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  Discussion on Inflammatory Airway Disease - IAD
Author Message
New Member:
kalnfizz

Posted on Sunday, Sep 9, 2007 - 7:58 am:

My gelding has IAD and cannot seem to get better. We just found out he had IAD in April of this year. He started his treatment right away. At first they put him on daily Prednisolone for a month, then the inhaler - Flovent. He was weaned off Prednisolone after a month, and kept on Flovent. Even kept in his pasture, and no exposure to hay - He has never been better and he is now back on daily Prednisolone. Since my horse has been on this program for so long; I'm concerned. He is not better, but actually getting worse. He is now breathing heavy 24/7 for the past 4 weeks.

I'm desperate for any advice. This horse is only 6, and last year was a top show horse. He has only been ridden 3x this year. He does not cough, have a temp. He just breaths hard, and looks/acts tired all the time. He is kept outside 24/7 with a shed and fans and kept with one other gelding. The shed is cleaned out daily with no bedding, just stone dust.

Is there anything I can try? My horse is not exposed to hay, shavings, straw, etc. I'm concerned my horse will never be ok!

Thank you
Moderator:
DrO

Posted on Sunday, Sep 9, 2007 - 9:01 am:

Stacey, there is a summer pasture associated form as described in the article but I would have thought MD a little far North for this form.

Note that IAD is not a diagnosis but a pathologic description and there are other diseases possible than inhaled allergins. Can you describe what you thought brought this on and what diagnostic work has been done so far?
DrO
New Member:
kalnfizz

Posted on Sunday, Sep 9, 2007 - 4:12 pm:

I have had my Paint gelding since he was a yearling. He started his show career at 3. Last year, as a 5-year-old he started the show season in March and after several months, I noticed he was always tired and seemed unhappy. Spring of last year, he was treated for Lyme Disease. Tho he tested neg for the Lyme titer. After that treatment, he was put on meds for Ulcers. That did not work and I was told he was "sour". I gave my horse 6 weeks off. Then I took him trail riding, and ponyed him. Once back in the show ring, he was the same "breathing hard" horse. After a 2 min trot and canter class he would breath real hard "like a race horse" and look unhappy.

I gave my horse 5 months off after that. March of this year, I started with light work, lunging & ponying. I also started to ride for about 20 min to 1/2 hour, 3x a week. For the next month my horse was tired after 20 min of riding. In April, I noticed my horse breathing real hard, even when he was resting in the shed. I called a new vet who listened to my horse breath. She performed a BAL test and stated my horse needed to go to New Bolton. At NB another Bal test was performed, along with a pulmonary lung function test. At this time, my horse tested normal, but I was told he was on the border and to bring him back in 2 weeks. I did, and the same test was performed. At this time, May 2007, I was told he has IAD. He was put on a 30 day Prednisolone program, and then put on Flovent and Albuterol for another 30 days. After this treatment, in July, my horse went back to NB for the same test. At this time, NB said my horse was OK to go back to light duty, he tested normal and I can ride him. I did for a few days, very light riding, and after 5 days he started breathing hard again. I was told to start the 30 day Prednisolone program all over again, and follow up with the Albuterol and Flovent treatment(same program as before). As of right now he is on 15 pills of P in the am and 15 pills in the evening. Nothing has changed, my horse is having a hard time breathing, and looks unhappy.

He has always been in the same pasture since he was a yearling, with the same horse. He is not on any hay, bedding, or near any hay. He is on 24/7 turn out. He has never coughed.

I am hoping I can get some help. I love my horse and want him to be comfortable; even if he cant be a riding horse.

Thank you!
Moderator:
DrO

Posted on Monday, Sep 10, 2007 - 11:45 am:

Stacey can you post all the physical and laboratory findings from New Bolton? It should be in your discharge papers.
DrO
New Member:
kalnfizz

Posted on Monday, Sep 10, 2007 - 6:12 pm:

