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  Discussion on COPD and herbal therapy
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Posted on Thursday, Jan 20, 2000 - 12:37 pm:

Hi everyone,

Okay, Dr. O., I went back and re-read your article, and then re-read the long posts that accumulated during your absence, to try to figure out where you may disagree.

I'm guessing here, but I'm going to throw a few things out and see what you say.

1/ In your article you say that heaves is caused by an overexposure to moldy hay. Although I agree with this statement, I do not believe that this is the ONLY cause of COPD. I do agree it is likely the most common. I've done a lot of research into COPD and consulted with the Equine Research Centre in Guelph, Canada, which is one of the leading research centres in Canada. Both research and experience have shown me that COPD can be triggered by: particles of dust and/or mold (which in addition to hay, can be found in old barns, bedding, feed), noxious fumes (such as ammonia -- I've walked into barns where the smell almost knocks you over -- imagine a horse standing in his stall all day in that environment), or even a virus, such as influenza. In my case, my horse was stabled in an old barn where the owner didn't turn the herd out for 3 months because she didn't want to "damage her paddocks". The hay fed was of good quality but the stalls were dusty. Stalls were cleaned with the horses in them.

And yes, I do believe, that if possible, horses with COPD should try to be removed from hay. However, this is not always possible (i.e. herd situations where individual turnout isn't possible) and I am always looking for alternatives to this. I.e. watering/soaking my hay. Although it's not the best solution, it usually works and my horses have no problem eating the hay wet/frozen even in the winter time.

2/ COPD vs. the allergic horse.
COPD is a full blown allergic response to inhaled mold spores (i.e. through the causes I mentioned above). This does not automatically mean that your horse has typical summer (pollen related) allergies - which I think is where some of this confusion is coming from. Not all allergic horses end up with COPD and not all horses with COPD have pollen allergies.

An allergic horse, kept in a clean environment, is simply that, an allergic horse -- showing many of the symptoms that an allergic person would show when exposed to allergans (runny nose, watery eyes, sinus congestion, cough).

However, I think the confusion arises because a large number horses with COPD DO have pollen allergies as well. Likely since their immune system is already weakened, as evidenced by the COPD, they are more susceptible to other allergies. In my case, my horse who has never been allergic in her life, after developing COPD then became allergic to pollen. Which explains why I (and I'm sure many other people) notice a difference (in a bad way) during the peak allergy seasons. This does not necessarily mean that my horse has summer pasture associated COPD (SPAOPD). My understanding is that horses with SPAOPD cannot be turned out on ANY pasture without reacting. My horse will quite happily be out on pasture without reacting UNTIL allergy season hits.

3/ The place of herbs/homeopathy in modern medicine. I know that this is a touchy subject for a lot of people because there are many who believe that herbs do not have their place in modern medicine. However, having experimented with them over the years, I see a noticeable difference in my horse when she is NOT on them. My theory is simple, if she is better with them than without, then they work. And if they in any way help her, then I will continue to use them. However, as this market has recently exploded, there are a lot of products out there which are garbage. You need to rely on someone with experience and the knowledge to use these herbs correctly. There are herbs perfectly safe for people which are potentially deadly to horses (i.e. black walnut). Herbs also need to be used within moderation as some herbs can be dangerous with overuse (i.e. ephedra -- this is a wonderful natural broncodilator when used CORRECTLY, however, overuse could cause anxiety and/or even heart failure). I have sought out a skilled homeopathic vet (who for those who don't have much experience with holistic medicine, this is a REAL vet who ALSO practices holistic medicine). It is the best of both worlds for those interested in trying natural solutions. In cases where herbal medicine is not enough, then the vet has the knowledge/skill to use conventional medicine. Within 3 months of my first visit with my now-faithful vet, Betsy was breathing normally, with ZERO medication (she was previously on high doses of pred), and no visible sign of respiratory distress or coughing. She was even back to dry hay for many many months. I strongly believe that this was due to the combination of homeopathy and herbs that we had added to her routine. It was only when we hit this past allergy season that we ran into trouble again. In terms of using herbs for other things, i.e. inflammation etc. -- my belief is to try them, and if they work, use them. If they don't, then don't. They don't work for all animals in all cases. But it never hurts to try.

Let's start with this, and see what kinds of reactions I get....and go from there.

