Summer Pasture-Associated Recurrent Airway Obstruction

(SPA-RAO)

Also known as: Summer Pasture-Associated Obstructive Pulmonary Disease, Summer Pasture-Associated Heaves

Description

Summer Pasture-Associated Recurrent Airway Obstruction (SPA-RAO) is an inflammatory condition of the lower airways affecting pasture-kept horses. This is in contrast to Recurrent Airway Obstruction that affects horses that are stabled. The disease is characterised by airway inflammation, increased airway mucus production, reduced mucociliary clearance and bronchoconstriction. It occurs most commonly in the South of the United States but has also been reported in the United Kingdom.

Signalment

The average age of onset of SPA-RAO is 9 years of age. There is no reported sex predilection but Quarter Horses are over-represented.

Pathogenesis

The pathogenesis of the disease is largely unknown but suggested hypotheses include inhaled pollens or outdoor moulds or ingestion of a pasture-derived pneumotoxin.

Clinical signs

Clinical signs are similar to those associated with RAO but occur in horses kept out at pasture during the summer months, usually for more than twelve hours a day. Signs may include exercise intolerance, cough (often productive), dyspnoea, increased expiratory effort, nasal discharge and flared nostrils. Pyrexia may be a feature if a seconday bacterial infection has occurred in the airways. In severe cases, affected horses stand with their neck arched and elbows abducted. An abdominal 'heave' line may also be visible due to hypertrophy of the external abdominal oblique muscles. Lung field auscultation reveals fine crackles and wheezes. In severe cases, wheezes may be audible without a stethoscope.

Diagnosis

Diagnosis is usually based on the characteristic and seasonal appearance of clinical signs combined with a history of exposure to pasture during late spring or summer. Endoscopy may be used in order to evaluate the airways and to examine the presence of inflammation or mucus. Alternatively a sample of mucous may be obtained via bronchioalveolar lavage which often yields copious mucupurulent material. Cytology usually reveals >25% non-degenerate neutrophils confirming the presence of lower airway inflammation. Curschmann's spirals may also be observed, representing inspissated mucus in the obstucted lower airways. Thoracic radiology is not commonly performed but may reveal an increased bronchointerstitial pattern.

Treatment and management

Affected horses should only be allowed access to pasture during late autumn, winter and early spring. They should ideally be kept stabled in a dust-free environment such as a stable with rubber matting and no bedding. If hay appears to act as a trigger to the horse, a complete pelleted diet may be fed or alternatively hay should be soaked. Alfalfa has been previously associated with less respiratory problems than grass hay and may be preferable.

In some cases, the response to environmental management may be significant and drug treatment may not be required. In other cases, drug therapy may be required to suffiently manage the clinical signs. Corticosteroids may be administered via nebuslisation using an inhaler in order to allow the maximum concentration of the drug in the respiratory tract, with minimal systemic side effects. This can be combined with a bronchodilator such as clenbuterol. Antibiotics may be required if seconday bacterial infection is present.

References

• McGorum, B. C., Edward Robinson, N., Dixon, P. M., Schumacher, J. (2007) Equine respiratory medicine and surgery Elsevier Health Sciences
• Orsini, J. A., Divers, T. (2007) Equine Emergencies: Treatment and Procedures Elsevier Health Sciences