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Exercise induced cough

Horse Care
#1

Will try to keep the short. Please know vet is fully involved but feeling unsure of his path…

homebred mare, healthy,shiny. Ridden on regular basis all year. Hacking and ring work. Last 2 years intermittent cough at start of ride. Never got worse and breathing was good at rest and sounded normal during exercise. I take regular jump lessons and she always had pep and cantered easily.

in work all winter and felt great. Lives out almost 24/7. In out of bad storms and hot buggy weather. Free choice hay, Just started night time pasture.

1 month ago ( early April) other horse came back to my farm from vet hospital for other issue. 7 days later my mare started coughing in barn when coming in for nap and grain. No fever. Did a walk hack and she coughed a bunch at walk.
Had vet out. He listened to her lungs and said sounded fine and breathing normal. Put her on dex for 2weeks. No coughing in barn but still coughing in paddock intermittently.
Back on dex for 3 more weeks. We just finished 1st week of 6cc im/ day will go down to 4cc next 7 days then to powder.

I have read that heaves is helped if horse is fit and in work. Rode her today and fine at walk but coughed trot 2 times then could really hear her breathing at canter. So stopped ride immediately. Vet said if virus it would have cleared up by now, so why is she still having trouble breathing and coughing more when trotting or cantering?
heaves, allergies other?

if dex were to help would you it have helped by now? Worried I can hear her breathing so easily and not sure where to go from here. Thinking just putting her on dex is not the right answer.

She is acting normal , bright eyed and alert.

#2

Considering the time of year, maybe seasonal allergies? My mare has them and I keep her on MSM and Ester C year round, and together they keep her cough free and breathing well.

#3

If it’s seasonal allergies is it okay to ride her to clear out her lungs or better to let her sit in field until allergy season passes?
I’ve started her on spirulina and Jiaogulan and flax but I know that will take awhile to kick in…

i know I have to ask my vet but he seems less worried than I do so just checking here for any input 😊

#4

This sounds like how my mare was acting before we diagnosed her with heaves. Many vets tried to tell me it was just allergies. I ended up switching vets and got them ultrasound her lungs, scope her lungs, and pull a BAL. my mare is the same way in that winter is much easier, but the heaves flares up with allergy season as well as humidity. She also had normal breathing most of the time when not in work, so the first vets threw out heaves immediately. My girl also did not respond well to oral steroids, I use inhalers and allergy medicine. I definitely would recommend looking further into heaves. If it ends up being heaves and you don’t treat it appropriately, you will scar the lungs and that deeply affects them in the long run.

if it’s heaves or allergies, working them helps. It expands the airways and allows for more airflow. If you feel too guilty working them mounted, a nice longe session can do a lot of good. Obviously you don’t want your horse to be completely out of breath, but I try to have my girl going to help get the coughing over with and to help extract any mucus that may be stuck in her airways. She always always gets better after a few minutes of coughing and working unless it’s a really really awful day (as in coughing fits in cross ties). Eventually, you will learn when it’s time to push and when it’s time to let them rest, but more often then not you need to push a bit.

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#5

I didn’t ride my mare while she had a constant wet cough–I waited till the C and MSM kicked in. I’d ask your vet.

#6

Freddo, do you use a nebuliser? Which allergy meds do you use?
She lives out and not sure I can change her environment much more if heaves. She’s not stuck inside a barn all night and I’m feeding her loose hay on ground, plus pasture. Riding on fields instead of sand ring but she still coughs when ridden in field. It’s so nerve racking! She’s only 8

#7

Ride. Riding is much better than longeing because you will be able to feel how your horse is doing. Is she less forward, or a little unbalanced, or rushing, or wanting to slow down.

Ride. Ride carefully and with great attention to her willingness to do more. How much trot before she wants to stop and catch her breath? Does the audible breathing change over the course of the ride? Does the need to cough reduce or increase? Is she happy and willing to go? Does her posture influence her cough or. breathing (long outline vs more upright, collected)?

Mine has heaves primarily affected by seasonal allergies, heat and humidity. He has had flares off winter hay. In the summer he gets 1-2 hydroxyzine capsules per day (2nd is added when the. humidity is high). He also gets Omega Alpha’s RespiFree which seems to help loosen any mucus and help him clear it. I keep Ventipulmin on hand for any bad flare ups.

Exercise through riding is the major management factor that keeps him breathing in the summer. He lets me know what he’s capable of doing and as the ride goes on his capability increases and the exercise naturally opens his airways. Yes, it’s a bit worrisome when they’re wheezing audibly which makes it super important for us to learn to feel how they’re doing and to trust that. The effects of exercise last as he is able to breathe more deeply hours after the ride.

When I see him breathing with a little, full-body jerk I know he needs to be ridden. I also count his breath rate and use that to determine the necessity for work on any given day. Counting after the ride and after his breathing has returned to resting rate gives me an idea of how well he’s doing on the day. Use of a stethoscope to listen to his lungs is another very useful monitor.

I did have my horse on Prednisone the first year his heaves showed up and it was very effective. The next year he started Prascend for his PPID and the Prednisone wasn’t as effective. I got him off the Prednisone for three years but an injury last year entirely removed exercise as an option so he went on Prednisolone for the summer ( in addition to the hydroxyzine and RespiFree) - which worked very well.

