EQUUS - - Eq Conversati­ons -

us­ing steroids, and cer­tainly if you have a horse that has foundered pre­vi­ously, there is more risk. But oth­er­wise it is a very safe drug. I’ve had many horses on dex­am­etha­sone over the years and have yet to see one founder. We usu­ally treat them for four or five days with a high dose, to give re­lief and get them com­fort­able quickly. Then I switch them to oral pred­nisolone, and the dose can be de­creased over time.”

The cor­ti­cos­teroids are avail­able in in­haled as well as oral or in­jectable forms; clen­buterol is avail­able as an oral syrup; ipra­t­ropium must be in­haled. The oral and in­jectable med­i­ca­tions tend to be cheaper and eas­ier to ad­min­is­ter. In­haled med­i­ca­tions re­quire the use of a de­vice—ei­ther a neb­u­lizer or an in­haler and mask—that cov­ers one or both of a horse’s nos­trils; when a va­por­ized form of the drug is in­serted into the de­vice, the horse breathes it in. Two gen­eral types of neb­u­liz­ers and in­halers are avail­able on the mar­ket (see “Breath­ing It In,” page 48). Typ­i­cally, a horse might need to be ac­cli­mated to the mask and the process.

“The aerosolize­d bron­chodila­tors seem to work more quickly than the oral med­i­ca­tion,” says John­son. “An aerosolize­d bron­chodila­tor has been shown to im­prove lung func­tion sig­nif­i­cantly within about five min­utes, and the oral drugs can’t act that quickly.”

Steroids in pill form are of­ten pre­scribed but they are also avail­able in an in­haled form. “Dex­am­etha­sone works very well in a neb­u­lizer, but the prob­lem is that it is also well ab­sorbed in the lungs, so if you are wor­ried about lamini­tis, the risk is no dif­fer­ent than giv­ing it in the vein or giv­ing it orally. It doesn’t really de­crease the side ef­fects,” says Cou­etil, who prefers in­tra­venous use for acute episodes of RAO. “If a horse is in cri­sis, hav­ing a hard time breath­ing, there is noth­ing bet­ter than IV dex­am­etha­sone to give re­lief. It will give the quick­est re­sponse.”

An­other cor­ti­cos­teroid that can be used with an in­haler is flu­ti­ca­s­one. “This is a hu­man drug and ex­pen­sive, but works very well,” says Vir­ginia Buech­ner-Maxwell, DVM, MS, DACVIM, of the Vir­ginia–Mary­land Re­gional Col­lege of Ve­teri­nary Medicine in Blacks­burg, Vir­ginia. “I’ve used it in my own horses, and it’s a safe and ef­fec­tive way to con­trol heaves with­out ex­pos­ing their whole body to high lev­els of cor­ti­cos­teroids.” Stud­ies that have com­pared the “whole body” ef­fect of ad­min­is­ter­ing ei­ther oral pred­nisolone or in­haled flu­ti­ca­s­one to RAO horses have shown that in­haled flu­ti­ca­s­one is very ef­fec­tive with fewer side ef­fects when com­pared to med­i­ca­tions like oral pred­nisolone. If the cost is within the owner’s bud­get, pro­vid­ing in­haled flu­ti­ca­s­one is a safer long-term treat­ment op­tion for RAO horses.

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