Calling anyone who’s dealt with (or is dealing with) respiratory issues! Particularly, a persistent cough

[StaceyA]

Hi everyone,

I’m hoping someone on here can help me. My main squeeze developed some respiratory issues this year, and can’t seem to shed the residual effects. Here is our story:

Early-August: mild cough began. Present only early in exercise (2-10 coughs). No other symptoms.

Mid-August: cough present at rest, constant during exercise. Yellow/green discharge from nose. No other symptoms. Our local vet was called, he was diagnosed with an upper respiratory infection and put on Uniprim for a week.

Late-August: mild cough early in work only.

Early-September: cough escalated. Uniprim again, 2 weeks this time. Also, an antihistamine tried.

Mid-September: mild cough SOMETIMES early in exercise.

Late-September: one big alarming coughing attack mid-workout. No other symptoms. I got a referral to go South to one of our bigger vet clinics. McKee-Pownell.

Early October: At Mckee we saw an internal medicine specialist and she performed a tracheal lavage cystology and a BALF. As well as a full physical exam. Results: two bacterial culture infections found (predominantly in the trachea), severe inflammation, and pneumonia.

Treatment:

1. Sputolysin
2. Excede injection into muscle, 2 doses given 96 hours apart.
3. Metronidazole tablets- 18 tablets, twice daily for 3 days.
4. Acetylcysteine nebulized in the morning for 5 days.
5. Excenel nebulized twice daily for 5 days.

Late October: mild cough early in exercise, sometimes while eating, no other symptoms.

Early November: Follow up- repeat of previous investigations. Results: no more infections, no more pneumonia, mild asthma and mild inflammation. Puffers prescribed and given twice daily for three days.

Mid-November- present day: mild cough early in exercise, sometimes while eating.

The cough is driving me NUTS. I want to do good by this horse, but what else can I do? The puffers aren’t doing anything about this cough.

I contacted the internal medicine specialist and she said that I have to take it all together, a cough is one thing but is there discharge? Is he struggling to breathe? Is there a roar? Answers are all no, just a cough. Local vet says I can keep throwing medicine at him if I want.

My coach and I are batting around ideas, would a supplement help? Is this a new normal? Is there anything new to his routine?

FAQ:

Hay - he’s on small square bales. I get them from the most reputable farmer in our area, he’s eaten the same hay from the same field his whole life. I feed in a hay optimizer in the morning, and he gets it soaked at night. I AM getting it tested, waiting for sample bags from U of G. Also, trying a new supplier in January. Just to see

Bedding- he’s on kiln-dried bedding, manufacturer is Top Bedding.

Turn-out: He lived outside 24/7 until October. Since there was no changes to his symptoms, he’s now outside dawn until dusk.

Allergies: There was no response to the antihistamine we tried earlier. If there was an environmental allergy vets said I would see a change in the behaviour as the seasons changed. No charge in symptoms was witnessed. The McKee vet didn’t think it was allergies.

Supplements: he currently gets msm and a probiotic.

Feed: He gets Jones 9158, beet pulp, finishing touch, and soaked alfalfa. I tried a process of elimination on all those as well, no change.

Does anyone have any ideas on how I can kick this cough? I’ve had an uncomfortable amount of people tell me, “my horse coughs, it’s normal. Especially in the beginning of a workout” but I don’t think it’s normal!

Tell me your stories.

[steelerino]

I had good luck with double dosing MSM. Particularly the Animed brand in the red tub.

[sascha]

First, I feel your pain and then some. I’ve battled “Mild IAD” diagnosed at OVC for three years now. Puffers were all pretty much garbage including the hated ASERVO pos device. I cannot say enough bad about it and I’m still mad I wasted money on that gong show of excellent marketing of a completely shite product, and all the usual cough treatments were equally useless.

I won’t know until either the next round of snot/coughing rears its ugly head or allergies get really bad next summer, but, and I am knocking on wood like a drummer in a rock band, it seems to be mostly under control right now, and for the past few months. I don’t believe this is just a fall/winter cyclical thing as I did not see this kind of improvement the 2 previous fall/winter changeovers.

