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New Member:
verona

Posted on Sunday, Apr 12, 2015 - 5:26 am:

Hello,
In june of last year my then 12 year old mare developed a constant cough. Prior to that she would have an occasional cough. I immediately called the vet and he gave her a steroid shot (one) and I started soaking her hay and feed. She was bedded on straw. Turnout was 10 hours a day. Within a month the coughing stopped all toghether and I rode her 5 days a week the whole summer and fall without a single cough. As winter and shorter days came I was having trouble wetting down her hay (I had to do it myself) and I decided to move her to a more expensive boarding facility where wet hay was included in the price. Also the new facility used good quality cubed hay and not the round bales I had before. The stable is also well ventilated with high cellings and the stalls have balconys which are open so there is constant airflow. Shavings as bedding. So on January 1st of this year I move her to this new facility and since January 4th she has been coughing constantly. Her first treatment was a dose of antibiotics and mucolytics wich seemed to help but after a corse of that her coughing returned. She had tons of white mucos discharge from both nostrils. It is important to state that the barn has a couple of coughing horses as opposed to the old barn which has one and there is far more dust exposure than in the new barn. The horses do not have a fever. So in February I call the vet again and I tell him I want to have her scooped and allergy testing done. The bronchoscopy shows a flow of mucus in her trachea, the larynx clear. The cytology report from the tracheal wash shows no bacteria at all and the microbiology report shows 95% neutrophil count (only a very small amount degenerate - don't know what that means), the remaing cells being cells being macrophags and enyzinophils. Intradermal allergy testing shows a small reaction to the mites and fungi antigen. In march I start dexamethasone treatment on her and she gets 5 ml of dexamethasone twice a day administered via inhaler for five days, and another 5 days once daily. This shows a great improvement on her cough. On the 9 th day I ride her to see where she is and their is a cough in the canter but overall she does very well. No nasal discharge. On the 10 th day I come to stable feeling very happy and I find her in an explosion of cough. I continue to administer 5 ml of dexamethasone via nebulizer daily and have mixed results. Five good days and then an eruption of cough). This has been happening till now. The nasal discharge has subsided, but she does now have an occasional yellow discharge from one nose. I call the vet and ask to administer higher doses of dexamethasone via injection but he refuses to do it due to the risk of laminitis. He is the only vet around, unfortunately for my horse I live in Croatia where quality horse care is a little underdeveloped. I don't even know how much dexamethasone would be appropriate for a 500 kg horse, as I am not a veterinarian. Is it 20 ml injection fluid? I also asked around to find a barn where she would be on 24/7 turnout but no one is willing to take this on, everyone is afraid of the horse breaking fences, running out during the night...
There is no haylage here.
The only option is to move my mare back to the barn where she was kept before but I find it hard to believe that a less dust free environment would suit her more. This would be the first case in history. I guess I am wondering if a higher dose of dexamethasone may help my mare and how much higher (so I can push the vet) and does an extremly high neutrophil count take a longer time to resolve? Or is this really the end to my beautiful horse?
New Member:
verona

Posted on Sunday, Apr 12, 2015 - 5:34 am:

Her breathing rate is currently 19 breaths per minute. No heavy line yet even though you do see the abdominal muscles working muscles working. Breathing not yet very loud.
Apetite still very good. How much longer do I have with my horse?
Member:
gramsey1

Posted on Sunday, Apr 12, 2015 - 7:18 am:

It sounds like you are treating her for allergies. The drug you have chosen is a type of steroid.
https://www.drugs.com/dexamethasone.html

It sounds like it is not very effective. I'm not a vet but I can think of two reasons.
1. The mare is reacting to the drug.
2. The cause of the cough is not an allergy.

