Equine Heaves/Equine COPD
IS THIS YOUR HORSE?
Rapid respiratory rate, coughing, nasal discharge, stressed, can’t breathe right so can’t ride.
Equine Heaves/Equine COPD – Full Article
Equine Heaves/Equine COPD – Diagnosis
Equine Heaves/Equine COPD – Aerosols
Equine Heaves/Equine COPD – Management
Equine Heaves/Equine COPD – Attacks
Equine Heaves/Equine COPD – Weight Loss
Equine Heaves/Equine COPD – Airway
Equine Heaves/Equine COPD – Why Vitamin E Can Help
Equine Heaves/Equine COPD – Prognosis
A. Many Names for the Same Airway Problem:
1. Equine Heaves/Equine COPD has many names for the same condition:
Equine Recurrent Airway Obstruction (RAO)
Equine Small Airway Inflammatory Disease (SAID)
Equine Allergic Airway
Equine Chronic Obstructive Pulmonary Disease (COPD)
2. Equine Heaves/Equine COPD is different from human asthma in that in humans, as they get older, signs diminish, but in horses, as they age, signs increase. Average age of a horse starting to show signs of Heaves is 8-10 years old. There is no “childhood” Heaves that they grow out of like in people.
3. Equine Heaves/Equine COPD is worldwide with usual onset at 8-10 years old with both sexes equally affected. It can effect any breed equally.
B. Diagnosis of Equine Heaves/Equine COPD
1. First of all, there are 2 forms of Equine Heaves/Equine COPD:
a. Year Round – In winter and spring, signs seen more strongly, but struggles all year. Horse can get problems with 3 inches of snow on the ground.
b. Summer Heaves – also known as pasture-associated Heaves – trees, grasses blooming, and horse starts showing signs. Seen more strongly in early summer and early fall (leaves dying so allergens up). In winter is normal.
2. Stages of Equine Heaves/Equine COPD
a. Early Stage:
1. Exercise intolerance at end of race, end of trail ride when did not have problem prior. No energy at the end of the ride and seems to get worse with time.
2. Coughing more.
3. No fever, blood work all normal, looks healthy. Cultures for bacteria are negative.
4. Mild nasal discharge but very watery, thin mucus – not yellow, green.
5. Breathes about two times the normal rate at 24-30 times a minute.
6. Reactions to vaccines more often than other horses – probably due to hypersensitive immune system.
7. Many horses with skin allergic conditions like hives from bites or Equine Summer Eczema appear to be more prone to Equine Heaves.
b. Chronic Stage (Often called Heaves or COPD)
1. Exercise ability much less – can overheat, exhausted due to so much energy used to breath.
2. Coughs more and more.
3. No fever, blood work normal, but mucus is a good media for bacteria to grow in, so mild lung infections on top of mucus of Heaves. Antibiotics help a little but never clear up cough or nasal discharge. Sometimes nasal discharge colored but usually just large amounts of clear, thin mucus.
4. Even at rest is “puffing” just like ran Kentucky Derby.
5. Weight loss – Click here for in depth information on weight loss in Equine Heaves/Equine COPD .
6. Grunt – exaggerated exhale – trying to force air out of airway. Also, will see exhale, and then exhale again – a double exhale later on. Finally, see a line along the rib cage of hypertrophied muscle – “Heave Line” from this constant forceful exhaling.
7. Condition worsens when exposed to allergens – hay/bedding. Worse when indoors due to higher counts of allergens. Worse with round bales in the field due to higher allergens. Horse Heaves also worsens in humid/hot weather – above 80% humidity, cases will increase. Many horses are already too hot from strenuous exercise of breathing too hard and hot weather on top makes it worse.
8. Scoping – “Excess neutrophils seen on cytology and confirm presence of lower airway ROA” – Dr. House, AAEP. In most cases of allergic airway in other animals, mast cells and eosinophils are seen, but in horses it is neutrophils. Dr. Lavole, University of Montreal Equine Professor, Geneva Conf. 2009.
9. Chest X-rays/Ultrasound – May see lung changes but tests are not specific enough to diagnose Equine Heaves/Equine COPD.
10. Heredity – “Incidences of ROA in horses with healthy parents is approximately 10% which increases to 44% if two parents are affected.” Dr. House, AAEP.
11. Age – Average horse, according to literature, is between 9-12 years old, but we have seen cases much earlier (5-7 years old).