There were 2 major changes before this seemingly lasting improvement. I went around my vet who was unwilling to do long-term ABX therapy and called in favours from everyone I could think of that might have access/on-hand drugs to “donate to the cause.” Ponypants was on about 2 months straight of Uniprim or SMZ or Excenel without a break - whatever drug I had she got with no break between.

Oh wait, maybe three changes, second was I nebulized the ever-loving crap out of her every day with Immuno-San until things seemed to have settled this fall.

Third thing was massive feed and supplement changes - zero grain. Nothing. All gone. Doubled the MSM, maxed the dose of spirulina (she is lucky I love her because that shit is nasty), added max dose of Jiaogulan given in 1/4 cup of soaked alfalfa pellets before turnout and about 20-30 minutes before evening exercise, added flax and W3 Oil.

Before we turned the corner, my vet’s office and I were desperately trying to track down 4% (preservative-free) lidocaine on this side of the border to try nebulizing that, but no dice, and for now I’ve given up. That may change next summer if she gets bad again.

Wish I could give you an actual hug. Dealing with this and all the expense and the scoping and waiting for BAL results and swab results and all of it is just so taxing emotionally, not to mention financially.

[NaturallyHappy]

You might consider asking your vet to ultrasound or radiograph the lungs, if that hasn’t been done. We had one develop EMPF (equine multinodular pulmonary fibrosis). His only symptom was weight loss. A very good veterinarian found it when she was ultrasounding his stomach. We were all shocked as he did not have a cough. Cough is a symptom. He did very well after treatment. I doubt that’s your problem ( and hope it isn’t) but it appears you’ve been spectacular about trying to figure this out. Others upthread have certainly provided great ideas. I hope those work.

[IPEsq]

Were the puffers bronchodilators or steroids? You might want steroids to knock down the residual inflammation. If you have a nebulizer, continue using it with saline also.

Friend’s horse has mild-moderate asthma and after getting some respiratory infection last year, they couldn’t get it under control until they nebulized steroids for a while. Usually horse maintains on antihistamines in season and saline. I think they also soaked his hay, which also helped some with irritation while eating (barn would not allow a steamer). And she had to stop using slow feed hay nets or feeders.

[Ghazzu]

What is a “hay optimizer”?
I would be soaking all the hay thoroughly.

[Gardenhorse]

Steamed hay was what helped my horse the most.

[hut-ho78]

I moved a horse into a barn environment after she been on pasture 24/7 her entire life. I think she was 6 then. She developed some allergies to dust, then picked up two normally harmless bacteria that live in hay and shavings. That kind of curdled her mucus from the allergies. She spiked a fever. We had to watch her for any signs of laminitis. The vet prescribed lots of penicillin and guaifenesin in a powder (great stuff-thins out mucus to help it drain). We moved her feed bucket lower, her hay was wetted and fed on the ground. Anything to get her head and neck in the grazing position to drain mucus and minimize dust. No more hayracks. It worked. In her 20s she showed a heave line though never really showed heaves. She lived into her 30s. Trail, little teeny jumps, took lower level dressage lessons. Good luck.

[Walk_N_Gal88]

My mama’s horse had a cough and yucky nose on and off for a month or two. when it didn’t go away on its own after a week (rapid weather changes initiated his, as usual), we started a new routine for him.

-He got fed in a bucket on the ground, instead of his wall- mounted bucket. We wanted a natural grazing position for proper drainage.
-He got Ani-Hist mixed in his feed along with some water to bind it to the feed.
-His hay got dropped on the ground in his stall instead of in his hay net. His hay did not get soaked as he refuses to eat it that way. Again, natural position for drainage.
-Bedding in his stall got changed to a fine blend that could be easily dampened while he was in there. I know, finer bedding sounds counterintuitive, but it worked for us. We could keep his stall cleaner because it was harder for him to bury his poop and the fine blend wetted down easier. So he didn’t breathe in as much dust.
-He was out as much as possible to keep him active and grazing. Again, natural drainage. I don’t think he got ridden much during this time either. He was only in his stall for feeding and daily checks unless it was raining hard.

Everything combined finally got the cough and yucky nose gone.

