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EIPH Management
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EIPH is ubiquitous in Thoroughbred racehorses and also occurs following other types of strenuous exercise. Most episodes of EIPH do not appear to be associated with reduced performance although the slightest evidence of EIPH is used to justify treatment with furosemide (F). Globally, F is the drug most commonly used to attenuate the severity of EIPH, regardless of whether its use is permitted on the day of competition or not.
It is unclear as to the extent of F use during training of racehorses, particularly when its use on raceday is prohibited. While reports are anecdotal, F use is apparently widespread globally in this context, with the frequency of use being highly varied. Little is known about the effects of repeated administration of F under these conditions. F reduces the severity of EIPH, particularly the more severe episodes (Grades 3 and 4), and horses’ performances are improved following administration of F ~4h beforehand. The mechanism by which F achieves these effects has not been clearly demonstrated although the reduced severity of EIPH is usually attributed decreased pulmonary arterial pressure. Other potentially important extrarenal effects of F have been studied in other species have not horses (eg, effects on pulmonary venous pressure and capacitance).
Personal observation indicates that many horsemen and some veterinarians are unsure of why they are using F to manage EIPH. There is widespread belief that F prevents EIPH rather than attenuates it and that its administration helps performance. It is not uncommon for people with large numbers of horses receiving F before strenuous exercise to believe they have no “bleeders” although they are all getting F. However, if these horses are competing well, no diagnostic test(s) for EIPH have been performed. If they had, it is likely that there would be signs of EIPH. A minority of horses develop debilitating pulmonary pathologies like veno-occlusive disease and pulmonary fibrosis secondary to the repeated presence of blood in airways and lung tissue, and reducing the likelihood of this may be the best justification for using F.
There are many other practices that are utilized in the cause of managing EIPH. They include pro-coagulants, nitric oxide analogs, phosphodiesterase type 5 inhibitors, antihypertensive agents and other diuretics, bronchodilators, and controlled access to water. None have been shown to be effective in mitigating EIPH severity. However, their use continues in many places.
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