12. “Skin tests do not predict allergens that will cause Heaves.” Dr. Robinson, Michigan State University College of Veterinary Medicine, July 2012, Veterinary News.
C. Aerosols (Inhalers) in Equine Heaves/Equine COPD.
1. There are pieces of equipment that go over your horse’s nose or are placed up to a nostril in order to apply inhalers. These are special order items that are an expense to you.
2. Your doctor may ask you to have some for daily use, some for possible emergency use – there are three main types:
a. Steroids – “Fluticasone inhaler after induction of severe Heaves resulted in complete resolution of clinical signs, normalization of pulmonary function tests and significant decrease in BAL neutrophils.” Dr. Giguere, University of Florida Veterinary School., Vet Immunopath, 2002.
c. Mast cell stabilizers.
3. It is extremely important to get the right inhaler – there are two types and if you get the wrong type it will not go one (1) inch up your horse’s nose and just cost a lot of money.
a. Aerosolized – for horses
b. Diskus powder – requires strong inhalation – not for horses.
4. Inhaler steroids have the advantage of sending medications right to the problem area of the airway without having to treat the whole body as in oral or IV meds. This allows a lower dose of steroid to be used.
5. Cost of inhalers is an important subject – need to look at prior to buying equipment. 8/2013 – CVS Pharmacy.
a. Advair (steroid/bronchodilator mix) – $348.99
b. Albuterol – $54.99
c. Steroid (Flovent) – $158.99
Veterinarians have advocated 8-12 puffs a day of Fluticasone for 2 weeks then go to every other day – so you can go through two of the Flovents in less than 3 weeks at the cost of over $300.00. Yearly use runs over $2500.00 for just the Flovent Steroids.
6. For most owners, the cost and labor of doing this on a daily basis is too much – a great concept but difficult in the usual world of horse owners.
D. Equine Heaves/Equine COPD Management and Treatment – Why Thyroid Powder Can Help
The Goal is to lower the amount of exposure to allergens (hay, bedding, mold, dust). Dust is not just powdered dirt – it contains many items such as bacteria, mold, organic plant allergens like hay, straw, endotoxins, and is called “organic dust”.
1. Eating hay outside/soaking hay if possible.
a. Horses, even on inhalers given daily, still had lung inflammation when fed hay indoors, but “once moved outside, the horse’s lung function continued to improve and inflammation resolved”. Dr. LeClare, University of Montreal, The Horse, 2013.
b. Hay outside can further be managed to lower allergens.
• Soak hay 10 minutes prior to feeding in a Rubbermaid container. Do not use flakes of hay to soak. First must tear up flakes into loose hay, then vigorously shake out hay to lower dust, then place in a hay net, then put in tub to soak with a brick on top.
• “No additional benefit from prolonged soaking. We found immersing hay until thoroughly wet had virtually the same effect as 16 hours soaking.” (on particle count) Dr. Pirie, Vet Sci Res., 2007 Click here to see Dr. Pirie’s abstract.
• Colder weather or boarding – may not have the ability to soak. Still take hay outside (do not do in the shed row) and tear up the flakes, shake out the dust, then bring back in if in the stall or leave outside in the field.
• “Soaked hay reduced respiratory particle number by 60%.” Dr. Clements, University of Edinburgh.
• Round bales have more allergens and can really be a problem in horses even on full turn out. “Round bales high in endotoxin and organic dust content and prevalence of round bales is potential cause of treatment failure in horses on pasture.” Dr. House, AAEP.
2. Bedding: (#2 cause of Horse Heaves)
• Fluffy pine shavings is the best bedding for horses with Heaves. NO Sawdust. NO wood pellets (too dusty) NO straw, even clean straw. Full of allergens. The worst bedding possible in COPD horses.
• 20 times less dust particles with shavings versus straw. Click here to see article on Dust Concentrations in Equine Stables.
3. Medicines (Click Here for Aerosols in separate section)
a. Oral Bronchodilators – Ventipulmin Syrup is given to open airways and lower spasms. Often, riders will give the 1-3 days on trail/shows (unsanctioned shows) – two times per day.
I. Note: After 5 days of continual use, this medication down regulates – its action stops or slows, so giving Ventipulmin for weeks/months in a row is a waste of time/money.
• “Regular use of Beta-Agonists leads to tolerance to their bronchodilator effects.” Dr. Sarah Haney. Click here to read Dr. Haney’s article in Respiratory Medicine 2004.
