Changes

Also known as: '''RAO — Chronic Obstructive Pulmonary Disease — COPD — Heaves

Also known as: '''RAO — Chronic Obstructive Pulmonary Disease — COPD — Heaves

===Clinical Signs===

===Clinical Signs===

Mildly affected horses generally present with a history of occasional coughing and exercise intolerance. Signs become more obvious as the disease progresses. Tachypnoea is often seen, and there may be a mucopurulent nasal discharge. Severely affected animals show signs of respiratory distress at rest. These can include flared nostrils, wheezing, paroxysmal bouts of coughing and a laboured abdominal component to expiration. Chronically, marked dyspnoea increases energy expenditure and the animal may lose condition, as well as developing a "heave line" due to hypertrophy of the external abdominal oblique muscle<ref name="one" /><ref name="six" /><ref name="eight>Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''</ref>. Fever does not normally develop unless there are secondary bacterial complications.

Mildly affected horses generally present with a history of occasional coughing and exercise intolerance. Signs become more obvious as the disease progresses. Tachypnoea is often seen, and there may be a mucopurulent nasal discharge. Severely affected animals show signs of respiratory distress at rest. These can include flared nostrils, wheezing, paroxysmal bouts of coughing and a laboured abdominal component to expiration. Chronically, marked dyspnoea increases energy expenditure and the animal may lose condition, as well as developing a "heave line" due to hypertrophy of the external abdominal oblique muscle<ref name="one" /><ref name="six" /><ref name="eight">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''</ref>. Fever does not normally develop unless there are secondary bacterial complications.

On physical examination, thoracic auscultation typically reveals a prolonged expiratory phase of respiration and adventitious respiratory noises. Wheezes are most pronounced during expiration, and crackles are associated with the excessive mucus production<ref name="eight" />. However, the airways are so obstructed in some severely affected animals that there is insufficient air movement to generate audible breath sounds, and the lungs are very quiet on auscultation<ref name="one" />. In mildly affected horses a rebreathing bag can be used to aid auscultation, but this should never be performed in dyspnoeic animals<ref name="one" /><ref name="six" />. There may be an increased sensitivity of the cough reflex on tracheal compression.

On physical examination, thoracic auscultation typically reveals a prolonged expiratory phase of respiration and adventitious respiratory noises. Wheezes are most pronounced during expiration, and crackles are associated with the excessive mucus production<ref name="eight" />. However, the airways are so obstructed in some severely affected animals that there is insufficient air movement to generate audible breath sounds, and the lungs are very quiet on auscultation<ref name="one" />. In mildly affected horses a rebreathing bag can be used to aid auscultation, but this should never be performed in dyspnoeic animals<ref name="one" /><ref name="six" />. There may be an increased sensitivity of the cough reflex on tracheal compression.

==Treatment==

==Treatment==

Environmental control to reduce allergen exposure is key to the management of recurrent airway obstruction, as signs will re-appear following discontinuation of medication if this is not implemented. Since dusts in hay and straw are the most common triggers for disease, animals should be kept at pasture if possible. The availability of fresh grass eliminates the need for hay, and supplementary feeding can be achieved with pelleted feedstuffs. Round bale hay should not be provided as it is particularly allergenic and can cause environmental control to fail<ref name="eight" />. If turn-out is not possible, for example due to weather conditions, stalled horses should be maintained in a clean, controlled environment. Complete feeds totally eliminate the need for roughage, although some horses prefer hay cubes or hay silage which are equally acceptable. Soaked hay should not be fed as dust is incompletely removed and the nutritional content is poor. Shavings, newspaper or peat rather than straw should be used to bed animals, and supplies of hay and straw should not be kept in the same building as an RAO-afflicted animal. The addition of good ventilation to the stable design is also helpful. For example, a louvered vent may be added at the back of the stable and the top door kept permanently open. Some horses will be controlled by environmental management alone.

