hemorrhage, benefiting human patients Antifibrinolytic treatments may result in increased stability/lifespan of the clot and control of numerous causes of hemorrhage, benefiting human patients

23 Treatment of EIPH Aminocaproic acid and Premarin Why try PREMARIN Why try PREMARIN Two primary mechanisms of action for conjugated estrogens are: Two primary mechanisms of action for conjugated estrogens are: Restoration and/or strengthening of vascular integrity by strengthening collagen and eliminating endothelial discontinuity and degeneration Restoration and/or strengthening of vascular integrity by strengthening collagen and eliminating endothelial discontinuity and degeneration Shortening the bleeding time Shortening the bleeding time

24 Aminocaproic acid and Premarin There was a trend ( p = 0.09) for decreased time-to fatigue by ACA (This is a negative) There was a trend ( p = 0.09) for decreased time-to fatigue by ACA (This is a negative) ACA treated horses performed at least one stage less than runs completed after PREMARIN or placebo administration ACA treated horses performed at least one stage less than runs completed after PREMARIN or placebo administration Time-to-fatigue was not affected by treatment with PREMARIN Time-to-fatigue was not affected by treatment with PREMARIN

25 Treatment of EIPH The principal findings of this investigation were that neither ACA nor PRE effectively reduced EIPH. The principal findings of this investigation were that neither ACA nor PRE effectively reduced EIPH. There was an acute decrease in pulmonary inflammation (i.e. decreased BALF [WBC]) which could be helpful There was an acute decrease in pulmonary inflammation (i.e. decreased BALF [WBC]) which could be helpful The decreased time to fatigue may partially explain some of the anecdotal reports by veterinarians that ACA may impair performance. The decreased time to fatigue may partially explain some of the anecdotal reports by veterinarians that ACA may impair performance.

26 Effects of intravenous aminocaproic acid on exercise-induced pulmonary hemorrhage (EIPH) B. M. Bucholz, A Murdock, W. M. Bayly, R. H. Sides Equine vet J 2010;42 (supp 38) 256–260 Effects of intravenous aminocaproic acid on exercise-induced pulmonary hemorrhage (EIPH) B. M. Bucholz, A Murdock, W. M. Bayly, R. H. Sides Equine vet J 2010;42 (supp 38) 256–260 Examined erythrocyte counts in BALF of 8 Thoroughbreds following treadmill exercise at an intensity level to achieve greater than that needed to reach maximal oxygen consumption Examined erythrocyte counts in BALF of 8 Thoroughbreds following treadmill exercise at an intensity level to achieve greater than that needed to reach maximal oxygen consumption Horses exercised to fatigue 3 times using saline placebo 2 and 7 grams ACA 4 hours before exercise Horses exercised to fatigue 3 times using saline placebo 2 and 7 grams ACA 4 hours before exercise

27 Effects of intravenous aminocaproic acid on exercise-induced pulmonary hemorrhage (EIPH) B. M. Bucholz, A Murdock, W. M. Bayly, R. H. Sides Equine vet J 2010;42 (supp 38) 256–260 Effects of intravenous aminocaproic acid on exercise-induced pulmonary hemorrhage (EIPH) B. M. Bucholz, A Murdock, W. M. Bayly, R. H. Sides Equine vet J 2010;42 (supp 38) 256–260 RESULTS: RESULTS: Aminocaproic acid had no effect on VO 2 max, run time, or erythrocyte counts in pre or post-exercise BALF Aminocaproic acid had no effect on VO 2 max, run time, or erythrocyte counts in pre or post-exercise BALF Conclusions: Conclusions: ACA was not effective in preventing or reducing the severity of EIPH or improving performance under the exercise conditions in this study

28 Treatment of EIPH Drugs with less available data for EIPH Drugs with less available data for EIPH An injectable product designed to reduce airway inflammation, concentrated equine serum An injectable product designed to reduce airway inflammation, concentrated equine serum Dietary omega-3 fatty acids, may also ameliorate EIPH (Erickson and Hildreth 2004). Dietary omega-3 fatty acids, may also ameliorate EIPH (Erickson and Hildreth 2004). Vitamin K deficiency of vitamin K is not occurring in EIPH Vitamin K deficiency of vitamin K is not occurring in EIPH

29 Treatment of EIPH Possibly or not effective in EIPH Possibly or not effective in EIPH Neither inhaled nitric oxide (irrespective of lowering pulmonary artery pressure, Kindig et al. 2001b) Neither inhaled nitric oxide (irrespective of lowering pulmonary artery pressure, Kindig et al. 2001b) Nor herbal formulations designed to remedy putative coagulation defects Have evidence of benefit Nor herbal formulations designed to remedy putative coagulation defects Have evidence of benefit