As heaves is a degenerative disease I do expect to have him on Prednisolone again at some point. I normally use the short time between ice/mud and too hot to get his cardio system fit. COVID-19 is hindering that critical regime this year and he may end up on Prednisolone again this summer. He’s fighting something right now that’s not responding the way his heaves do (possible brewing pneumonia) which isn’t helping either.
”‹”‹”‹”‹”‹either.

My horse is 22. We started treating his heaves when he was 16. So far he’s not lost any lung function. I have learned a lot about managing him.

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#8

Tufts has some good information on respiratory health, and there’s a free eBook you can download. https://equine.vet.tufts.edu/respiratory-health/

Has she been scoped or had a BAL?

My old gelding would periodically develop an exercise induced cough in the spring/early summer. Had him scoped twice over the years when it was really bad to rule out something like an entrapped epiglottis or guttural pouch issue, and also a BAL.

Long story short his cough seemed to correlate to really wet spring weather. Used Ventipulmin when it was really bad.

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#9

So for allergy meds my girl gets 10 Benadryl AM and PM. I tried hydroxizine and she didn’t do as well on it and Benadryl is cheaper. You have some room to trial and error antihistamines to see what your horse does best on. You’ll just want to note if any seem to make them sleepy or have any side effects.

For her inhaled Heaves meds she gets 5 puffs of an albuterol inhaler wait 20 minutes then 10 puffs of a fluticasone inhaler (Flovent). When we started the inhaled meds we did a week of a nebulizer with a steroid in it. Then did 10 days of both inhalers everyday, then 10 days of the albuterol every other day and the Flovent everyday. Then we bumped it down to just giving it before rides. I know that summer and fall she needs both before every ride but winter she sometimes doesn’t need them at all. 1-2x a year I’ll use the nebulizer and restart the whole process it she’s having a bad time with her breathing.

Some horses don’t need the inhalers and some vets don’t want to prescribe them because they’re expensive (I do have insider tips on getting them MUCH cheaper so if you’re willing to go down that path I can give you the tips) but I didn’t want to have to have my horse on oral steroids for the rest of her life. She was 20 at the time we diagnosed her and it didn’t seem right to have her on the oral ones. She also didn’t seem to improve too much breathing wise while on it (though she felt great movement wise!) Also something to consider if you do oral steroids forever, if your horse ever gets PPID you will have to totally change medicines and get a new plan.

A lot of figuring out a plan is trial and error and seeing what works for you horse. That goes for both the medicine side and the riding side. I know when my horse is having really really bad days (humid warm fall days) that those are days we do long walks. I know when her days seem bad but she just needs to work a bit to get the air flowing.

I was very stressed and anxious when I got the heaves diagnosis. It is absolutely manageable and you can definitely have your horse comfortable and in full work. I absolutely recommend having your vet pull a BAL and looking at the lungs (beyond listening) before stuffing your horse with any more steroids after your current round is over. It will give you an idea of any kind of damage you are already dealing with which is what will alter your expectations for your horse (if there is severe damage their lungs are not able to expand normally during hard work). Extreme damage is unlikely as you have been very on top of the coughing, but it is definitely something to be aware of.

As far as environmental changes, I would just lightly wet all the hay you feed. You don’t need to soak it as You aren’t removing the sugar, but lightly wetting it will remove some of the dust that they inhale when eating dry hay.

#10

Very interesting thread. I had my vet check my horse’s heart/lungs because in the past month he has started breathing much harder in work. To be fair, I am also suffering from allergies at this time of year, so it might be that. Tried him on oral antihistamines for a few weeks with zero change. His breathing does come back to normal pretty quickly, so my trainer thinks he is just working harder. He has always had a seasonal cough, and within a few minutes of trot work coughs twice and then he’s done.

But the heavier breathing is a new thing. Not that I’m any expert, but it does sound as if the effort is more nasal (?) and not so much in his body. No physical demonstration of heaves or symptoms of heaves that I can see. It seems to come on pretty quickly in trot and much more evident in canter, but his work ethic has not changed and there is no indication he is losing energy or slowing down because of it. He has never looked better in terms of fitness, and we have been raising the bar.

Any thoughts on next steps? Wait another month and see if it is allergies? As long as he is not affected in quality/energy of work, I am not sure what if anything would be recommended.

#11

Does he sound to be wheezing or is there any crackling in his breathing? When your vet listened to his lungs did he do a rebreathing exam with a plastic bag? If it’s just heavy breathing during work it doesn’t sound like heaves, unless there’s is any kind of wheeze or crackle to his breathing.

#12

thank you so much for all this information. I will definitely have vet do more diagnostics after the dex and before doing anything else.
Another question, in your opinion if they sound wheezy at canter do you keep cantering to help clear lungs or go back to slower work? She will keep going but I’ve been stopping her as the sound makes me so uncomfortable!

The inhalers that you speak of are they used with tha nebulizer ? Trying to figure out if i have to invest in one. Or are they a separate thing?