It looks to me like the drug could actually cause an increase in neutrophil count. And if she is fighting an infection, be contraindicated.

https://www.merckmanuals.com/pethealth/horse_disorders_and_diseases/blood_disorde rs_of_horses/white_blood_cell_disorders_of_horses.html

More food for thought.
https://www.doctorramey.com/allergies/

This sounds more serious than allergies, but, have you considered the less aggressive path of antihistamines? There is some good information right here on horseadvice about them.

https://www.horseadvice.com/horse/messages/5/318998.html
I have used Cetirizine to help one of our lesson ponies with an exercise induced summer cough.
New Member:
verona

Posted on Sunday, Apr 12, 2015 - 8:25 am:

The cytology report from the tracheal wash found no bacterial infection which leaves me only with the possibility of a virus infection. Or maybe my mare could have had a bacterial infection the antibiotics cleared up and was left with a cough that refuses to clear up. I don't know. Shouldn't a virus infection show different cell counts than neutrophils. My vet never mentioned the possibility of an antihistamine treatment. He said it was RAO/ heaves. I feel like I have to make all the suggestions for treatment and I am by no means a veterinarian. To my understanding, an allergy that acts upon the respiratory system is infact RAO/ heaves.
The only antihistamine I have is quercetin and I suppose I can try giving 5x the human dose and see what I get. It's not like I have many choices to get my mare better. Urghh.
Member:
jhyrick

Posted on Sunday, Apr 12, 2015 - 10:47 am:

This was an earlier reply I did. My mare is now 29 years old, fiesty and fine:
Posted on Monday, Nov 3, 2014 - 12:40 pm: Edit PostPrint Post
About 4 years ago, my Arabian mare was diagnosed with severe COPD and she also has Cushings.
She'd cough so hard, she'd urinate at the same time. I had allergy testing done, and she was very sensitive to corn, molds and fungus. I ordered her the allergy serums and she went on a shot regiment. Now once monthly.
I purchased a hay steamer from Happy Horse Products, USA and now she eats only steamed hay. (kills the fungus and mold spores). If she's out with another horse, they get the steamed hay too. I steam about 1/2 bale a day and hang in bags so they are handy for her stall. I also purchased a horse nebulizer for her. Though pricey, it delivers ampules of human asthma medication direct to her lungs, and the steroids don't have to be systematically in her system. I don't have to do this daily anymore. Just if I see her nostrils flare, or breathing a little labored. She does not require Ventipulmin now (though I keep a bottle on hand). Saving the Ventipulmin price, justified the battery operated horse nebulizer.
She is now 28 years old, and is as ornery and spunky as ever, and is still ridden some. I haven't heard her cough in months, though hot humid weather seems to aggrevate her condition.
So for me Stable Mate Hay Steamer, (portable traveller unit is available for less in order to try), Flexineb Portable Equine Nebulizer System
and allergy shots. When I board her in the winter, it's a lot of instructions for the farm owner, but a little extra money for her makes their effort worthwhile.
Moderator:
DrO

Posted on Sunday, Apr 12, 2015 - 12:26 pm:

Welcome twomares,
As I read your posts above it strikes me you have not studied the article associated with this discussion area. It gives specific recommendations you have not followed. Your history and lab work is certainly consistent with COPD / RAO however horses with this condition will not consistently get better till the cause of the allergy is removed. You will also find palliative treatment recommendations including dosages and links to whole articles on these medications. Just click on the link article to the article "Heaves & Chronic Obstructive Pulmonary Disease" at the top of the page.

With proper management a horse in the early stages of RAO can lead a normal life.
DrO
New Member:
verona

Posted on Sunday, Apr 12, 2015 - 3:51 pm:

I'm sorry for my long post. I have read the above article (and many others on the internet) and have done everything in my power to move my horse to the most dust free environment I could find. I can not provide 24 hrs turnout for her as none of the barns are offering this and I do not have property of my own where I could keep her. She gets turnout from 9 am to 7 pm. As for substituting hay with haylage or alfa alfa cubes this is impossible. I don't even know where I could buy this in this part of the world. As for a steamer I don't think there is a single one in the whole of Croatia. All I can offer is soaked hay of good quality and this does not seem to be helping. Neither is 5 ml of injectable dexamethasone delivered via inhaler.
If I do the math correctly I can inject 0.1 mg of dex per kg to an adult horse. This would be 0.1 x 500 kg = 50 mg. And if 1 kg =1 liter, then 1 mg would equal 1 ml, then it would be safe to administer 50 ml of injectable dexamethasone. Of course non of this is sufficient if I do not remove her from the barn all together, but hypothetically if I were to take absence from work for a month and sleep with her in an open field there would be a chance with 50 ml of dex to at least close this acute flareup caused by, irronicaly, moving to a more dust free environment!
Member:
rtrotter

Posted on Sunday, Apr 12, 2015 - 5:27 pm:

Hi Twomares,

Ever consider it is not the dust? My horse has 2 issues. Pollen and bugs. He is fine in the winter with no bugs or pollen, but the first day the temp gets above 55 degrees my horse starts living inside. He is a race horse so he gets his exercise by jogging, he wears a special mask. Turning him out does not work, it makes him worse. I do not keep his bedding extraordinarily dry, I have found a bit of moisture to be more beneficial that super dry bedding.

