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Recurrent airway obstruction (RAO), also known as equine asthma, is a condition that can affect all types of horses and ponies. It is progressive and chronic in nature and can become a lifelong condition that must be managed with long-term husbandry changes and therapeutic help. RAO develops as a response to allergens which cause inflammation and thickening of the airways and ultimately airway obstruction. Typically horses can “flare up” in the summer in response to pollens, but RAO can also be a year-round problem for many horses react to the allergens in dust, mould and other irritant airborne particles.

Signs of RAO

• Increased respiratory rate
• Abdominal effort while breathing
• Visible heave line
• Flared nostrils
• Reduced exercise tolerance and poor performance
• Cough

The signs of RAO may start as mild changes such as coughing at the beginning of exercise or the onset of poor performance. It is important to notice subtle changes as the earlier the condition is noticed and managed, the better the long term prognosis.

RAO treatment and management

Controlling the horse’s environment to reduce exposure to allergens plays a vital role in managing the condition. Identifying which allergen the horse is reacting to is an important first step, as it is necessary to reduce the horse’s exposure to the trigger allergen or allergens as much as possible. Other husbandry changes include changing the bedding to a dust-free variant, soaking or steaming hay and ensuring optimal ventilation within the stable. It may also be necessary to relocate the horse to another pasture depending on the external triggers – for example some horses are affected by rapeseed so if their paddock is close to a rapeseed field, moving paddocks during these months can help to control their RAO.

Management changes are a key component in managing RAO, but sometimes these changes alone are not always enough to alleviate the signs and restore performance. In these instances, further treatment is needed, and your vet will advise as to which options are most appropriate. It is important to seek veterinary advice as soon as possible as early intervention and prompt treatment can reverse some of the changes within the lungs. Without timely treatment, RAO can progress to a chronic condition.

How does nebulisation work?

Nebulisation is a very effective means of delivering prescribed medication directly to where it’s needed in the lungs and lower airways. It’s administered in a very similar way to when treating humans, whereby medication is mixed with saline and inhaled. Nebulisers are typically used for short sessions, so the treatment can be given while you’re grooming or mucking out.

Nebulisation reduces the risk of side effects that may be associated with systemic medication, which works throughout the body. Most nebulisers are also easy to use and well tolerated by horses. Once the nebuliser is correctly positioned, horses breathe normally and there is no need to synchronise giving medications when the horse inhales.

What is Flexineb?

Flexineb is a nebuliser that delivers targeted medication to the lungs and lower airways in as little as five minutes. It works silently, which makes it ideal for sensitive horses. It is lightweight, compact and battery powered, so you can use it wherever you need it, and you can get up to three hours use from a single charge.

The Flexineb is available in three sizes – fitting all horses from foals to heavy horses – to ensure a good seal.

For more information or to purchase a Flexineb, visit breatheazy.co.uk

Case study: Jenny and Lou

Jenny was preparing her 12-year-old Thoroughbred-cross, Lou, for the Trec summer season when she noticed some worrying signs.

“I’d had Lou for a few years and never had any previous problems,” Jenny explained. “But in the early spring, I noticed that when we started a schooling session or ride, Lou would cough a few times as if clearing her throat.”

After a winter of being stabled in a barn environment where different types of bedding were used, Jenny thought it was just a build-up of dust in the barn, and as she was just about to move to full time turn-out, expected it to quickly clear. However, even when turned out, the coughing continued over the next few weeks, worsening with faster work.

“One day after hacking on a bridleway through a flowering oilseed rape field, I found Lou standing in the field with her head down, wheezing with every breath. After some investigation, the vet diagnosed RAO and started a regime of inhaled medication.

“With hindsight, I realised that even at rest, Lou’s nostrils had been flared, her respiratory rate had been faster and her flanks were moving up and down with each breath,” she revealed.

Jenny was able to stabilise the RAO with medication and nebulisation.

“Lou easily accepted the regime and over time the condition was managed with improved stable ventilation, dust-free bedding and forage, and acting promptly to medicate if necessary when pollen triggered a flare up.”

Lou was soon able to return to work, enjoying hacking, long distance rides, Trec and dressage events.

“I was really relieved that with good advice and support from the vet, the condition was easily manageable.”

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