Efficacy of salmeterol xinafoate in horses with recurrent airway obstruction.

OBJECTIVE: To determine the onset, magnitude, and duration of bronchodilation after administration of aerosolized salmeterol xinafoate in horses with recurrent airway obstruction. DESIGN: Randomized controlled study ANIMALS: 6 horses with recurrent airway obstruction. Procedure Horses received aerosolized salmeterol (210 microg) or no treatment, using a crossover design. Salmeterol was administered, using a mask designed for aerosol delivery in horses. Subjective rating of airway obstruction (RAO), maximal change in pleural pressure (deltaPplmax), and pulmonary resistance (RL) were determined at baseline; 5, 15, and 30 minutes; and 1, 2, 4, 6, 8, 10, and 12 hours after administration of salmeterol and in horses that did not receive treatment. RESULTS: The deltaPpl and RL were improved 15 minutes through 6 hours after administration of salmeterol, compared with values obtained from horses receiving no treatment. The RAO was improved 15 minutes through 2 hours after administration of salmeterol. The maximal response to salmeterol was evident 30 to 60 minutes after administration and was characterized by a 59 + 19% decrease in deltaPpl and a 56 +/- 13% decrease in RL. The deltaPpl and RL were not different from baseline values 8 hours after salmeterol administration. CONCLUSIONS AND CLINICAL RELEVANCE: Duration of action of salmeterol in these horses was approximately 6 hours. Maximal bronchodilation was somewhat delayed (30 to 60 minutes), and the magnitude of response was similar to that of short-acting beta2-adrenergic agonists. Salmeterol provides moderately sustained bronchodilation in horses with recurrent airway obstruction and may be an effective drug for long-term control of this condition.     

Intravenous histamine administration in ponies with recurrent airway obstruction (heaves)

Pulmonary function and airway reactivity to IV histamine were measured in a group of ponies with a history of recurrent airway obstruction (heaves) and their age-, weight-, and gender-matched controls. Ponies were studied during a period of clinical remission (period A), after exposure to a barn environment (period B), and twice during a 2-week recovery phase (periods C and D). At periods A, C, and D, PaO2, dynamic compliance (Cdyn), pulmonary resistance, tidal volume, respiratory frequency, and the log dose of histamine required to reduce Cdyn to 65% of base-line value (log ED65Cdyn) of principals and controls did not differ. Barn exposure (period B) decreased Cdyn, PaO2, and ED65Cdyn and increased pulmonary resistance in principals but not controls. The slope of the histamine dose-Cdyn response curves was not different between principal and control groups of ponies and was unaffected by barn exposure or return to pasture. There was a poor correlation between ED65Cdyn and indices of airway caliber. During acute airway obstruction, ponies with a history of heaves were hyperreactive to IV histamine, but during disease remission, airway response to histamine was not different from that of control ponies. Seemingly, hyperreactivity in principal ponies after exposure to a barn environment cannot be explained solely by alterations in base-line airway caliber.     

Mechanical properties of excised calf lungs: effects of airway obstruction with beads

Isolated lungs of five calves were suspended in an airtight box used as a ventilator. Lungs were ventilated from the outside at different levels of transpulmonary pressure. Dynamic compliance (Cdyn) and total pulmonary resistance (RL) were measured. These pulmonary function values were also measured during central and peripheral airway obstructions. It was demonstrated that both central and peripheral obstructions induced significant variations of Cdyn and RL. However, decrease of Cdyn was greater and increase of RL was smaller during a peripheral obstruction than during a central one.     

Effects of xylazine on airway function in ponies with recurrent airway obstruction.

The effect of IV administration of the alpha 2-adrenoceptor agonist xylazine hydrochloride (0.5 mg/kg of body weight) was examined in ponies with recurrent obstructive pulmonary disease, commonly called heaves. Six ponies with the disease (principals) were studied during clinical remission and during an acute attack of airway obstruction precipitated by stabling and feeding of dusty hay. Six control ponies were also studied. In principal ponies with airway obstruction, xylazine administration significantly (P < 0.05) decreased pulmonary resistance and increased dynamic compliance, but did not affect PaO2 or PaCO2. The alpha 2-antagonist yohimbine blocked the pulmonary effects of xylazine. Administration of saline solution was without effect in both groups of ponies at all periods and xylazine did not have effect in controls or in principals in clinical remission.     

