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  Discussion on Use of Torpex inhaler for managing symptoms in draft horse with COPD
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New Member:
Brezniak

Posted on Friday, Oct 4, 2002 - 11:44 pm:

I have a Shire mare with "chronic allergic bronchitis" (vet's words) who had occasionally had coughing spells in the past but had a bout of breathing problems starting a few weeks ago (little coughing). I live in the northeast and we have had an exceptionally dry summer until (surprise) a few weeks ago. We put her on clenbuterol for several days and she improved (it also rained and got colder). My vet is afraid to death to put her on any steroids because she suffered a severe case of founder in connection with having a problem with a late term pregnancy that resulted in a dead foal. Although the clenbuterol was effective, it is very expensive especially at the dosage required for a draft horse of her size.

We had another crazy spell of hot and humid weather uncharacteristic of October and she started having problems again. This time I am trying a Torpex inhaler (albuterol) but my vet is not sure how well it will work due to the size of the mare. Does anyone have any experience with the inhaler, specifically with draft horses. The normal dosage does not appear to do much and repeating the normal dosage after 10 minutes (suggested by manufacturer) does seem to alleviate the wheezing but not completely slow down the respiratory rate. The few people that my vet has had try it on light horses have a success with it.
Moderator:
DrO

Posted on Monday, Oct 7, 2002 - 8:30 am:

Hello Diane,
I have not had experience with these inhalers yet but be sure you understand that this is just "symptomatic relief". The article explains how to correctly manage this disease so neither inhaler or steroid is needed.
DrO
Member:
Brezniak

Posted on Monday, Oct 7, 2002 - 2:10 pm:

DrO,
I have read a fair amount about COPD and understand that all medications are symptomatic relief. Question then, does removing the symptoms have any effect on lessening any damage that may occur to the lungs? This is my main concern.

My horses are never stalled. They have access to the barn (which is very well ventilated all year long) if they choose but this mare seems to know that she is better off outside. Still, she currently can go in if she wants and I am thinking about changing that. In terms of hay removal, she is still on high quality hay that has been thoroughly soaked for several hours. I have read where you say that soaking hay doesn't do much good but I don't understand why not. It certainly has to cut down on any "dust" flying around and why it would not cut down on the amount of inhaled spores is another concept I don't understand. I really don't have any pasture and am trying to avoid feeding three or four horses Dengie, hay cubes, etc. due to the tremendous expense involved (they are all large and eat a lot of hay, the mare can eat a 60-70 lbs bale a day alone). Right now, I am not sure the hay itself is the cause of her allergy. I have a "gut feeling" that there is some else in the environment that came in strong after a summer of DrOught followed by a large quantity of rain. Time will tell as winter approaches and I will continue to try to do whatever I can to help her.

I just spent a year saving this mare from an episode of founder that was so severe that the veterinary surgeon and master farrier at Cornell U hospital could not believe that the mare was standing let alone in the excellent body condition she showed. I am not about to give up on her now!
Moderator:
DrO

Posted on Monday, Oct 7, 2002 - 6:57 pm:

It may slow it down some, but in cases where I could not get owners to remove hay from a heavey (COPD ) horse's diet the result is a slow downhill slide to permanant lung damage. It has been shown that 30 minutes exposure to typical "barn air" results in 21 days of lung hyperreactivity in heavey horses. It is a fact that the mold spore count in the trachea did not go down significantly following soaking.

THE HAY AND BARN ENVIRONMENT IS THE CAUSE and until you realize this you will continue to shorten your horses life span and the last years will be painful and torturous as your horse struggles for his next breath. I have seen this happen several times.
DrO
Member:
Equus

Posted on Tuesday, Oct 8, 2002 - 11:26 am:

I wanted to ask about the medication /symptom thing mentioned on this thread too. But a variation of it. As you may remember, I have "Cisco" a COPD/SPAOPD gelding in Florida. He has been off hay for years and only comes in to a well-ventilated "barn" or open-sided run-in during hot summer days. (We experimented with this and he is definitely worse off in the heat and high pollen of summer than in the run-in.)

I worry about the "continued worsening until painful death" all the time. But this part confuses me. The difficulty breathing worsens because accumulated mucous consolidates air sacs in the lungs, correct? But if steroids alleviate the immune response that creates the excess mucous, how do things continue to worsen?
Member:
Brezniak

Posted on Tuesday, Oct 8, 2002 - 11:04 pm:

DrO, do you have some journal references for the studies on hay soaking and mold spores and also exposure to "typical" barn air. Since I am a scientist I would be interested in reading the original references.

My vet was more concerned about dust than hay. My mare has improved over the last two days as the weather changed and I have not used the inhaler.

Heather, I would also like to know the mechanism by which the lungs deteriorate. I know there is an acute and a delayed response to the allergens but what the delayed response is, I don't know.
Moderator:
DrO

Posted on Wednesday, Oct 9, 2002 - 7:21 am:

The article on COPD explains the pathogenesis Heather including the irreversible part, look under the clinical signs subtopic of he article. As to whether a concerted and persistant effort with steroids, that keeps the horse symptomless will prevent the end stage of this disease, I do not think we know. I do know the episodic treatment of acute exacerbations with steroids will not prevent the end stage.

Diane, we do not believe it to be the inorganic forms of the dust as these have low antigenicity, it is what is in the dust, that is a problem. The article explains what we know about the cause including its relation to hay and mold.

