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Systemic Anti-inflammatory Therapy for LRT Disease
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The airway obstruction and pulmonary dysfunction, and consequent morbidity and mortality, that are associated with lower respiratory tract (LRT) diseases, are attributable largely to inflammation. Consequently, anti-inflammatory agents have an important role in the management of most LRT disorders. Ideally these agents should be used in conjunction with treatment targeted at the underlying aetiology, such as provision of an organic dust-free environment in the case of recurrent airway obstruction (RAO). Furthermore, it is important to recognise that, because anti- inflammatory agents afford no immediate improvement in airway function, they should be used in conjunction with bronchodilators in horses with significant LRT obstruction. Systemic anti- inflammatory drugs may be more beneficial than inhaled drugs because aerosolised drugs are poorly distributed in the lungs of horses with diffuse severe airway obstruction.
Glucocorticoids
Glucocorticoids, administered systemically or by inhalation, effectively attenuate pulmonary inflammation in many LRT diseases including RAO, summer pasture associated obstructive pulmonary disease (SPAOPD) and inflammatory interstitial lung disease. Glucocorticoid administration is also indicated in IAD, especially for refractory cases and cases which have an eosinophilic or mast cell dominated cytological pattern. Glucocorticoids are the only agents which reduce nonspecific bronchial hyper- responsiveness, which is responsible for much of the pulmonary dysfunction associated with LRT inflammation. Prednisolone (1 mg/kg bwt per os q. 24 h) and dexamethasone (0.04–0.1 mg/kg bwt i.v. q. 24 h) are most commonly used. Both corticosteroids improve pulmonary function in RAO horses, in spite of continuous organic dust exposure. However, oral dexamethasone at 0.05 mg/kg bwt is more effective than prednisolone at 2 mg/kg bwt in the treatment of RAO. [...]
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