Histamine inhalation challenge in normal horses and in horses with small airway disease

A histamine inhalation challenge (HIC) procedure was developed to assess hyperreactive states in horses. Following clinical evaluation, percutaneous lung biopsies were performed on nine light breed mares aged 6 to 15 years. Five horses, with normal small airways, were classified as group A and four subjects with small airway disease (SAD) lesions formed group B. Pulmonary mechanics parameters were monitored following an aerosol of 0.9% saline and every 5 min for up to 30 min after HIC with 0.5% w/v of histamine diphosphate, administered through a face mask for 2.5 min. Tidal volume (VT) and airflow (V) values were obtained with a pneumotachograph. Transpulmonary pressure (delta Ppl) was measured by the esophageal balloon catheter method. Dynamic compliance (Cdyn), total pulmonary resistance (RL), end expiratory work of breathing (EEW) and respiratory rate (f) were calculated by a pulmonary mechanics computer. Group A horses had increases in RL, and decreases in Cdyn whereas horses in group B were hyperreactive and showed greater changes in EEW, Cdyn, and delta Ppl but with a relatively lower variation of RL. One horse in clinical remission from SAD, but with a high biopsy score (group B), and one clinically normal horse belonging to group A showed marked hyperreactivity as shown by increases in EEW, maximum change in delta Ppl and RL and decreases in Cdyn. These results suggest that the HIC described can be used as a method to investigate airway hyperreactivity and SAD in horses.     

Comparison of barometric whole body plethysmography and its derived parameter enhanced pause (PENH) with conventional respiratory mechanics in healthy Beagle dogs

The purpose of the study was to compare barometric whole body plethysmography (BWBP) and its derived parameter, enhanced pause (PENH), with conventional respiratory mechanics measurements. Resistance (RL), dynamic compliance (Cdyn) and pleural pressure changes were measured in six healthy anaesthetised Beagle dogs using a pneumotachograph and oesophageal balloon technique consecutive to BWBP-derived variables. Upper airway airflow limitation was established (1) by a filter or (2) by insertion of a narrow endotracheal tube. Bronchoconstriction was induced by nebulisation of carbachol at increasing concentrations until PENH exceeded 300% baseline. Upper airway narrowing significantly increased resistance (baseline RL 2.0+/-0.3, RL filter 11.8+/-3.2, RL luminal narrowing 21.1+/-2.3cm H(2)O/L/s; P <0.03), whereas PENH did not change significantly (baseline PENH 0.55+/-0.17, PENH filter 0.49+/-0.10; PENH luminal narrowing 0.50+/-0.18; P >0.05). Carbachol-induced bronchoconstriction caused a significant increase in PENH (baseline PENH 0.43+/-0.14, PENH carbachol 2.62+/-2.14; P <0.02) and resistance (baseline RL 2.1+/-0.3, RL carbachol 28.8+/-13.0 cm H2O/L/s; P <0.01), and a pronounced drop in compliance (baseline Cdyn 163.3+/-73.9, Cdyn carbachol 9.7+/-2.9mL/cmH2O; P <0.02). It was concluded that BWBP detects airflow limitation due to bronchoconstriction but not due to upper airway obstruction in healthy dogs. BWBP represents a valid, although not very sensitive screening tool for respiratory function testing.     

Aerosol pirbuterol: bronchodilator activity and side effects in ponies with recurrent airway obstruction (heaves).