I am posting the thread from last year to show you the mask. I also put Vicks on the inside of his mask.

https://www.horseadvice.com/horse/messages/7/425449.html

Unless you find the cause of your horses issues, you will not be able to find a solution.

Good Luck.
New Member:
verona

Posted on Sunday, Apr 12, 2015 - 6:30 pm:

I did intradermal allergy testing and she reacted to the mites and fungi antigen. And they are everywhere! If the dex were to work and make her stop coughing I could do a little experimenting but since she coughs all the time I am unable to pinpoint at anything specific. She does strangely cough every time she is tied to the rail where saddling and grooming is done. She doesn't need to be saddled nor groomed but she will cough violently. Maybe rails are just not her thing. Sometimes she coughs when she comes to greet me. I watch her in the pasture she doesn't cough, I call her, she comes, she coughs. It could even be me.

I love the homemade mask, I might try something like that for arena riding that is if I ever get to ride in an arena.
Member:
verona

Posted on Monday, Apr 13, 2015 - 7:54 am:

Dr. O,

This is my mare's cytology report:


Sample: tracheal lavage. Made five spaces in all identical findings and moderate to higher cell count. More than 95% of the cells make neutrophils that only rarely have expressed signs of degeneration. Among other cells, most are macrophages that have a moderate amount of partially vacuolated cytoplasm and less phagocytosed basophil granules. The rest of the cells are prismatic cells ciliary respiratory epithelium. In the samples can be seen a small number of red blood cells, and in the background is present rarely protein liquid which exhibited crystalline structure (crystallization solution lavage). Interspersed cells are embedded into smaller clusters of densely-protein mucolike content.
Diagnosis: purulent inflammation of the upper respiratory tract (tracheitis, bronchitis)

What has me confused and worried is that the report suggests an upper respiratory problem and not a lower one and I do not know if I should be exercising the mare or not? On the days when she did not present a cough while at rest I tried riding her and she started coughing.
Moderator:
DrO

Posted on Monday, Apr 13, 2015 - 6:03 pm:

That is because the report is incorrect, the trachea and bronchi are considered the lower respiratory tract. If the problem is RAO due to mold allergies your mare may not substantially improve until removed from a barn and hay. While expressions above of other possible causes may bear out, you will never be able to rule out mold spores until you remove them from her environment.
DrO
Member:
rtrotter

Posted on Monday, Apr 13, 2015 - 7:43 pm:

One of the things that sticks out at me, is her violent coughing in certain area( the saddling and grooming area). There may be something around that area that may be causing her coughing fits. That how I figured out it was the swarming gnats that was causing my horse to cough out on the track. His coughing was very specific to two areas of the track and one day while jogging him early in the morning, I saw the swarming gnats in the sunlight that was streaming through the trees. The rest of the track was relatively clear although there were other bugs. As soon as I starting jogging him in his mask, he was immediately better even in the swarm areas. I went with a full mask because I did not feel that the nose net gave him enough protection from the gnats going under the nose net and flying into his nose.

In your mare's case, I think I would try a set of pantyhose stretched over her nose, prior to you bringing her over to the grooming rack as a way to test whether it is something specific to that area.

Here is a video for the panty hose,although this is for headshakers, it may help and act like a respiratory mask, you might be able to get a human respiratory mask and put it inside of the panty hose, I'm not sure if that wouldn't be too much. But may be a bit more protection to see if you can reduce the amount of stuff going up her nose.

https://www.youtube.com/watch?v=DegSrwcSF3k
Member:
verona

Posted on Wednesday, Apr 15, 2015 - 5:02 pm:

Thank you rtrotter and Dr. O. I am substituting some hay for beet pulp and am now at 1/4 beet pulp, 1/4 grass, 2/4 soaked hay (good quality). It is the best I can do for now.
My mare has yellow sticky mucus coming out her nostrils. Would you say this is a good thing in terms of the need for her lungs to clear from all the built up? Her breathing is still not labored, she doesn't seem to be in distress for air yet. I know a horse that has shallow rapid breathing, very loud, 44 breaths per minute at rest (counting nostril movement). The owners don't seem to mind. Am I right to think this is quite severe?
Moderator:
DrO