30 JBS UNITED, INC. TECHNOLOGY LICENSING PROFILE Treatment of EIPH: use of a proprietary Omega-3 technology Treatment of EIPH: use of a proprietary Omega-3 technology A study conducted at Kansas State University reported that feeding this proprietary Omega-3 technology, designed to provide specific dietary levels of essential fatty acids (EPA and DHA), to horses with varying degrees of EIPH appears to be helpful in managing the condition. A study conducted at Kansas State University reported that feeding this proprietary Omega-3 technology, designed to provide specific dietary levels of essential fatty acids (EPA and DHA), to horses with varying degrees of EIPH appears to be helpful in managing the condition. Levels of EPA and DHA increased in blood of horses Levels of EPA and DHA increased in blood of horses

31 JBS UNITED, INC. TECHNOLOGY LICENSING PROFILE Ten Thoroughbred horses with a history of EIPH Ten Thoroughbred horses with a history of EIPH Horses were subjected to a pre- treatment maximum treadmill run followed by bronchoalveolar lavage Horses were subjected to a pre- treatment maximum treadmill run followed by bronchoalveolar lavage Diets were fed for 145 days. Maximum exercise runs were performed at 83 and 145 days of feeding Diets were fed for 145 days. Maximum exercise runs were performed at 83 and 145 days of feeding

32 JBS UNITED, INC. TECHNOLOGY LICENSING PROFILE Results: Results: RBC in BAL fluid of control horses increased relative to the pre-treatment run (773 ± 32 %). While horses fed EPA and DHA had substantially less change (P < 0.05) in BAL RBC (186 ± 32 %). RBC in BAL fluid of control horses increased relative to the pre-treatment run (773 ± 32 %). While horses fed EPA and DHA had substantially less change (P < 0.05) in BAL RBC (186 ± 32 %).

33 Herbal formulations to treat EIPH but Little or No published scientific research EASTERN MEDICINE What are these said to do: Decrease inflammation and edema in the lung Move stagnated blood out of the airways Address coagulation defects, such as platelet function, proposed to contribute to EIPH in horses during exercise. Erickson et al evaluated the effects of (Yunnan Paiyao and Single Immortal) Herbal formulations were not effective in reducing EIPH severity in horses exercising on the treadmill as evaluated by BAL However, time to fatigue was slightly, but significantly increased after treatment with Single Immortal.

34 To date, the authors are unaware of any experimental or clinical evidence that an aerosolized product to treat EIPH is effective or, indeed, even available. To date, the authors are unaware of any experimental or clinical evidence that an aerosolized product to treat EIPH is effective or, indeed, even available.

35 Diseases that might be related to EIPH As Dr. Robinson indicated part of the mechanism for EIPH may be related to other diseases affecting small airways As Dr. Robinson indicated part of the mechanism for EIPH may be related to other diseases affecting small airways If a horse has a bacterial infection then appropriate antibiotics could be useful in treatment of EIPH If a horse has a bacterial infection then appropriate antibiotics could be useful in treatment of EIPH If a horse had bronchconstriction as a result of inflammatory or reactive airway disease use of bronchodilators such as Clenbuterol, Albuterol or others as inhaled or systemic administration If a horse had bronchconstriction as a result of inflammatory or reactive airway disease use of bronchodilators such as Clenbuterol, Albuterol or others as inhaled or systemic administration

36 Diseases that might be related to EIPH Additionally horses with inflammatory or reactive airway disease might also benefit from either inhaled or systemic corticosteroids However work in his and Dr. Fred Derksen’s laboratory have not strongly supported this conclusion However work in his and Dr. Fred Derksen’s laboratory have not strongly supported this conclusion

37 Corticosteroids do not provide immediate improvement in pulmonary function Corticosteroids do not provide immediate improvement in pulmonary function Aerosolized corticosteroids work best with mild exercise intolerance to moderate increases in respiratory effort Aerosolized corticosteroids work best with mild exercise intolerance to moderate increases in respiratory effort Available equine formulations: Available equine formulations: Fluticasone 2,000ug BID most potent and most expensive Fluticasone 2,000ug BID most potent and most expensive Beclomethasone 500-1500 ug BID Beclomethasone 500-1500 ug BID

