COPD and Exercise

My horse was just diagnosed with COPD, he was in quite a state when the vet came out. I have spent hours and hours educating myself on the topic as this is one I do not have experience with. While I understand the condition can be managed and dealt with my concern is more of a humane one. I have my horse to enjoy and ride. While he is feeling better is it humane to ride him? He can’t tell me how he’s feeling and the thought of him not being able to breath breaks my heart and I can’t stand the thought of making him do something he’s not able. I am doing everything possible to keep him happy but is it fair? I know this is partially a personal question but in all the reading I have done there is no mention of exercise or what physically is good for horses with COPD. 

COPD is a gradually progressive respiratory condition that occurs when exposure to environmental irritants and allergens triggers inflammation in the lungs, causing thickening of the air passages and increased mucus secretions. Over time, oxygen exchange gets less efficient and the horse has to make an increased effort to breathe because of the excess mucus and loss of airway elasticity. Some horses are more susceptible to this condition and acute attacks of wheezing and coughing can be triggered by exposure to an allergen that they are particularly sensitive to. It sounds like this is what happened with your guy.

While we cannot reverse or cure the effects of COPD, the good news is that we can significantly help horses suffering this condition through environmental management and judicious medication. There are several COPD Q&A files on our “Ask The Vet” archive that cover various current treatment and management strategies.

Although COPD is a chronic condition, the good news is that a horse can usually continue to enjoy their regular activities once the acute attack has resolved and an appropriate management plan has been instituted. As long as those small airways are protected from irritation, mild to moderately affected horses generally perform quite comfortably. One of my own COPD affected horses was still able to compete at the advanced level in three day eventing once we had successfully identified and controlled his triggers and the associated inflammation. In his case we gave him as much turnout as possible, changed to dust-free bedding, provided soaked hay and hay cubes, and treated him with inhaled medication which directly treats the irritated airways with a relatively tiny dose of drug.

The best plan for you is to talk to your vet about the stable management and medication strategy that best suits his environment and routine. Once he’s past the acute event, start riding again and monitor his performance carefully. Signs that he’s not coping well would include increased recovery time after exertion, coughing, lack of desire to go forward, and increased respiratory effort with flaring nostrils. You will probably find he has great days and some off days, usually when the heat or environmental conditions hit extremes. But please don’t think it is cruel to continue enjoying your time together on the trail or schooling ring. It’s overall much healthier for a horse to have some exercise and it should not trouble him as long as you have adequately addressed the underlying condition.

Help With COPD

My horse has been diagnosed with COPD a few weeks ago and has been on Ventipulmin and respipulmin for about two months now. Though he has only been getting worse and when he is having a better day its not really that good of one. I find the drugs dont seem to do anything for him and have given him Ventipulmin and waited hours before and has never worked. He gets so bad sometime that its so hard for him to breath and will breath hard for days no matter how much of the drugs he is on it doesn’t seem to help him at all.

This started in September with a cough and runny nose (White stuff) and was told it was allergies and I tried other drugs over winter to help him but it never went away and then in May his breathing all of a sudden got really bad and was struggling to breath. Since then till now hes gotten a bit better and the heavy breathing has come down a bit but still comes and goes and has never gone back to just a cough. His nose is now always pouring out this white stuff and when he puts his head down it just pours out of his nose. The cough as well is super flemmy and he cant even trot 4 steps anymore without coughing and the cough is a full body cough that rips me out of the tack. I am currently not riding him at all as its to hard for him and just a 10 minute lunge is so hard on him and breaking out in a sweat at only a trot not cantering.

I am wondering if there are other options for him. We are currently looking to move him to a new place that will be able to take him off the round bales and soak his hay in a dust free area. Aside from that is there anything I can do that im not already or other drug or supplement options? Or if thats even what he has as i had some issues with vets getting a answer for months. I have a vet coming out this week for a second opinion before i just and do anything drastic like moving him if he really doesnt need to be. I just want to be 100% sure thats what he needs before uprooting him.

Im also wondering if this will ever get better and will I be able to ride him ever again or is this the end of his riding carrier and should i look for a retirement facility for him to move to.

I hope someone will be able to help and have input on his condition as well as experience with it.