[StaceyA]

Hi everyone, wow! I admit I felt a little emotional reading the responses. I live in a small town and our horse community is very small. The only person I can bounce good ideas around with is my coach, so it can get a little lonely. It so nice to feel a little less alone.

@sascha was your horse casually coughing as well? What were they physically doing when they coughed?

@NaturallyHappy That’s a great idea, and one I’m going to look into. I did ask the respiratory vet about other explorations when he was down there for his follow up and she said having found the infection(s) and inflammation, she was confident we were on the right track. In retrospect, he has responded to the initial treatments. Would he have responded if it was EMPF? What’s the treatment for EMPF?

@IPEsq Inhaler one was an antispasmodic, Ipratropium Bromide, and administered 20 minutes before inhaler 2; which was Ciclesonide, a corticosteriod. I do have saline and I have been encouraged to use it. Which I have been. Do you know what saline does? All I know is that it nebulizes SO FAST, but I’m curious and never asked the vet!

Are slow feeders bad? I always assumed they were good because the horses can’t borrow into it.

@Ghazzu https://optimizer.systemequine.com/

I love it, so much less waste. But maybe the slow feeder isn’t ideal…

@Amberley Right now we’re buried in snow (no indoor) but we were riding on granite screenings. We just installed the ring this spring. I put 4 shoes on him and rode in the screenings all summer to let things settle, and will finish in sand in the spring. Could have been screenings dust?

Question for all. Is there a situation where a bacterial infection, leads to asthma, then leads to allergies?

Tentative plan of attack:
Trial #1 - I’ll start graining him on the ground. He’s currently only sometimes coughing when eating as he isn’t in work.
Trial #2 - Nebulize once daily with saline
Trial #3 - another round of steriods
Trial #4 - an antihistamine
Trail #5 - ultrasound

what do you think? Should I change the order?

I don’t want to turn into a helicopter parent. I keep a log and he’s coughed once (on a walk out to turnout) in the past 5 days. Maybe I do trail #1, take a victory if he stops but if he starts again when we go back into exercise in the new year I’ll run at it again.

I personally struggle with fretting and not taking a breath. He isn’t in distress, there’s no nasal discharge, recovery is good, breathing is normal.

Is there ever a situation where a cough is normal?

[sascha]

@StaceyA

was your horse casually coughing as well? What were they physically doing when they coughed?

Very, very occasional casual coughs during harvest/dusty ring riding. She actually went to OVC for noisy breathing and nothing showed up in her throat on any of the scopes so we went ahead and did a BAL which showed mild asthma. Putting her on puffers (brochodilators and steroids) brought on a cough about 15 minutes after treatment. Like clockwork. Ugh.

Carried on with all sorts of other treatments that did nothing for her. Meanwhile, she developed exercise intolerance and snot. Treated her for snot several times of the next couple of years and it was like an infection was there, would get knocked back (snot would go away, exercise intolerance would improve) and then it would come back.

When what I believe to be infections flared up, she would occasionally cough at rest, but it was almost always while working that it would get bad to the point last summer that there were days I couldn’t even do a walking only hack and on less awful days, could walk but not go up any hills without a coughing fit.

Never a heave line (knock on wood), and still no heave line. Her coughs were rarely that deep, deep body shaking cough that one might normally associate with ‘heaves’.

I have a question for you - did you use the Aservo inhaler for Ciclesonide, or were you able to source human/generic?

FWIW, I saw about zero difference using saline in the nebulizer. Immuno-San seemed to help somewhat and man it smells delicious, “Just lemme stand right under your snout as you exhale so I can get your exhaust ok?” “Mother. You. Are. Weird. But, ok. whatevs.”

Personally, I don’t think there is ever a situation where a cough is normal.

Your trial plan sounds pretty decent. That said, like I stated in my original post, I ended up going totally off course when nothing seemed to be working and took her off her allergy meds, all asthma meds, and hitting her hard with ABX, nebulizer, and pretty drastic feed and supplement changes. And, I still won’t know if any of it is really working/has worked until we’ve gone a few more months without an infection and then through next summer’s allergy season without a relapse. It’s so frustrating to not be able to get a solid answer and solid plan of attack despite having thrown a lot of time, money, and worry at it.