Posted on Sunday, Apr 19, 2015 - 9:53 am:

In general COPD horses do not drain mucopurulent material from the nose, this would be more consistent with a upper airway inflammatory disease. For more see HorseAdvice.com » Diseases of Horses » Respiratory System » Colds, Influenza, and Upper Respiratory Infection.
DrO
Member:
verona

Posted on Wednesday, Apr 22, 2015 - 7:56 am:

Thank you. I'm sorry to be a bother, but I have one more question. Why do COPD/RAO horses cough while eating?
My mare comes to me, I take her out of the paddock she is fine, we go for a walk she is fine, I take her out to pasture, she starts grazing (she is not a slower eater), she starts a coughing fit. I get her off the grass, we go for a walk she calms down. I feed her an apple she coughs violently. I stand with her in the middle of the road (concrete) because I have no idea what to do anymore she calms down. Could she have some type of digestive problem along with the COPD/RAO?
Member:
rtrotter

Posted on Wednesday, Apr 22, 2015 - 8:31 am:

Has she been scoped recently? Sounds to me like she has some sort of blockage that bothers her when she eats. I'd wet down everything that goes down her throat and I would keep her away from dry grass and any treats( Apples etc) unless they are cut in very tiny pieces. I would eliminate them all together until you figure out the reason why she is doing this. I'd also try a mix of Honey and glycerin and shoot it slowly down her throat(soothes) before she eats.
Member:
moxshi

Posted on Wednesday, Apr 22, 2015 - 8:54 am:

I keep thinking "scope," too, rtrotter, although I see that the mare was scoped earlier on, but maybe the vet wasn't looking for a foreign object and maybe he wasn't scoping the right area. If it's something like a splinter of hay or wood that is lodged in her throat or palate, could it cause the coughing fits?
Member:
rtrotter

Posted on Wednesday, Apr 22, 2015 - 9:13 am:

Holly,

Something is causing this and it may not be the original reason. and sometimes if there is a lot of garbage, mucous etc its hard to see anything else. Because of the color of the mucous, to me it sounds like an infection or a cold. So it needs a present time scope to determine what exactly it is. while this might have started out as an allergy it could have morphed into something else by now or be something completely different.
Member:
moxshi

Posted on Wednesday, Apr 22, 2015 - 9:26 am:

I does seem that with the yellow drainage there is some kind of infection. My kids used to drink Slippery Elm Tea (ThroatCoat) when they had throat irritations. I wonder if that would work for a horse.

Are you thinking "interference with breathing" or "interference with swallowing?" Would one affect the other in a horse?
Member:
verona

Posted on Wednesday, Apr 22, 2015 - 9:45 am:

She was scooped once when the vet took a sample of her tracheal fluid. The upper airways seemed clear, the lungs full of mucus. She has neutrophil inflammation, COPD, no doubt about it. Was the vet paying attention to other things as well I don't know. I've been trying to cut down on her hay intake so I attempt to hand graze her more, but within a minute I always get the same response, violent cough. So I stop. The cough is rarely present during dinner when she she gets soaked hay. I am starting to think I might be having two issues interfering with one another. Either that or everything has to be wet down for her, including fresh grass. And the nasal discharge has changed from white to sticky yellowish. She was on dexamethasone 5 mg via inhaler for 5 days then weaned down to 5 mg once a day for 10 days, then 15 days 5 mg every other day with mixed results. Now she's on fluticasone 10 puffs once a day, and atrovent 20 puffs 30 minutes prior to fluticasone (flixotide). Biggest symptom is cough and nasal discharge, and even do you do occasionally see the nostrils flare (especially after coughing fit) otherwise she doesn't appear to be in respiratory distress. I've pumped her with so many steroids the last month I've probably gone crazy. And I've tried to get her off hay as much as possible and then she coughs on me while grazing. I've also tried ventipulmin 24 g 2 x per day along with the dex, no difference.
Moderator:
DrO

Posted on Friday, Apr 24, 2015 - 1:34 pm:

The cough you describe is more consistent with a pharyngitis possibly secondary to the upper respiratory disease she had earlier this year. I think re-scoping might be productive too.
DrO
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