COPD is a disease of the smaller airways (bronchioles and alveoli) in the lungs caused by an allergy to small dust particles and spores that are inhaled by the horse when he breathes. Fungal spores and/or pollen dust are most important in terms of allergic ‘trigger’ factors. Previous viral and bacterial infections in the lung can predispose a horse to this condition. The allergic reaction in the airways results in the production of fluid and thickening of the walls of the small airways of the lungs, causing their obstruction. This means that the horse has to make an increased effort to breathe and he develops a cough to clear trapped mucus. The pathology that occurs in the horse’s lungs, except perhaps in the very early stages, is not reversible and so it is important to understand that this is a progressive condition. It cannot be ‘cured’ but the progress of the disease can be halted and the horse can be helped to accommodate to it.
There is no standard scoring system for the severity of COPD in an individual. Many horses will range from mild to severe depending on factors such as season, stabling conditions, bedding, forage, exposure to particular allergens, and air flow.
Environmental management is the key to controlling COPD, and this alone can take a horse from the “severe” to the “mild” category. Affected animals should be kept in dust-free conditions (as much as is reasonably possible in a barn), designed to keep environmental dust and spore levels as low as possible. Bedding should be paper, shavings, or other non-organic material and should be kept scrupulously clean. Hay should be soaked for 10 minutes or steamed with a commercial hay steamer before being used. Haylage can be fed but carries a risk of botulism so any horses on this type of diet should be appropriately vaccinated. I cannot emphasize enough that round bale hay should never be fed to COPD individuals. Horses should not be stabled on straw and away from hay and straw stores, muck heaps, and other sites where dust and allergens are stirred up. Those that suffer from pasture-associated COPD should be kept in during high season.
If your horse still has breakthrough symptoms, a course of bronchodilators and steroids can be administered, either orally or via inhaler. While I prefer the inhaler so the overall dose of medication can be minimized, oral drugs can be more economical and are often more effective for getting severe flare-ups under control. Horses with COPD should not be administered a bronchodilator such a ventipulmin alone without the addition of some kind of steroid anti-inflammatory such as dexamethasone or prednisolone. Otherwise you are just opening up the airways even more to the irritating moulds and allergens, creating more exposure and irritation to the lung and ultimately worsening the condition.
A broncho-alveolar lavage (BAL) is a simple on-farm diagnostic test that allows your vet to sample some of the fluid from deep in the airways. This fluid is then analyzed at the lab to determine what types of inflammatory cells are present and also if there are bacteria in the lungs. This can provide additional information to help direct medical therapy for that particular horse. Horses with COPD cannot be cured but many are able to carry on with light athletic duties for many years if they are successfully managed, hopefully this has been helpful for you to understand the condition and gives you a few questions to ask your veterinarian.

Melissa McKee DVM

Allergy Testing

How do I test my horse for allergies? I’ve heard you can treat it with an oral or injectable serum- is that expensive?

There are two ways to test your horse for allergies. Serum testing involves sending away a blood sample that is tested for reactivity against typical environmental and feed allergens (there are a LOT of them!). You get a report indicating which allergens your horse is sensitive to, and which are particularly problematic.

The other method, which is considered the gold standard, is the skin bleb test. In this case, an area on the neck is shaved and a grid of tiny injections with different allergens is made in the skin. Reactivity is determined by the size of the hive that occurs at each site. This is considered a superior test to the serum test, but requires a lot of expertise to perform and is subject to much higher error.

In the field, we typically rely on the serum test for horses with various stubborn skin, digestive, neurologic (head shaking), and respiratory ailments, and I have been satisfied with the results. Once the allergens have been identified, the lab then creates a custom desensitization serum for your horse and you administer them on a very specific program of diminishing dose and frequency. I have not heard of a reliable oral alternative to this method, but new developments are always occurring so I will keep my ear out.

The injection course is quite prolonged, it usually takes up to a year to run the full series, but the needles are very tiny and the frequency drops off fairly quickly. The initial blood test is a few hundred dollars and the serum is a bit less than that. You should be able to test and treat fully for under $1000. I am not sure of the cost of skin testing, we would typically refer that situation to a board certified veterinary dermatologist to perform the test. Hope this helped a bit!

Melissa McKee DVM

COPD Management and Expectations

Can COPD be managed and are there levels of impairment, #1 being little impairment and #5 being pasture ornament on scale of 1-5?

Is it expensive to manage the respiratory health of a horse with COPD in order to do level 3 or 4 dressage? No showing would be involved, just using the horse as a schoolmaster. Is fitness difficult to achieve in a COPD horse?