[StaceyA]

Your cough sounds very similar to mine. What did your exercise intolerance look like? Was it disruption due to excessive coughing, or breathing distress?

We’ve had no breathing distress.

One thing that has baffled everyone is his lack of any other symptoms. The only explanations the vet(s) have had is that he’s stoic. Dr.Cruz (respiratory vet) said it was the worst she’s ever seen.

Photo attached. right is the trachea infection, left is from the BAL.

Also attached a photo of him, so you all have a face to refer to

[sascha]

Sweet face <3

Exercise intolerance was, “I don’t wanna today” from a normally game in all weather horse coughing and panting (rapid breathing after short bits of exercise).

Our BALs did NOT look like that! It was basically clear fluid that came back out, both about 3 years ago at OVC and this past spring at home.

[StaceyA]

Yeah, it was pretty extreme. The first sample’s consistency was the worst. It looked like mayonnaise and they had an awful time sucking it out.

I forgot to respond to your inhaler question. They were the human/generic kind, from our local drug store. The most sticker shocked I had been through navigating this experience was when I picked up those inhalers.

[sascha]

The equine specific stupid Aservo one is even worse and the whole device is a gong show.

[NaturallyHappy]

Hi! EMPF is rare and if I remember correctly, is autoimmune. We (well, the brilliant vet) discovered it by accident as I mentioned. The treatment was valycylovir and dexamethazone. It worked very well for this horse. We lost him at 28 due to a strangulating lipoma. He had also developed DSLD and his owner was concerned about recovery if she did surgery, so she kindly sent him to Heaven. I don’t know if any other drug would make a difference in EMPF; I rather don’t think so.

[Bewildered]

Were the inhalers given for only 3 days? When I was going through my horse’s respiratory troubles, he was prescribed 2x a day for 2 weeks, 1x a day for 2 weeks, then every other day as needed. This was a bronchodialator and steroid 15min apart. Could be he needs more time with the puffers to knock the inflammation out.

DHEA/Omega 3 supplements have good research backing their efficacy for lung function. I didn’t see if you were feeding anything like that.

Mine maintains on daily Zyrtec and rarely need the inhalers anymore. None of his tests came back indicating allergies, so it was a bit of a surprise that it had such a big effect. I know you tried antihistamines, but maybe a different kind/medication will have a different effect.

[IPEsq]

Maybe you need to use fluticasone. Also, 3 days was probably not enough for the steroids.

My horse gets saline in his nebulizer. He has mild mast-cell IAD according to his BAL. I live in a very dry climate, and he’s also somewhat allergic to our general air (dust, pollution, smoke). The saline helps to give him a little bit of humidified air to breathe, and it also has a mucous thinning effect. He’s not an ideal candidate for steroids of any kind, and Zyrtec and saline seem to help him function ok. My friend’s horse had a more complicated BAL along with a structural abnormality in the upper airway, but he’d been doing ok on a similar routine until the infection. Something went through that barn, and he had an awful time with it and a really hard time getting back to normal after.

Perhaps your horse had some underlying mild IAD you didn’t know about? With my horse, he rarely ever coughed. Occasionally once or twice at the start of exercise. For him, very unusual. Mostly he had exercise intolerance, couldn’t get fir, didn’t wanna go or pooped out after 20 mins, and he got muscle sore everywhere especially when we had wildfires in the general area.

[hut-ho78]

Those samples look like what they pulled out of my horse when she was so sick (I posted upthread). I described it as curdled milk. Mayonnaise is a good description. I’m fascinated by the treatments available since my horse went through her trouble in the 1980s. I’m sorry everyone had to or is going through this. We were lucky with mine and figured out how to manage it. Best of luck to everyone.

[beau159]

My little suggestion might not mean much, considering the gammat of things you’ve tried with your horse with no result. But I have been super impressed this year when I put my horses on the CEP Daily Lung supplement. I did the pellet form. I put them on it for about a month in the spring and then I don’t think I appreciated what it did, because the runny noses and random coughs came back. I put them back on it in the fall and THEN I realized it was the supplement that was doing it.

And then I sold my Flexineb. Which didn’t do anything for either of mine. shrug

So if you get to a point with your horse where you are ready to try something in the form of the supplement, my vote would be for CEP daily lung.