Environmental control to '''reduce allergen exposure''' is key to the management of recurrent airway obstruction, as signs will re-appear following discontinuation of medication if this is not implemented. Since dusts in hay and straw are the most common triggers for disease, animals should be kept at pasture if possible. The availability of fresh grass eliminates the need for hay, and supplementary feeding can be achieved with pelleted feedstuffs. Round bale hay should not be provided as it is particularly allergenic and can cause environmental control to fail<ref name="eight" />. If turn-out is not possible, for example due to weather conditions, stalled horses should be maintained in a clean, controlled environment. Complete feeds totally eliminate the need for roughage, although some horses prefer hay cubes or hay silage which are equally acceptable. Soaked hay should not be fed as dust is incompletely removed and the nutritional content is poor. Shavings, newspaper or peat rather than straw should be used to bed animals, and supplies of hay and straw should not be kept in the same building as an RAO-afflicted animal. The addition of good ventilation to the stable design is also helpful. For example, a louvered vent may be added at the back of the stable and the top door kept permanently open. Some horses will be controlled by environmental management alone.

When medical therapy is necessary, bronchodilators and corticosteroids are used. Bronchodilators, such as clenbuterol, relieve bronchospasm and minimise respiratory distress. Since mucus accumulation and inflammatory changes in the airway wall also contribute to obstruction, complete resolution may not be seen<ref name="six" />. Atropine is the best "rescue drug" in the event of severe respiratory distress. The concurrent administration of corticosteroids with bronchodilators addresses airway inflammation as well as bronchospasm. Oral, intravenous of inhaled steroids may be used. Inhaled steroids are advantageous as they are delivered directly to the site of inflammation and so lower doses are required. Fewer systemic side-effects are therefore experienced. However, in RAO the airways requiring anti-inflammatory treatment are obstructed, and inhaled steroids are only of use after lung function has been improved through the used of bronchodilators or systemic corticosteroids<ref name="six" />. This prior treatment may not be necessary before the use of inhaled medication in mild cases of RAO. Generally, medical treatment should be considered a short-term measure while environmental improvements are instituted.

When medical therapy is necessary, '''bronchodilators''' and '''corticosteroids''' are used. Bronchodilators, such as clenbuterol, relieve bronchospasm and minimise respiratory distress. Since mucus accumulation and inflammatory changes in the airway wall also contribute to obstruction, complete resolution may not be seen<ref name="six" />.''' Atropine is the best "rescue drug"''' in the event of severe respiratory distress. The concurrent administration of corticosteroids with bronchodilators addresses airway inflammation as well as bronchospasm. Oral, intravenous of inhaled steroids may be used. Inhaled steroids are advantageous as they are delivered directly to the site of inflammation and so lower doses are required. Fewer systemic side-effects are therefore experienced. However, in RAO the airways requiring anti-inflammatory treatment are obstructed, and inhaled steroids are only of use after lung function has been improved through the used of bronchodilators or systemic corticosteroids<ref name="six" />. This prior treatment may not be necessary before the use of inhaled medication in mild cases of RAO. Generally, medical treatment should be considered a short-term measure while environmental improvements are instituted.

NSAID, antihistamines, and leukotriene-receptor antagonists have all failed to demonstrate therapeutic benefit in RAO<ref name="eight" />.

NSAID, antihistamines, and leukotriene-receptor antagonists have all failed to demonstrate therapeutic benefit in RAO<ref name="eight" />.

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[[Category:Allergic Respiratory Diseases]]

[[Category:Allergic Respiratory Diseases]]

[[Category:Expert Review]]

[[Category:Expert Review - Horse]]

[[Category:Respiratory Diseases - Horse]]

[[Category:Respiratory Diseases - Horse]]

[[Category:Type III Hypersensitivity Diseases]]

[[Category:Type III Hypersensitivity Diseases]]

[[Category:Bronchi and Bronchioles - Pathology]]

[[Category:Bronchi and Bronchioles - Pathology]]

[[Category:Respiratory System - Inflammatory Pathology]]

[[Category:Respiratory System - Inflammatory Pathology]]