COPD is a disease of the smaller airways (bronchioles and alveoli) in the lungs caused by an allergy to small dust particles and spores that are inhaled by the horse when he breathes. Fungal spores and/or pollen dust are most important in terms of allergic ‘trigger’ factors. Previous viral and bacterial infections in the lung can predispose a horse to this condition. The allergic reaction in the airways results in the production of fluid and thickening of the walls of the small airways of the lungs, causing their obstruction. This means that the horse has to make an increased effort to breathe and he develops a cough to clear trapped mucus. The pathology that occurs in the horse’s lungs, except perhaps in the very early stages, is not reversible and so it is important to understand that this is a progressive condition. It cannot be ‘cured’ but the progress of the disease can be halted and the horse can be helped to accommodate to it.

There is no standard scoring system for the severity of COPD in an individual. Many horses will range from mild to severe depending on factors such as season, stabling conditions, bedding, forage, exposure to particular allergens, and air flow.

Environmental management is the key to controlling COPD, and this alone can take a horse from the “severe” to the “mild” category. Affected animals should be kept in dust-free conditions (as much as is reasonably possible in a barn), designed to keep environmental dust and spore levels as low as possible. Bedding should be paper, shavings, or other non-organic material and should be kept scrupulously clean. Hay should be soaked for 10 minutes or steamed with a commercial hay steamer before being used. Haylage can be fed but carries a risk of botulism so any horses on this type of diet should be appropriately vaccinated. I cannot emphasize enough that round bale hay should never be fed to COPD individuals. Horses should not be stabled on straw and away from hay and straw stores, muck heaps, and other sites where dust and allergens are stirred up. Those that suffer from pasture-associated COPD should be kept in during high season.

If your horse still has breakthrough symptoms, a course of bronchodilators and steroids can be administered, either orally or via inhaler. While I prefer the inhaler so the overall dose of medication can be minimized, oral drugs can be more economical and are often more effective for getting severe flare-ups under control.

If you catch this situation relatively early, there is no reason your horse cannot school mid-level dressage. You may have to ease off during certain times of year when it is hard to maintain good air quality, but many of these horses can perform athletically for years. One of my own horses had mild COPD and we were still able to compete at advanced level three day eventing, back in the days when cross-country was still 4 phases long. It took some extra conditioning and aftercare, but it was possible! Do your best to keep his environment clean and see what happens, you may be pleasantly surprised.

Melissa McKee DVM

Coughing Pony

I have a pony that come high humidity and summer develops a dry cough. We have had him checked for heaves and any other lung/respiratory issues, and he has no issues. He is fine all other times of the year, just with the humidity starts to cough. He lives outside 24/7 with fresh hay, and has no access to dust. We have tried him on ventipulmin (sp?) and it works pretty well, but he still coughs while under saddle. His breathing is fine most of the time while in the paddock but once I start to ride he starts to cough. Any ideas on what I can do to help prevent him from coughing while riding? Any good medications? 

Ventipulmin relaxes small airway spasm so if he improves while on this drug then he does have some degree of lower airway sensitivity contributing to this cough. His management is excellent and you are doing all the right things to help prevent this from progressing to clinical heaves. It is area you ride him in a bit dusty? If so, I have had a lot of success using a type of throat spray that we use to help racehorses with sore throats. It can be given orally prior to exercise and provides some lubrication and anti-inflammatory protection to the upper airways when the horse is breathing hard. There are no commercially available preparations of this product but most vets have a version of it they can mix up. Other than that, there are several excellent over the counter products for mild airway irritation that are available at most tack shops. If there is an allergic component to his cough, spirulina can also soothe the inflammation. I would talk to your vet about these options and they can advise you what would be best for your pony.

Melissa McKee DVM

Square Bales and Coughing

My horse was given large square bailed hay very tightly packed a few months ago. The hay looks good on the outside but when you open it up it clogs together and when attempting to shake it out it is full of dust and small particles of hay fly into the air. There is no visible signs of mold.

My horse started coughing a few weeks after being given this hay, and now coughs every time I ride him.

I spoke to a farmer who informed me it could be chemicals used in the curing of the hay that are bothering him.

My vet finds nothing wrong with him, and says to wet his hay before feeding it to him

I have no knowledge if chemicals used in curing of hay, could this be the cause of the cough.