• “It is inappropriate to treat heaves with bronchodilators as solo therapy. Bronchodilators do not address underlying inflammatory problem and tolerance develops rapidly to Beta-Agonists (5 days) when administered along to horses with heaves.” Dr. Rush’s book. Equine Respiratory Diseases, 2004, page 193, Kansas State Veterinary School.
II. Clenbuterol (Ventipulmin): USE WITH CAUTION IN INSULIN RESISTANT AND PAST LAMINITIS CASES.
1. Bronchodilator will increase Insulin in horses.
“Insulin levels were higher in the group that received Clenbuterol.”
Click here for article by Dr. Ferraz, J. of Equine Veterinary Science.
2. Human study showed it had profound effect on raising Insulin.
“Raised serum glucose by 174% and Insulin to 379% of control.”
Over three times the control! Within 30 minutes of administering.
Click here for article by Dr. Edwards, Life Sciences
3. “Clenbuterol and exercise decreased blood volume by an average of 10% resulting in a DECREASE of aerobic performance.”
Click here for article by Dr. Kearns, Med. Science Sports Exercise. So when on it, take it easy on the horse.
Dr. Reilly Comment: Good for short-term use of no more then 5 days in a row. I have seen an Insulin Resistant pony being controlled on Insulin for years, flip into Laminitis after on Clenbuterol for 30+ days in a row.
b. Oral Antihistamines, NSAIDS (Bute, Banamine)
•”NSAIDS/Antihistamines have failed to demonstrate therapeutic benefit in horses with Heaves“. Dr. Rush, Kansas State Veterinary School.
•Many owners try them and most report little help. Even IV antihistamines in our practice do little.
c. Antibiotics – The mucus accumulating in the airway is ripe to grow bacteria, so the horse can get a mild lung infection and horse Heaves together.
• Naxcel is recommended in these cases. Dr. Orsini, 1998 Manual of Equine Emergency.
d. Oral Steroids – Prednisolone used in Equine Heaves/Equine COPD can be effective short term (1-3 weeks). Care must be given for long use in Equine Cushings or Equine Insulin Resistant horses due to Laminitis issues.
e. Omegas for Horses with Heaves/COPD Airway Problems. – Proved to help your horse. There are many sources of Omega’s for your horse.
• Ground Flax Seed – need to grind. Click to see a whole section on Flax Seed – #1 source of Omega 3’s in plants. Great 4:1 ratio of Omega 3 to Omega 6. Good for Insulin Resistance and COPD horses. Flax Information, How to Give, Best Types.
• Whole Chia Seed – #2 source of Omega 3’s in plants. Good for Insulin Resistance and COPD horses. Great 3:1 ratio of Omega 3 to Omega 6. Give 2 Tablespoons a day.
“Clinical improvement was noted in all horses involved in group receiving Omega 3’s. Cough score improved 60%. Respiratory effort decreased 48%.” Dr. Nogradi, 2015, J of Vet Internal Medicine. Click here for article on Omega-3 Supplementation helping COPD.
4. Stall Management
a. “What we know for certain about Heaves is that in many horses it is precipitated by stabling.” Dr. Robinson, Michigan State Veterinary School, DVM magazine, 2012.
b. Ammonia from urine is an airway irritant which can lead to more mucus accumulating – so less air flow. Sweet PDZ powder put on the stall floor after mucking is helpful.
• Study shows partial mucking still creates the least amount of ammonia production over a complete mucking or no mucking. Dr. Fleming, University of Minnesota, J. Am Sci, 2012. The more you churn the stall up, the more ammonia, so light picking out of manure and wet spots is best. The worst choice is no mucking.
c. Shavings/shredded newspaper/cardboard has less allergens than straw. Straw is a problem.
d. Increase ventilation to reduce particle exposure.
• Attic Fan in Barn
• Turnout more
• Stall with window for air flow
• Stall with fan for fresh air
• Stall at the end of barn – more air flow
• Higher ceiling in barn – more flow
• No hay/stray in loft – showers all the allergens down
• No tossing hay down from loft into stall aisle
• Cobweb Barn – spider webs full of dust
• If stacks of hay in the aisle or a stall, move Heave horse to other end
• Keep horses in barn or turn out away from dusty road
• Use fly spray – horses inside or outside create dust from stomping. Click here to see top-rated fly spray in the USA.
e. Clean stalls when the horse is not in the barn – you kick up lots of dust picking out stalls. You are kicking up dust when sweeping aisle. You kick up lots of dust even cleaning stall next to a Heave horse. Mold grows in the bedding.