Posted on Thursday, Jan 20, 2000 - 7:53 pm:

Hello Sheila,
It does seem unlikely that hay molds are the only cause of COPD. SPACOPD may be an example of one (then again it may not, see below). But the fact is none of these other causes have ever been identified that I can find in the literature. When critical testing is done on COPD horses almost 100% of COPD horses respond to mold allergins while the controls do not, see references at end of article.

I have never had a case of COPD that did not respond to being out of the barn and off hay.
I am not talking about horses with a little barn cough, runny nose, or red eyes as these are not primary signs of COPD. I am talking about horses having trouble breathing with whistles and rales in their lung fields on auscultation. Some of these horses were brought to me on homeopathic medications, others on more traditional medications like antihistimines and bronchodialators. Until these horse was removed from the barn and taken off hay you can not get a good clinical response with these medications. Steroids could relieve the symptoms but this was only temporary if the environment wasn't controlled.

There is no doubt that other environmental factors play important but secondary roles in COPD. Most of these factors can only be effectively managed by removing the horse from the barn.

Concerning feeding hay to the COPD horse, I have have seen COPD horses that if caught and treated correctly could be put back on very clean hay. But I have also had some that everytime they were put back on hay, even if soaked, began coughing followed by difficult breathing. I presume these horses allergies are more sensitive. If you do not get these horses off hay, they will eventually develop consolidation and emphysema and the most humane thing done is euthanasia. I have seen this happen twice: people ignored the warning signs for years and eventually the horse did not have enough breath to stop and eat.

Studys on wetting hay have shown it is not very useful in lowering the amount of hay mold and neutrophiil associated inflammation found in the lower respiratory tract. I too have not found it very useful for curbing symptoms of COPD horses. There is probably a small margin of horses that the little bit of benefit make the difference but they have been the exception not the rule.

I am not sure what to make of your allergic comments, of course not all allergies are COPD. There are dozens of different types of allergic disease. COPD is a hypersensitivity reaction usually to inhaled hay molds that results in a inflammatory lower air way disease (pneumonia). I do not remember identifing a COPD horse that was not effectively managed by controlling hay mold exposure. Nor do I remember any of the COPD patients having secondary allergic type symptoms that might have been associated with other allergies. Nor have I seen any scientific reports that have identified such. A large percentage of SPACOPD also have regular COPD. Dr Robinson, one of the foremost researchers in the world on lower respiratory disease in the horse, hypothesizes that SPACOPD may be a response to a pasture mold (AAEP Milne Lecture on Lower Airway Disease 1997).

None of my previously COPD horses are on prednisolone (prednisone is not recommended~DrO), though I always use it in the initial stages to control the inflammation once responded and proper management instituted they remain symptom free, without homeopathic treatment. Some have even been able to return to hay and a clean dust free barn. Even better, by aggressively persuing managment objectives based on these principles I no longer see horses develop heaves, it has become almost nonexistant in my practice but remains one of the most frequent reasons for referral to my practice.

Concerning your theory on testing homeopathic medicine: "if she is better with them than without them..." ignores a simple fact of nature: 80% to 90% of the diseases that afflict us will get better no matter what you do as long as you do no harm. So if you use absolutly useless treatments they look great because they work 80 to 90 % of the time. Without critical scientific investigation medicine returns to the the times that more people died seeing the doctor than did not.
DrO

Vet Immunol Immunopathol 1998 Dec 11;66(3-4):245-56
Studies on pulmonary and systemic Aspergillus fumigatus-specific IgE and IgG antibodies in horses affected with chronic obstructive pulmonary disease (COPD).
Schmallenbach KH, Rahman I, Sasse HH, Dixon PM, Halliwell RE, McGorum BC, Crameri R, Miller HR
Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, UK.

Am J Vet Res 1999 Jul;60(7):841-7
In vitro allergen-induced degranulation of pulmonary mast cells from horses with recurrent airway obstruction (heaves).
Hare JE, Viel L, Conlon PD, Marshall JS
Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Canada.

Am J Vet Res 1999 Jul;60(7):841-7
In vitro allergen-induced degranulation of pulmonary mast cells from horses with recurrent airway obstruction (heaves).

Equine Vet J 1993 Jul;25(4):261-7
Responses of horses affected with chronic obstructive pulmonary disease to inhalation challenges with mould antigens.

Br Vet J 1995 May;152(3):283-306
The pathogenesis of chronic obstructive pulmonary disease of horses.

Posted on Friday, Jan 21, 2000 - 12:41 pm:

Crap! I wrote a response and then mistakenly hit the wrong button and it disappeared. So I'll try again....

Dr. O,
Thanks for the references, I will check them out.