The dose of aerosol pirbuterol that could be administered safely to ponies (weight approximately 200 kg) was determined by observation for sweating, trembling and excitement and measurement of heart and respiratory rates during cumulative administration of the drug. Sweating, trembling and excitement were first observed following a dose of 2,400 micrograms and became more severe at 3,200 micrograms. These effects were accompanied by an increase in heart rate but not a change in respiratory rate. When 3200 micrograms was administered without prior administration of lower doses, side effects were trivial. This dose was therefore tested for its bronchodilator activity. Pulmonary function was evaluated in ponies that developed airway obstruction ('heaves') when housed in a barn and fed hay. Measurements were made when ponies were in clinical remission (Period A) and during an acute attack of airway obstruction (Period B). At Period A, pirbuterol had no effect on pulmonary function. Barn housing increased pulmonary resistance and decreased dynamic compliance. At Measurement Period B, pirbuterol administration significantly reduced pulmonary resistance and increased dynamic compliance and minute ventilation. These changes were significant 5 min after drug administration and lasted for the 30 min duration of the study. Vehicle administration had no effect on pulmonary function. It was concluded that aerosol pirbuterol has few undesirable side effects and is an effective bronchodilator in ponies with recurrent airway obstruction.     

Effect of clenbuterol on histamine-induced airway obstruction in ponies

We determined the effect of IV administered beta 2-adrenergic receptor agonist clenbuterol on pulmonary function and on the response to histamine in 12 healthy ponies. Measurements were made at base line and after saline solution or clenbuterol was administered IV at a dosage of 0.2, 0.8, or 1.6 micrograms/kg. The dosage of clenbuterol used in each study was unknown to the investigators until all the data had been analyzed. Intravenous administration of saline solution or clenbuterol did not alter base-line pulmonary function significantly. Aerosol histamine administration significantly decreased arterial oxygen tension and dynamic compliance and increased pulmonary resistance, respiratory frequency, and minute ventilation, but had no effect on arterial carbon dioxide tension and tidal volume. The magnitude of change in these variables was unaffected by previous administration of clenbuterol at any of the dosages tested. We conclude that clenbuterol at the dosages tested is not a bronchodilator in healthy ponies and does not exert a significant protective effect against aerosol histamine-induced airway narrowing.     

Effect of exercise on the partitioning of equine respiratory resistance

Pleural, tracheal, pharyngeal and mask pressures as well as airflow and tidal volume of five ponies on a treadmill (incline 8.3 degrees) were recorded simultaneously while resting, walking, trotting slowly, trotting fast, after standing for 30 secs and 5 mins after the end of the exercise. The curves obtained were used to calculate total pulmonary resistance (RL), lower airway resistance (RLA) and upper airway resistance (RUA). The latter was also divided into nasal resistance (Rnas) and laryngeal plus extrathoracic tracheal resistance (Retr + lar). Furthermore, the inspiratory and expiratory components of each of these R values were estimated. Levels of RL, RLA and RUA were increased significantly during exercise but, during the recovery period, the values were significantly lower than those pre-exercise. RUA represented 82 per cent of RL at rest and this percentage did not change significantly during and after exercise. The nasal resistance to RUA ratio was always higher than 0.5. The fact that RL increased with exercise intensity was due to the increase of RUA during inspiration, and mainly a result of the increase of RLA during expiration. At fast trot, RLA represented 5 and 50 per cent of RL during inspiration and expiration respectively. It was concluded that heavy exercise induces in ponies an increase of RL, one reason for which could be the partial collapse of the extrathoracic and intrathoracic airways during inspiration and expiration respectively.     

Aerosolized Micropolyspora faeni antigen as a cause of pulmonary dysfunction in ponies with recurrent airway obstruction (heaves)

Ponies with recurrent airway obstruction (principal ponies) and their controls were given aerosolized Micropolyspora faeni antigen via endotracheal tube during a period when the principal ponies were in disease remission. In both groups of ponies, we performed bronchoalveolar lavage (BAL) and measured pulmonary function at base line, and 5 hours after aerosol administration of 30 ml of 0.9% NaCl solution or 30 ml of 1% w/v particulate M faeni antigen in 0.9% NaCl solution. In both groups of ponies, aerosolized M faeni antigen increased WBC count, neutrophil numbers, and albumin concentration in BAL fluid, but macrophage numbers decreased. In the principal ponies, BAL mast cell numbers were decreased 5 hours after administration of M faeni antigen. The M faeni antigen had no effect on the mechanical properties of the lungs or on gas exchange in the control ponies, but did increase respiratory frequency minute ventilation and pulmonary resistance, and decreased arterial oxygen tension in the principal ponies. Changes in pulmonary function were apparent only in the principal ponies, which suggests that neutrophils, per se, do not cause pulmonary dysfunction and that M faeni may be one of the etiologic agents involved in chronic obstructive pulmonary disease.     