• 19 times more respiratory particles when stall is being mucked out. Dr. Clements, University of Edinburgh.
Outdoor sheds need to be free of allergens
• Use shavings, pea gravel, or mats to keep dirt down. Avoid stone dust.
• Clean out sheds regularly. Old, dry manure kicked around no good.
• Broom out cobwebs that hold dust.
f. Hay Management
• Tear flakes apart outside barn, shake out really good to reduce dust, put in hay bag, soak for 15 minutes. If winter or not able to soak, still tear up and shake flakes.
• Baled hay density is 8 pounds/cubic foot versus 4 pounds/cubic foot in loose hay – let air get to it. Pennsylvania State Dept. of Agriculture, 2009.
•”Inflammation occurs in lungs within 6-8 hours when brought in from pasture into the barn.” University of Kentucky, College of Agriculture.
g. Pelleted feed has less dust, so use these.
h. Most horses do not do well on just hay cubes and pellets. They need hay, but you can reduce the hay amount from 20 pounds a day (2% body weight in hay in 1000 pound horse) to 15 pounds of hay and 5 pounds of cubes/pellets, to help reduce allergen load.
i. Ponies – they are lower to the ground so are going to inhale larger number of allergens if bedding/management is not good. Open stall doors, apply webbings so air flow is better.
j. Click here for University of Kentucky Equine Department article on Management of Horse Heaves.
5. Keep these Heave horses away from dusty roads.
6. In trail riding, keep up front – don’t eat the dust of 10 horses ahead of you.
7. Keep blankets clean – if full of dust/dirt are following horse all day.
8. Traveling – bring your own shavings so not at mercy of barn arriving at. Get windowed stall, get at end of barn, bring your fan.
9. Turned out or in stall use fly spray – stomping feet kicks up lots of dust. Click here to see top-rated fly spray in the country!
E. Sudden/Dramatic Equine Heave/Equine COPD Attack Crisis
This information on Equine Heave Attack Crisis is only on our site – Original Case Management
At times, a large antigenic load may severely compromise your horse’s ability to breathe. I have been called out on cases to see a horse for the first time on an emergency that was staggering around from not getting enough air and with mucus membranes on his gums the color of mud.
Hank was in crisis but in five minutes was a lot more comfortable and his breathing rate was reduced significantly after IV medications.
As an owner, you need to know:
1. Prednisolone Tablets and Clenbuterol (Ventipulmin syrup) will not help these horses in severe crisis – do not try to ride out the storm with these medications.
2. Get them in the shade, hose off with cold water, and then scrape off excess water. Many are half in heat exhaustion from laboring to breath. Repeat this every 15 minutes until Vet comes.
3. Get horse out of the barn. If it falls down, it is easier to work with in the field near the barn, and the barn is full of possible allergen triggers.
4. Do not feed any hay/grain – we need airway clear. Wash out mouth with water. Can allow him to drink if the horse wants.
5. If there is a lot of mucus in nostrils, wipe it out with paper towels. Will help airflow.
6. Stand still – do not keep walking around. Want quiet, calm. Keep in an area by himself. Do not want other horses poking at him.
7. If they go down, do not panic. All our cases of Heave attacks that were down, recovered well because we got there within 30-45 minutes of being called.
8. Your doctor may direct you to use aerosol inhalers for your horse prior to their arrival, but often people do not have these or the inhalers are all used up with no puffs left.
9. Your doctor may need to give oral or IV fluids if your horse is exhausted. Just because breathing is better, does not mean all is ok. Often, these horses get impaction colics 1-2 days later due to lack of water intake prior to Heave attack. We may give Banamine the day of a Heave attack but no more after that due to Banamine can slow gut motility when given many days in a row. We need to see normal manure production within a day of a Heave attack or may need another tubing of fluids.
10. Look around – what triggered attack? Probably hay or bedding. Bring in new hay from neighbor and strip out stall bedding if the horse was in the stall in the last 24 hours.
11. Steroids IV in Equine Cushings or Equine Insulin Resistance horses – We had several horses with these conditions get Heave attacks and, in a crisis, these medications are needed. Low dose Dexamethasone or Solu-delta Cortef did not trigger any Laminitis events in these horses.
12. Start Heave Ho Program.
F. Weight Loss in Equine Heaves/Equine COPD
1. Extreme/moderate labored breathing overcomes horses need for food and water. They are too busy trying to catch their breath.