Even the best quality square and round bales will have more dust and mould present than is found in traditional small bales. Even if you can’t see actual mould blooming on the stems and leaves, it will be present in the dust and becomes airborne when a horse rummages around in the hay at feed time. It is very unlikely that the chemical used to accelerate the drying process have anything to do with your horse’s cough. It is much more likely that he has early stage RAO (reactive airway syndrome) that is making him more sensitive to these environmental factors than the other horses in the barn. This is a situation that you want to get under control now, as the longer this lower airway inflammation persists, the more likely it is that you will end up with a chronic problem on your hands. The most important thing is to either stop feeding this hay, or set up a system that allows you to submerge it in water for a few minutes immediately before feeding. Sprinkling water on the flakes will not sufficiently reduce the airborne dust and mould particles to have any benefit. I have found a handy way to achieve this is to rig a pulley system in the wash stall over a garbage pail of water. Put your hay in a nylon hay net (cotton will rot) and string it through the pulley. Dunk the hay for a few minutes then use the pulley to haul it up and drain it before hanging the net in the stall. This is still pretty labour intensive, so the easiest solution is to find him an alternate hay source and get him as much turnout as possible. If this coughing continues, he may also need medication to reduce the inflammation and irritability of his airways. Generally the vet will perform a respiratory examination, including rebreathing, to assess that lungs, and they may want to pass an endoscope especially if a lot of nasal discharge is noted. In severe cases, we perform a broncho-alveolar lavage (BAL, several ATV postings regarding this procedure) to get a sample of the type of cells and contaminants in the lungs. This will help us to decide exactly what dosage and type of medications are the most appropriate for each case. Some of the drugs we use are pretty powerful and can affect more than just the respiratory system, so careful diagnostics are worth the effort to avoid medicating in error or exacerbating other health problems a horse may have.

Melissa McKee DVM

 

 

Steroids for Airway Disease

I was wondering if the various steriods used to treat allergies/airway disease in horses have differences among them. Does Dex work in the same way as Pred etc. or can one be more effective for a particular horse/issue than another? If an inhaled steroid does not ease the symptoms is it worth it to try an oral or injectable one, or if one type doesn’t work well can it be assumed that none will?

Steroidal anti-inflammatories all act on the same basic pathway, just like all non-steroidal drugs, but there are some differences between them in potency and duration of effect. Dexamethasone is a very effective medication and can powerfully suppress inflammation especially in emergency cases, but not one that we would want to use for weeks on end to treat chronic conditions such as heaves. Dex is usually the vet’s “go to” drug for rapid relief of various swellings, reactions, and allergic flare-ups. It also has a very short withdrawal time, making it a good choice for competitive horses. In general though, if we want to treat a long-term condition, we typically choose a milder form of steroid, which can be injectable (such as predef) or oral (such as prednisolone). As with all medications, we want to find the lowest dose of the mildest form of the drug that will still be effective, so some trial and error may have to occur in the initial stages. When treating respiratory conditions, my preference is to use inhaled medications as this significantly reduces the overall dosages necessary. If a horse is severely affected with heaves or reactive airway syndrome, inhaled medications may not reach the inflamed bronchioles due to mucus accumulation and a course or oral or injectable versions might be necessary to get the horse started on the road to recovery before switching to aerosolized drugs. If you are not getting good results from the steroid treatment alone, your horse may need to be on a bronchodilator or antihistamine as well, depending on the nature of his condition. In this case a BAL might be a useful diagnostic to determine why his response to medication has been poor.

Melissa McKee DVM

Heavy Breathing

I notice my horse breathes very heavily when I’m riding her, especially when we canter. The barn we’re at is pretty dusty so I’m worried that it might get worse. Would you recommend putting her on something like Peak Performance Hemo Cease?

As long as you have ruled out any fitness issues, the rapid respirations you have noticed could indeed be a very early sign that she is having trouble coping with the dusty environmental conditions. If the condition progresses, you will probably start to see some whitish nasal discharge and hear an occasional cough as you start working her. It’s great that you have noticed this now since it is much easier to prevent reactive airway disease, commonly known as heaves, than to try to manage a chronic established case. The most important component is to improve the quality of air she breathes. This can include increased turnout, soaking her hay (not just sprinkling it with water), and either riding outside or inside only during quiet times when there is less dust kicked up in the arena. If her stall faces onto the arena or is next to where hay and shavings are dropped down, I would move her to another stall, preferably near the doors for improved ventilation. Round bale hay, no matter how clean, will have a higher degree of mould and dust than regular hay so you may have to find an alternative if this is the only hay source. You can certainly try the product that you mentioned, it will not do her any harm and can help in mild cases of airway hypersensitivity, but if the condition progresses I would talk to your vet about medications that will help fight the inflammation and relax the spasm in her lower airways before permanent changes have occurred.