Comparison of forced oscillation with the conventional method for histamine bronchoprovocation testing in horses

OBJECTIVE: To compare response of horses to histamine bronchoprovocation (HBP), using total respiratory resistance (Rrs) measured by forced oscillatory mechanics (FOM) with dynamic compliance (Cdyn) and pulmonary resistance (RL) measured by the esophageal balloon method. ANIMALS: 10 horses with various degrees of airway reactivity. PROCEDURE: The 2 methods for measuring airway responses to HBP were performed on separate days. Endpoints compared were increase of 150 or 200% of baseline Rrs (PC150Rrs, PC200Rrs) and to 150% of baseline RL (PC150RL) or decrease to 65% of baseline Cdyn (PC65Cdyn). Frequency dependence of respiratory mechanics, using FOM, was evaluated, using the slope of Rrs over 1 to 3 Hz and the ratios of Rrs at 1 Hz to Rrs at 2 and 3 Hz (Rrs1Hz/Rrs2Hz, Rrs1Hz/Rrs3Hz) and of Rrs at 2 Hz to Rrs at 3 Hz (Rrs2Hz/Rrs3Hz). Effect of histamine on frequency dependence was assessed. RESULTS: Correlation with PC65Cdyn was high for PC150Rrs (rs = 0.93) and PC200Rrs (rs = 0.96). Correlation between PC65Cdyn and PC150RL was weakly positive (rs = 0.61). The slope of Rrs over 1 to 3 Hz changed significantly between baseline (-0.07+/-0.09 cm H2O/L/s/Hz) and final histamine dose (-0.28+/-0.10 cm H2O/L/s/Hz). The Rrs1Hz/Rrs3Hz and Rrs2Hz/Rrs3Hz differed significantly (P < 0.05 between baseline [1.27+/-0.36 and 0.96+/-0.11, respectively] and final histamine dose [1.62+/-0.37 and 1.09+/-0.14, respectively]). CONCLUSIONS: Correlation between histamine-induced changes in respiratory mechanics, as measured by FOM and the pneumotachograph-esophageal balloon method, was good. The FOM results indicated frequency dependence of respiratory mechanics during HBP. CLINICAL RELEVANCE: A noninvasive method of measuring airway reactivity will facilitate routine evaluation of horses with suspected small airway disease and may be suitable for field studies.     

New perspectives in cardiopulmonary therapeutics: receptor-selective adrenergic drugs

Recent advances in basic biomedical research have led to the development of clinically useful drugs known as "second generation" adrenergic receptor stimulants (agonists) and blockers (antagonists). Adrenergic receptors are now differentiated into 4 distinct subtypes: alpha 1, alpha 2, beta 1, and beta 2. The new drugs are more receptor-selective and tissue-specific than older ones and, hence, have increased potential for directed therapeutic action, with relatively less side effects on nontargeted organs. The beta 2-selective agonist terbutaline, eg, causes bronchodilation with less beta 1-cardiac excitation than does the beta 1-beta 2 nonselective agonist isoproterenol. Compared with the latter, the beta 1-selective agonist dobutamine increases myocardial contractile force and cardiac output with less beta 2-mediated vasodilation and hypotension. The beta 1-selective antagonist metoprolol has advantage over the beta 1-beta 2 nonselective blocker propranolol for controlling beta 1-cardiac excitation in patients with compromised pulmonary function. Prazosin, an alpha 1-selective blocking agent, evokes peripheral vasodilation with less reflex tachycardia than does the nonselective alpha 1-alpha 2 blocker phentolamine, probably because the former spares the prejunctional alpha 2-receptors that subserve autoinhibition of norepinephrine release from the sympathetic neuron. The contemporary practice of internal medicine will no doubt include an understanding of the pharmacologic properties associated with the various adrenergic receptor subtypes.     