38 Inhalation therapy Treatment: Treatment: Equine Aeromask (Canadian Monaghan, Ontario, Canada) Equine Aeromask (Canadian Monaghan, Ontario, Canada) Can be used for nebulization solutions, MDI devices, or dry powder inhaler get ~6 % of CFC propellant and 14% of HFA propellant drugs Can be used for nebulization solutions, MDI devices, or dry powder inhaler get ~6 % of CFC propellant and 14% of HFA propellant drugs

39 Inhalation therapy: Inhalation therapy: Equine patients are ideal because of their cooperative nature Equine patients are ideal because of their cooperative nature Large tidal volume Large tidal volume Obligate nasal breathing Obligate nasal breathing Newer systems for delivery have made this even more effective and easy Focus is on bronchodilators and anti-inflammatory agents

40 Inhalation therapy: Inhalation therapy: Anti-inflammatory therapy is the KEY component to treatment of non-infectious respiratory disease Anti-inflammatory therapy is the KEY component to treatment of non-infectious respiratory disease Bronchodilators are important for immediate relief of symptoms Bronchodilators are important for immediate relief of symptoms Mast cell stabilizers sodium cromoglycate and nedocromil sodium inhibit degranulation of Mast cells Mast cell stabilizers sodium cromoglycate and nedocromil sodium inhibit degranulation of Mast cells

41 Diseases that might be related to EIPH Another important problem is pleuropneumonia Another important problem is pleuropneumonia In my opinion EIPH is one risk factor associated with development of this condition In my opinion EIPH is one risk factor associated with development of this condition For purposes of example I have included a typical case scenario For purposes of example I have included a typical case scenario

42 Signalment 3 year Thoroughbred colt 3 year Thoroughbred colt History: Raced on Saturday, shipped on Monday did not eat on the day of arrival History: Raced on Saturday, shipped on Monday did not eat on the day of arrival Post race scope revealed a trail of blood in trachea Post race scope revealed a trail of blood in trachea Primary complaint dyspnea (RR 36), fever (T – 103.5 F), depression Primary complaint dyspnea (RR 36), fever (T – 103.5 F), depression But often all you see is FEVER But often all you see is FEVER

43 EIPH

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45 Normal thorax

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49 Pleuropneumonia The majority of pleural effusions and septic pleuritis (pleuropneumonia) result from pneumonia or pulmonary abscesses The majority of pleural effusions and septic pleuritis (pleuropneumonia) result from pneumonia or pulmonary abscesses Pleuritis/pleuropneumonia is sometimes the result of thoracic trauma, esophageal rupture Pleuritis/pleuropneumonia is sometimes the result of thoracic trauma, esophageal rupture The microorganisms most commonly isolated are aerobic or facultative anaerobic organisms which reside in the oral pharynx such as Streptococcus spp., Pasteurella spp., Actinobacillus spp., E. coli, and others The microorganisms most commonly isolated are aerobic or facultative anaerobic organisms which reside in the oral pharynx such as Streptococcus spp., Pasteurella spp., Actinobacillus spp., E. coli, and others Anaerobic organisms are Bacteroides, Peptostreptococcus, Fusobacterium, and Clostridium Anaerobic organisms are Bacteroides, Peptostreptococcus, Fusobacterium, and Clostridium

50 Pleuropneumonia Epidemiology Epidemiology Factors commonly associated with the onset of pleuropneumonia in horses are Factors commonly associated with the onset of pleuropneumonia in horses are Transportation for long distances Transportation for long distances Extreme exercise often with EIPH Extreme exercise often with EIPH Viral infection Viral infection General anesthesia General anesthesia Systemic disease (e. g. Colitis) Systemic disease (e. g. Colitis) Other factors incriminated: Other factors incriminated: Aspiration of microorganisms of the upper respiratory tract Aspiration of microorganisms of the upper respiratory tract Interference with the respiratory tracts ability to clear these organisms Interference with the respiratory tracts ability to clear these organisms

51 Pleuropneumonia Pathogenesis Pathogenesis These factors compromise the pulmonary defense mechanisms and permit bacterial contamination of the lower respiratory tract and subsequent pneumonia or formation of abscesses These factors compromise the pulmonary defense mechanisms and permit bacterial contamination of the lower respiratory tract and subsequent pneumonia or formation of abscesses

52 Pleuropneumonia Treatment Treatment 1. Chronic Effective Drainage 2. Appropriate Antimicrobials (penicillin, gentamicin, metronidazole) 3. Anti-inflammatory medications (e.g. flunixin meglumine or phenylbutazone) 4. Nursing Care

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54 Pleuropneumonia


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