Melissa McKee DVM

Allergic Pony

I have a 5 year old pony that has always had a mild stable cough. He would cough once or twice at the beginning of turnout or at the beginning of being ridden. I had the vet in to listen to his breathing in the spring and do blood work. His breathing sounded normal and blood results came back normal. The vet suggested wetting his hay and suspected that he had allergies. I asked for some ventipulmin and would give it to him occasionally.

He has been fine since the spring, but the past few weeks during the humidity and with local farmers harvesting their hay, he has had a lot of trouble breathing. His cough has become more persistent, he became lethargic and went off his food. I had the vet out again and she gave him dexamethasone, sputolysin and sulfa pills.

How effective are allergy tests? Generally how much do they cost? What does it involve?

Would it be helpful to put him on hay cubes? Or should I find out if he is allergic to a certain type of hay first?

What are some other types of allergy medications that could help him? I want to start showing him this summer, so the medication needs to be something that won’t test.

I am sorry to hear that your pony is affected by allergies at such a young age. The two diagnostic tests that may help you figure out the best way to manage him are a broncho-alveolar lavage (BAL), and serum allergy testing. The BAL allows us to obtain a sample of the inflammatory cells in the lung, as well as bacteria and other abnormalities such as blood. If you search the “ATV” archives there should be a detailed description of this procedure. Since different types of immune cells are involved in the inflammatory/allergic response, the BAL can help you identify which ones are causing the problem and allow you to tailor his medications more specifically.

I have also used allergy testing with some success in difficult cases. This test measures the level of reactivity to a vast number of allergens that a horse may encounter in their environment. Based on the results, a customized antiserum can be generated that is injected under the skin in tiny amounts over about a year with gradually decreasing frequency. The premise of this treatment is to eventually desensitize the horse, in a similar manner to “allergy shots” that many of us received as children. The catch here is that you must be really committed to the treatment because it takes so long to complete the series, and if you stop early, you might as well have never started. The test often indicates that your horse is allergic to a startling number of substances, and while it is not practical to try to eliminate all of these from the environment, you can certainly target a few of the highlights and try to manage those. It also sounds like you pony has “pasture associated” reactive airway disease, so during this horribly hot and humid weather, he may actually be better off kept inside in a screened stall with fans on him, and consider turning him out at night when it is cooler. As for medications, there are not may out there that you can show on, but using the inhaler method of delivery you can substantially decrease the necessary dose, with a much closer withdrawal time. The serum allergy test is the most expensive part of the process, while the customized allergy shots are fairly reasonable. The cost of this and of the BAL procedure will vary between vets so I suggest you contact your regular vet for a quote.

Melissa McKee DVM

Single Nostril Discharge

My new mare has drainage that comes out of one nostril, this only happens after I exercise her, the drainage is sometimes white and cloudy and ends up clear. I bought her six weeks ago and it looked like she may have had a cold as she had a bit of a cough, and nasal discharge was slightly green, seemed to clear up on its own, now it has returned, it seems to be worse when she is excited.

Discharge from one nostril indicates that the source is either in the sinus or guttural pouch on that side. The sinus openings are located below the point where the nostrils separate into two separate passages, so they can only  drain on that particular side. Although the guttural pouches open into a single common area in the top of the throat, they are located well onto each side of the pharynx and tend to predominantly cause discharge on that  particular side. An endoscopic exam of the upper airways at a time when the drainage is evident can help to sort out the actual source of the fluid. Skull radiographs can also be quite effective for demonstrating fluid accumulation in these cavities, as well as identifying tooth root abnormalities, tumors, and infection which can also be a source of discharge. In most cases, the cause is a mild sinusitis aggravated by allergies that resolves with antibiotics and anti-inflammatories. Once you find out the cause you will be able to decide on an appropriate course of action.

Melissa McKee DVM