2. The labor of breathing more times a minute and trying to exhale stronger burns tremendous calories.
3. Exhaustion – your horse is so tired, they just lay down more and skip food and water.
4. Coughing is exhausting – it also burns tremendous amounts of calories.
5. Coughing can irritate the upper airways making swallowing painful.
6. Are on drugs that knock down their appetite.
7. Stressed, so higher cortisol which leads to tissues being broken down.
8. Helpful hint in older horses or horses with teeth problems:
• Total immersion of hay for 10 minutes can increase water content of hay from 10% to 50%. This water increase can provide 10-20% of water needs and cut down on impactions. In older people, saliva can drop 50%, so in older horses soaked hay helps in chewing, swallowing, and nutritional access.
9. Older Cushings horses have higher ACTH, Cortisol hormones, and on Pergolide that all lead to some weight loss that layers on top of Equine Heaves/Equine COPD.
G. What happens to your horses airway in Equine Heaves/Equine COPD?
1. Your horse reacts to a level of stimuli from allergens that do not effect normal horses.
• “Hyper-responsiveness to allergen for even a brief time and its effects can last for days.” University of Kentucky, College of Ag.
• Even if remove offending cause, may still be effected in their airway days later.
• Hay and straw bedding are the usual allergens leading to Equine Heaves/Equine COPD. “Most common environmental entity precipitating an episode of airway obstruction in Heaves affected horses is organic dust of hay and straw.” Dr. Rush, Kansas State UNiversity, Equine Respiratory Disease, 2004.
2. Three things occur after exposure:
a. Constriction of airways – walls of airway become smaller so imagine breathing through a garden hose and then breathing through a straw.
b. Mucus accumulates in airway paths – this further blocks air flow. Imagine your horse sipping water through a straw and then having to sip pudding – extra effort.
c. Airway spasms – an already narrowed airway becomes super narrow as spasms further reduce airflow.
See above how the area of airflow is less and mucus debris further blocks air. Picture by Dr. Laurent Viel, University of Guelph.
Click here to see a Real World Story how Heave Ho/Health E Helped a Horse.
H. Vitamin E can help with Equine Heaves/Equine COPD
Heave Ho has high dose Vitamin E – 5784 IU in each scoop – Rated #1 in highest levels. Vitamin E in horses is proven to increase immunity to help decrease chronic and constant lung infections. This can cut back on snotty noses, constant antibiotics of secondary bacterial infections. The Vitamin E has also been proven in horses to increase immunity via immunoglobulin protection increased.
Click below on Science Articles on Why Vitamin E helps COPD:
1. Blood Vitamin E levels lower in COPD. See Dr. Hanson’s 2016 below.
2. Supplementing with Vitamin E improved breathing components. “Positive association with dietary Vitamin E intake and lung function.” Tocopherol Levels in Lung Function, C. Hanson
3. “Vitamin E may be beneficial in the prevention and treatment of harmful effects of COPD.” Oxidative Stress of COPD Lowers Vitamin E, T. Tug
4. “Vitamin E supplements decreased DNA damage to white blood cells.” Long-Term Vitamin E Supplementation helps COPD, TC Wu
5. Patients on Vitamin E had greater lung capacity and produced less phlegm. Vitamin E Helps Reduce Phlegm of COPD, Y. Kelly
6. Long-term regular use of Vitamin E may help decrease risk of COPD. Increased Vitamin E Prevents COPD, American Thoracic Society
1. Heave Ho Powder: 2 Scoop AM and 1 Scoop PM for 7 day, Then 1 Scoop a day. 1 Container has 30 Servings.
2. Click here to see other steps you can take to also help your horse through the management of the environment.
Click here for full-size version of Heave Ho Powder Bottle
1. “Depending on the clinical signs, severity of ROA, horses with this condition can be managed successfully for much if not most of their lives. Many of these horses are able to be excellent pleasure, trail riding, and even competition horses with dedicated owners that understand it is a chronic condition that will require life-long management.” Dr. A. House, AAEP.
2. Combining management with Equine Heave Ho Oral Therapy helps you be able to continue to enjoy your horse in many activities.
3. Many people have airway allergy issues and know that with daily, diligent care, can do very well.
4. Medicines and supplements are not going to work unless changes to the environment are done at the same time.
Equine Heave Ho Oral Supplement is to help maintain horse health and is part of a comprehensive program. This product is not intended to diagnose, treat, cure, or prevent disease.