I have a horse with IAD (Inflammatory Airway Disease) / respiratory allergies. I had him scoped and it didn’t look terrible, just some inflammation. No mucus. I also had an allergy test done and he is highly allergic to dust, mold, some grasses, and a few other things/plants. So it’s crucial for him that his hay and environment is mold free. I also soak/wet his hay. This helps immensely.
When he has a flare up - coughs when starting work, or can tolerate walk, some trot, but coughs at the canter, I use a Flexineb. I out Pulmicort and Atrovent into it for inhalation. A steroid and brochodilator does the trick for him. I treat for 1 to 2 weeks daily before riding. I’ve used Dex before, and that was ok too. I will only use Dex in the nebulizer as the dose is very small and direct to the airway. This greatly lessens the laminitis risk that is associated with Dex.
I have used VentiPlus and other oral meds in the past that worked ok too. But the nebulizer is direct to the airway, he likes it, and I don’t have to worry about putting stuff in his food, him eating it, etc. He does get a “bronchial” liquid during a flare up/winter - Equistro Sekrosan
He can go months on end without needing meds. He seems to struggle a bit more in the winter/this time of year. It’s damp here, so there is probably some mold in the air or around.
But it is really important to take care of this now vs later. You do not want to deal with scars, as others mentioned.
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I think a good first step is soaking hay. A horse with COPD really can’t have dry hay anyway. What is your bedding? Mostly dust free? Is the horse outside? It is best for them to be/live outside… Out of a more enclosed and dusty stable environment.
Exercise is good as fitness usually helps the condition.