My point about the differing allergic conditions was meant more for the people following these discussions. I believe there is a strong confusion in the industry, particularily when people first start learning about COPD. I just meant to point out that because a horse has seasonal allergies, it does not automatically mean that an owner should jump to the COPD conclusion. That's all. However, and my horse is walking proof, a COPD horse may be afflicted with other allergic conditions, which would explain overreactions during prime allergy seasons. Perhaps, as you suggested, this is caused by mold in pasture. I would be interested in reading further studies to find out if this were the case.

I agree that proper environmental management is very important. As with anything, prevention is the best cure.

However, I do not believe that alternative medicine can be so easily discounted as a coinqi-dink of nature taking its course. Again, my point was simply that it is still an avenue to be explored. Searching the web last night, I found that the ERC in Guelph recently did a study on an herbal product called Breathe (manufactured by Herbs for Horses) in its benefit to horses with COPD. I have used this product on my horses and think it's wonderful. Although it's not an in-depth study, it shows us that modern medicine is beginning to recognize the growing use of non-traditional forms of treatment. Hopefully in the future, more research will show us either the benefits or non-benefits of these products. For interest, the article is at

https://www.equinecanada.com/spring99/eq_magazine_nutraceuticals.htm

By bringing these matters to the table, I do not mean to devalue anyone else's opinions or research that has been done. And I hope that everyone who reads these posts realizes that. This is simply my opinion. If everyone agreed on everything, then we would learn very little in life.

Cheers.

Posted on Saturday, Jan 22, 2000 - 7:57 am:

Hello Sheila,
We are now into a semantical discussion: what is Alternative Medicine. To me anything that has good scientific proof of safety and efficacy is good medicine. I do not care if it grows in the swamps of Okeefenokee. Everything else is just here-say and potentially dangerous due to:
1) not seeking effective treatment
2) toxicity

I don't know of a good doctor that thinks herbs may not have a place in medicine, all traditional medicines are derivatives from natural substances. However many of the products available are of unknown toxicity, efficacy, and potency. I have received a copy of a european organizations review of the use of herbals in humans and am interested in reading it.

Sheila, good medicine really is more than: if it feels good do it. Let me give you an example based on this case. Lets say continued research supports the work done by ERC. It was a small test, monetarily supported by the company that makes the product, and published in the paper that is monetarily supported by the company that makes the product. None of this says the research is not valid. I would love to see the experimental design, and the actual numbers but the article has the important key words of statistically significant and double blind. In research this type of experiment is always reviewed with a microscope and often found wanting. I think Schering ripped off the whole United States with its PHF testing and vaccine and I have let them know it.

But I digress, let's get back to the research and let's say you can get significant relief of symptomology using this product. Did you notice the statement that there was no change in neutrophils in the lavage fluid from the lungs? What if this product relieves symptoms without curing the allergy? The result may be that horse owners continue to expose horses to conditions that while the horse remains acceptably symptom free, the lungs are quietly becoming consolidated? If this seems far fetched, this is exactly what happens when you try to mange this disease by substituting drugs for aggressive management of the environment. By using palative medications you can kid yourself into thinking you are OK while the horses lungs become consoliidated over time.

Sheila, I know it must seem like I am picking on you here, but this board is more than a list of horse owners opinions. People come here for advice and I am here to insure it is good advice, based on my experience, education, and power of reason. Anytime someone jumps to a therapeutic recommendation (whether traditional or alternative) based on anything other than a reliable diagnosis we have not served that poster. Every day I talk to clients on the phone and when I get out and actually examine the horse find it is something different than what was described. I have found most people really need to know what questions to ask and the solution will fall out of that.
DrO
I apologize ahead of time for standing on such a tall soap box.

Posted on Saturday, Jan 22, 2000 - 8:32 am:

Hey Dr. O.

Don't worry about the tall soapbox. I hear what you're saying. And yes, I did pick up on the fact that there was no change in the lungs in that study. But I'm hoping it's just the beginning of studies that might show us a more natural way of treating ailments. And I agree, on the surface it may appear to be an easy way to treat our animals, and therefore owners may be tempted to fall short of doing the necessary and critical environmental changes. My way of thinking, is that alternative medicine (herbal, homeopathic, whatever) should always be IN ADDITION to proper health and evironmental management. And perhaps that's where I haven't been clear. But I still long for the day when we can treat our animals and ourselves, without the aid of modern drugs...SMILE.

Thanks for the discussion.

Sheila
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