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Bal Cytology in Horses with Exercise Intolerance: What Does it Tell us?
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The concept that infectious and allergic inflammatory airway diseases hold considerable importance to the horse industry is beyond dispute. Exercise intolerance or poor performance are terms used loosely by horse owners or trainers to describe failure of the athletic animal to reach a perceived maximum potential. In a large prospective study of two- and three-year-old Thoroughbred horses in training, cough and nasal discharge were second only to lameness as the most common reason for loss of training days (Bailey, 1999). In recent years, particularly in racing horses when no musculoskeletal problems could be identified, veterinary practitioners have associated poor performance mostly with exercise-induced pulmonary hemorrhage, lower inflammatory airway diseases, or upper airway abnormalities. In this context, exercise intolerance or poor performance is commonly associated with substandard athletic performance, interruption of racing or training, and ultimately premature retirement (Viel, 1997), (Hoffman, 1995), (Rush, 1996). However, in older horses (>10 years old), the prevalence of non-infectious inflammatory airway disease also appears to be high as demonstrated in an abattoir survey where a 37% incidence of characteristic histological lesions of this condition was observed (Winder, 1988). Therefore, it is obvious that respiratory disorders play a significant role in the health and performance of horses of all age groups and athletic functions. This paper will focus on describing non-infectious inflammatory airway disease (NIAD) commonly observed in the young athletic horse. The latter term should not be confused with the well-known clinical entity heaves (formerly known as COPD) in older horses, which was clearly defined at the International Michigan Workshop in June 2000 (Robinson, 2001).
The clinical appearance of NIAD can be similar to many other respiratory conditions, and may include coughing, nasal discharge, and a slightly elevated respiratory rate. However, in many horses with NIAD, the clinical signs are often limited to reduced exercise tolerance or poor performance, with a prolonged recovery period following racing or training. The physical examination may reveal subtle abnormalities such as a slight abdominal lift on expiration and abnormal lung sounds on auscultation amplified by the use of a re-breathing bag. Although detection of early NIAD depends upon keen observation and thorough clinical evaluation of the patient, it is ideal to diagnose the condition at this early stage to avoid further progression of the airway inflammation. In more advanced stages where the NIAD has been inadequately treated, exercise intolerance may manifest as an apparent lack of energy, persistently elevated respiratory rate (puffing) and flared nostrils after exercise.
Today the use of fiberoptic bronchoscopy is a common and standard diagnostic procedure, allowing not only direct visualization of the upper airways but also of the lower conducting airways. During passage of the endoscope through the nasopharynx, trachea and large bronchi, the quantity of mucus secretion can be readily assessed as well as the degree of mucosal edema and bronchospasm.
While performing this bronchoscopic procedure, samples from the lower trachea and large bronchi can be obtained for bacteriology, viral identification and cytology. [...]
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