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Evidence-based Medicine Applied To Heaves
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Introduction:
It is now well accepted that heaves is an inflammatory airway disease in which neutrophil accumulation in the airway lumen is accompanied by airway obstruction that is due to bronchospasm, mucus accumulation, and airway wall remodeling. Inflammation is initiated by exposure of susceptible animals to organic dusts, particularly hay dust. Treatment of heaves, therefore, involves prevention of exposure to organic dusts, reduction of airway inflammation by use of steroidal anti-inflammatory drugs, and relief of airway obstruction by use of bronchodilators. Although these treatments are now recommended in most equine medicine texts, the details of how treatments should be applied, which are most effective, and how long they should be administered is frequently omitted because the information is not available. Horse owners, possessing increasing medical sophistication, want to know what is the best treatment for their horse. Clinical trials can provide the basis for sound, evidence-based advice on the therapy of heaves.
Reduction of Exposure to Organic Dusts:
The most logical way to prevent and treat heaves is to reduce exposure of the susceptible horse to organic dusts known to initiate airway inflammation. This was recognized as early as 1656 by Markham who noted that the best cure for heaves was green grass in the summer and hay sprinkled with water in the winter. Although there have been measurements of the amounts of dust and its components in hay, the clinical recommendations for the treatment of heaves have not changed much since 1656.
Measurements have been made of the dust levels to which horses are exposed and the dust content of different feeds and beddings. If hay is mouldy, dust levels in the breathing zone can be as high as 25 mg/m3. Better quality hay is associated with much lower dust levels but even these can be sufficient to induce airway obstruction in very susceptible individuals. The role of bedding in the induction of airway obstruction is not clear. Wood shavings are usually recommended for the treatment of heaves but these can be more dusty tham straw. Flax straw is a bedding with a lower dust content.
Improvements in lung function that result from reduction in dust exposure have been documented by several authors. Moving affected animals to pasture, bedding horses on shredded paper and feeding a cubed diet, feeding silage, and feeding a pelleted diet are all effective. It is essential to emphasize to horse owners that relatively brief exposures of susceptible horses to organic dusts can result in airway inflammation and hyperresponsiveness that can persist for days. Procedures such as bringing horses indoors for grooming or for overnight stabling will be sufficient to prevent the beneficial effects of keeping the horse at pasture. [...]
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