I would start with the scientific reports at the bottom of the article. They have both a refererence and a short summary and I have tried to cover the most important points. The above reference to both the reactivity of the horses lungs and soaking mold spores comes from a oral presentation I attended given by Dr N. Edward Robinson at the December 2000 AAEP the paper can be found in the preceedings:
Stabling, Airway Inflammation, and Dorsal Displacement of the Soft Palate in Young Horses
Susan J. Holcombe, VMD, PhD; N. Edward Robinson, B.Vet.Med., PhD, MRCVS; Cynthia Jackson, DVM;
Cathy Berney, B.S.; Vincent Gerber, DMV; Andrew Jefcoat, DVM
Authors’address: Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan
State University, East Lansing, MI 48824-1314.
The proceedings itself does not state these two facts presented at the meeting but does list these references:
1. Moore BR, Krakowka S, Robertson JT. Cytologic evaluation of bronchoalveolar lavage fluid obtained from standardbred racehorses with inflammatory airway disease.
Am J Vet Res 1995;56:562–567.
2. Sweeney CR, Humber KA, Roby KA. Cytologic findings of tracheobronchial aspirates from 66 thoroughbred racehorses.
Am J Vet Res 1992;53:1172–1175.
3. Schenker MB, Christiani D, Cormier Y, et al. Respiratory health hazards in agriculture. Am J Resp Crit Care Med 1998;158:S1–S76.
4. Woods PSA, Robinson NE, Swanson MC, et al. Airborne dust and aeroallergen concentration in a horse stable under two different management systems.
Equine Vet J 1993;25: 208–213.
5. Dixon PM, Railton DI, McGorum BC. Equine pulmonary disease: a case control study of 300 referred cases. Part 1: Examination techniques, diagnostic criteria and diagnoses.
Equine Vet J 1995;27:416–421.

I am not asking you to take my word, or even Dr. Edward's word, for this however: just look at your current management scheme and realize that having to treat pharmocologically represents a breakdown in management and think about what you are doing that might not be working. Still allowing the horse into the barn and the continued feeding of pasture cured hay (even good quality hay that has been wetted down) are the 2 most common events I see associated with recurring problems in COPD horses.
DrO
Member:
Brezniak

Posted on Wednesday, Oct 9, 2002 - 10:22 pm:

DrO, I asked for references simply because I was interested in more detail, not because I didn't believe you or someone else. As a chemist my job is to question and evaluate data and no offense was intended. I just have an analytical mind.

I did read something last night however that I would like to bring up. It came off an article on SAID as they call it from a Tufts University website ( https://www.tufts.edu/~ahoffm01/SAIDwizard/treatoptions.htm). I quote,

"Of course, the most important aspects of long-term control have nothing to do with drugs. Avoidance of dust, hay, and air pollutants, and lowering the incidence of viral infections by vaccination are the most important facets to prevent SAID. Even with these efforts, much SAID and COPD in New England and other regions is seasonal--hay can not be implicated as the primary cause, so environmental control alone is not sufficient".

As you (and others) have said you have to avoid the allergens that cause the problem in the first place and I have no argument with that or with the fact that molds, dust or its components can exacerbate the situation. My question has to do with just what I quoted above - seasonal allergies. Being that I live just about in New England (Tufts is closer that Cornell) I am wondering if this is something to consider. I am always looking for new ways to approach a problem.
Moderator:
DrO

Posted on Thursday, Oct 10, 2002 - 6:26 am:

Hello Diane,
No offense taken! If you can take my needling I certainly should be able to provide some documentation to what I say. I like folks who question what they hear and that is really a main thrust of this site, a lot of what is considered fact in equine medicine and care is at best not well established.

My point above was an attempt to direct you back to your case and for you to use your horse as the basis for management decisions and that until you have done everything possible to reduce mold spores from this horses environment, you do not know how well your horse can be. After all the degree of allergy and perhaps even the specifc allergins will surely differ from horse to horse and the article addresses how to explore what your horse will tolerate.

Concerning the Tufts statement, I have known many horses that suffered from COPD were well controlled year after year with environmental treatment. The article we have on the site has the summaries of scientific reports that describe rdozens of horses that improved with just environmental adjustment. We do know there are a subgroup of COPD horses that have trouble with something they are exposed to on summer pasture that is not related to the molds found on hay. But they need the ultimate in environmental treatment: moving north of the Mason Dixon line. I do not think the Tufts statement was meant to be a excuse to get slack on experimenting with well established environmental adjustments that may prevent your horse from ever needing drugs to treat the problem.
DrO
Member:
Brezniak

Posted on Thursday, Oct 10, 2002 - 1:17 pm:

DrO, agreed, I don't take the Tufts statement as ignoring specific environmental changes either and they start their remarks by saying so. And I agree that the best medicine is no medicine. Just wondering if our unusual weather conditions this summer caused an "outbreak" of perhaps a different kind of mold or allergin not necessarily present in hay but somewhere in the outdoor environment. As you know, there were some unusual weather conditions in Kentucky 2 years ago, which are being linked to Mare Reproductive Loss SynDrOme. But that is another story.

We live in a wooded area and there are lots of possibilities. I also know a few people who have allergies that experienced a lot of breathing difficulty at about the same time as my mare. I know this is circumstantial but who knows. Of course my goal is to help this special mare. She lives outside 99% of the time anyway and my barn is really like a big run in but we are addressing the barn environment and have some ideas of how to improve it with respect to lowering any particulates in the air. The hay issue is harder from a financial viewpoint but we will deal with it somehow.
Moderator:
DrO

Posted on Friday, Oct 11, 2002 - 11:28 am:

Allergies to other substances certainly is possible but other than these cases in the Gulf States area there have been no other established causes of COPD in horses except mold spores. We believe it has to do with the size and density that allows this very antigenic particle to penetrate to the broncioles and alveola and an allergic reaction to develop.
DrO
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