My horse was presented to New Bolton on 5/23/07 with a history of exercise intolerance. He is currently receiving no medications.
My horse was sedated and pulmonary (lung) function testing (open plethymography) were performed as a noninvasive method of measuring airway resistance. The lung function test showed my horse has NORMAL baseline airway resistance (less than 1L deltaFlow; normal<1L). My horse was nebulized with a saline solution and demonstrated NO increase in deltaFLOW in response to the saline. He was then nebulized with increasing concentrations of histamine in a saline solution and a measure of airway resistance was evaluated after each increase in histamine concentration and nebulization. This histamine bronchoalveolar challenge indicated markedly reactive airways with increased activity. There was a 35% increase in baseline deltaFLOW at ~4.0 mg/ml of histamine in saline. This indicates that my horse is considerably more sensitive to histamine challenge than a normal horse.
A (BAL) was performed to evaluate the cellular component of the airways and degree of inflammation. The results showed 13% neutrophils, which indicates significant inflammation (normal is less than 5%)
These findings are consistent with a diagnosis of inflammatory airway disease (IAD). This disease is similar to "asthma" in humans. Most likely stimulated by an increased sensitivity to small particulate matter within hay (dust,mites, etc). IAD is not a curable disease, but can be managed. Our goal in this therapy is to reduce the degree of reaction. Ideally my horse should be turned out 24 hours a day. If this is not possible, please ensure the horse has excellent ventilation, no hay is stored in the loft above him. Consider using a "processed hay form" such as Dengie or hay cubes, in addition to complete feeds.
Follow the corticosteroid and inhalant program described below.
Week 1 - 400mg prednisolone by mouth every 12 hours.
Week 2 - 300mg " "
Week 3 - 200mg "" -at this time start inhaler-- 4 puffs of Albuterol 5-30 min before Flovent. Flovent 10 puffs every 12 hours.
Week 4 - 200mg every 24 hours and same for inhaler
week 5 - inhaler only - 10 puffs of Flovent once a day.
Week 6 - 5 puffs Flovent every other day.

At the first sign of worsening of respiratory signs (cough,exercise intolerance) resume previous level.

After the first 2 weeks of inhaled therapy, use Albuterol as needed or before exercise.

Please rest the horse, turn out only.

Please schedule a recheck lung function test in 4 weeks.

That is what is on my papers from New Bolton. As you can see from my previous message, I followed the program, right down to the 5 puffs of Flovent every other day. He is now back on this program all over again, since he did not respond the first time.

Today, my horse still has the same issue - he breaths hard and has no energy. He is not ridden and can hardly walk across the pasture.

Any advice; I am thankful for.
Moderator:
DrO

Posted on Tuesday, Sep 11, 2007 - 7:15 am:

Stacey, I am a bit confused about the treatment history. NB implies the horse was improving (ready for light work) while being treated with prednisolone and in their instruction asks if there is no response you are suppose to return to the previous level of treatment. Yet you imply in several places that since this has begun the horse has not improved at anytime, even while being treated, but you did wean down the treatment as though you saw a response. Can you clarify this?
DrO
New Member:
kalnfizz

Posted on Tuesday, Sep 11, 2007 - 7:49 am:

When my horse started the treatment, I had him boarded at a lay up farm. I did not have the ability to treat my horse 2x a day and was not sure how to use the "mask". Since I did not see my horse everyday, I believe he was better. After the 4 or 5 weeks of treatment at the lay up farm, my horse went back to NB for the follow up test. That was the time, I was told my horse was "normal" and could go back to light duty. I then took my horse home and he was only on 5 puffs of Flovent every other day. I did ride him around my property and the first few times, he was OK, but I noticed he was always breathing hard in the pasture and in the shed. I called the vets every week, telling them my horses is no better. At that time they told me to go back to the start of the treatment all over again. After starting this program again, and keeping him at my house, I noticed the same breathing. I have called back to the vets again, and I was told to keep the program going and "maybe next year they can try shots". To me, this is not acceptable. My horse is uncomfortable, he has been this was for over a year, and I spent thousands in meds, not alone the vet bills. My horse is no better. I have read some very interesting articles on your web site, and I am trying to see if I can help my horse in anyway.
I appreciate your help and advice.
Moderator:
DrO

Posted on Wednesday, Sep 12, 2007 - 2:09 pm:

Stacey assuming the diagnostics have correctly identified the problem as a non-infectious inflammatory disease of the airways. It is a common problem in horses and caused by inhaled allergens. Your history suggests that your horse is allergic not to hay molds but something in the outside environment since the horse has worsened even though not exposed to the air in a barn or hay. If this is true the only cure is going to be finding a location where this unknown allergen does not exist.

The corticosteroid therapy they prescribed did appear to help your horse though it appears symptoms did not completely go away and/or the symptoms reappeared rapidly following cessation. Stacey I would consider using higher doses of prednisolone for a longer period of time. Call NB tell them he is not responding to the current dose of pred and ask for a prescription for higher doses and be sure he gets all of the doses. If the problem is inhaled allergen I do not know of any more effective therapy and your posts suggest it helped him some before, just not enough. The only final solution for such an allergy would be moving the horse to a location where the allergen does not occur but that would be trial and error since we do not know what it is.
DrO
New Member:
kalnfizz

Posted on Wednesday, Sep 12, 2007 - 5:29 pm:

Thank you for taking the time to review my horse and his issue. I did place a call to NB today. I will be getting a call back, once the vet reviews my horses case.

You have a great web site, and I learned a lot about respiratory issues.

THANKS!!!
Member:
jamie111

Posted on Friday, Aug 15, 2008 - 12:55 pm:

Hi, Stacey. I am curious as to what happened with your horse after your last post -- almost a year ago now. Did you go to a higher dose of predinsolone? I'm interested in your story because I have a horse with an outdoor respiratory allergy problem.
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