#13

I would push her a little bit. So when I feel my girl is a bit wheezy, I will push and make sure she isn’t getting worse. If she’s getting worse we have a walk break and maybe reevaluate my plan for the day, but if it’s getting better or staying the same I will go about my normal work plan. However, in your case that call may be a bit harder to make until you know if it’s heaves. When I was waiting to get my girls diagnosis I gave her lighter rides just in case it wasn’t heaves. A lot of working with respiratory issues is just making sure that they’re comfortable. While working can make them feel better for the rest of the day, you have to be careful about overdoing it so they don’t get in distress.

The inhalers are regular human inhalers that can attach to a nebulizer, but I decided not to buy one as I don’t need it enough to justify the cost. And I have the benefit that I can rent a flexneb any time I need it from my vet. Instead of using the inhalers with a nebulizer, I use an equine aerosol chamber.
Specifically this one: https://www.amazon.com/AEROHIPPUS-Equine-Aerosol-Chamber-Inhalers/dp/B00YHZSCWW/ref=mp_s_a_1_3?dchild=1&keywords=equine+inhaler&qid=1588765898&sprefix=equine+inhaler&sr=8-3
I’ve had it for about 3 years and it’s still holding up nicely.

#14

Sounds like inflammatory airway disease should be explored. IAD is not heaves.

#15

By explored is doing lung ultrasound and bal adequate to confirm iad diagnosis? Or am I missing something?

#16

Performing a BAL will give you the answer as to what it is.

#17

Thanks again! I’ve never owned a horse with breathing issues and I grew up on a horse farm! So this is all new to me.
appreciate everyone’s feedback.

#18

I was able to find the vet report to give you an idea of the respiratory evaluation process in a clinic.

I had brought him in to our local University for a shockwave treatment and mentioned his cough (I had already had my vet out and we did a couple of courses of dex.)

They were able to get him in with internal medicine for respiratory evaluation including a scope/BAL while he was there. After this we did another course of dex and also Ventipulmin. The cough resolved itself mid-summer.

[I]"While at the Equine Center, Jupiter was evaluated by the Internal Medicine Service for a chronic cough of
approximately one month’s duration. As a 3-year-old Jupiter experienced a persistent cough that responded
to therapy with antibiotics, corticosteroids, and allergy shots. The cough resolved and no further symptoms
were noted until this summer.

He has been treated with two tapering courses of dexamethasone, but only slight improvement has been noted. Aside from the cough Jupiter seems normal; he has remained bright with an excellent appetite throughout, with no evidence of fever or infection. Jupiter lives outside full-time and eats small square hay bales that are not dusty or moldy. The owner reported that she did not hear any coughing today, so his condition may be improving.

Physical exam was within normal limits; no cough was noted, nor could one be elicited with tracheal
compression. A re-breathing exam revealed occasional mild wheezes and fine crackles in the lower front
region of his lungs. Endoscopic examination of his nasal passages, pharynx, and larynx was performed
under sedation (shockwave was performed immediately prior) and revealed no visible abnormalities and
normal dynamic function. There was no evidence of infection, foreign body, inflammation or pharyngeal
hyperplasia.

However, Jupiter did cough extensively as the endoscope was advanced near his larynx, suggesting that his throat may be irritated and hyper-reactive. His trachea and bronchi appeared normal, with no significant exudate or mucus.

A bronchoalveolar lavage (BAL) was performed to look for inflammation within the small airways deep within his lungs. The only abnormality noted on cytological evaluation of the fluid collected was a slight increase in the proportion of mast cells (4%; normally less than 3%). This cell type plays a role in allergic and inflammatory responses within the lung. Since the increase was very slight, the significance of this finding is unclear.

In view of the mild wheezes and crackles heard in Jupiter’s lungs, however, it is possible that his cough is the result of mild case of inflammatory airway disease characterized by increased numbers of mast cells. Alternatively, he may be recovering from a recent viral or bacterial infection with residual airway hyper-reactivity.

In view of the recent improvement in Jupiter’s cough, we recommend that you monitor the cough while continuing to soak his hay prior to feeding. In addition, avoid exposure to dust where possible.

If it persists, Jupiter may benefit from medications for inflammatory airway disease (dexamethasone, and possibly a
bronchodilator such as Ventipulmin)."[/I]

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#19

I second all of this, very similar experience with my mare. My vet said the work helps as long as you’re not pushing them to the point of coughing fits, and I do find this to be true. If my mare sits too long, the next time I bring her out is worse. I tend to tailor her work to what she can do comfortably that day, some days its more some days it’s less. You’ll learn to read those signs as it sounds like you’re already doing.

I’d also just add that getting ahead of allergies is key. My mare has had them for several years now so I know when I need to start her antihistamines (typically early March here). One year I didn’t start early enough and she got really bad, and I had to go to steroids (prednisolone) to get under control. My vet says antihistamines don’t help as much once the body is already overreacting, so just FYI.

#20

My one mare had a similar condition, it was reaction to a bad haybale that caused a lung infection that was mild and hung around for some time. We did Dex and the expulsion drug I can’t remember what its called, but it makes the mucus leave the body. The dex cleared her 100% she recovered fully.

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