Effects of bovine respiratory syncytial virus on airway function in neonatal calves

Respiratory syncytial virus (RSV) infection causes severe lower respiratory tract disease in infants and calves. Neonatal respiratory tract infection in children often produces persistent changes in lung function. The specific objective of this study was to determine whether neonatal calves have transient or persistent alterations in pulmonary function and airway reactivity following RSV infection. Six 2- to 3-day-old Holstein bull calves were inoculated with 10 ml of bovine respiratory syncytial virus (BRSV) inoculum (10(2.7) to 10(3.8) cell culture infective doses/ml) intranasally and 10 ml of BRSV inoculum (10(4.8) to 10(5.9) cell culture infective doses/ml) intratracheally for 4 consecutive days, and 5 other calves were sham-inoculated. Prior to inoculation (day 0) and on days 4, 14, and 30 after the last inoculation, body weight (kg), dynamic compliance (Cdyn), pulmonary resistance (RL), and 2 indices of airway reactivity (effective dose [ED] 65Cdyn and ED200RL) were measured. Control calves gained weight progressively throughout the study, whereas RSV-inoculated calves failed to gain weight for 14 days, but equaled control calf weight by 30 days after inoculation. The Cdyn of control calves increased significantly by 30 days, but did not in the RSV-infected calves. Pulmonary resistance was increased significantly at 4, 14, and 30 days, but was unaffected by sham inoculation. The ED65Cdyn and ED200RL indicated an age-dependent increase in reactivity to histamine and an increase in responsiveness in the infected group beginning at 14 days and persisting until the end of the study.(ABSTRACT TRUNCATED AT 250 WORDS)     

Interactions of cold stress and Pasteurella haemolytica in the pathogenesis of pneumonic pasteurellosis in calves: changes in pulmonary function

Thirteen healthy neonatal Holstein calves were cold stressed twice by hosing with cold water for 20 minutes, 12 hours between hosings. Measurements of the pattern of ventilation [tidal volume (VT), respiratory frequency (f), minute ventilation (VMIN), and functional residual capacity (FRC)], gas exchange properties of the lungs [alveolar ventilation (VA), oxygen uptake (VO2), CO2 production (VCO2), dead space ventilation (VD), dead space/tidal volume ratio (VD/VT), arterial oxygen tension (PaO2), arterial CO2 tension (PaCO2) and alveolar-arterial oxygen difference (AaDO2)] and of the mechanical properties of the pulmonary system [dynamic compliance (Cdyn), pulmonary resistance (RL), and total respiratory system resistance (RRS)] were taken. Calves responded to chilling by increasing VO2 and VCO2 necessitating an increase in VA. This was accomplished by increasing VT with reciprocal decreases in f so that VMIN remained constant. There was no change in Cdyn, RL, or AaDO2. Seven of these 13 calves were then exposed to intratracheal inoculation of 2 X 10(9) organisms of Pasteurella haemolytica, the remaining calves serving as controls. Within 1 hour, calves exposed to P haemolytica had increased VMIN, f, VD/VT, and VD. There was a decrease in PaO2 associated with increased AaDO2, but no change in PaCO2, Cdyn or RL. By 3 hours after inoculation, there were pronounced changes in PaO2 and AaDO2, and Cdyn was reduced below base-line values. By 12 hours after inoculation, calves infected with P haemolytica had increased RL and RRS and PaCO2, in addition to the previously mentioned changes. Data from Pasteurella-exposed calves indicate that gas exchange impairment and peripheral lung injury occur rapidly and that increases in airway resistance develop relatively late in the disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

A novel model for equine recurrent airway obstruction

Equine recurrent airway obstruction (RAO; a term combining both chronic obstructive pulmonary disease (COPD) and summer pasture associated obstructive pulmonary disease (SPAOPD)) is one of the most common equine respiratory diseases with up to 50% of horses affected worldwide. The etiopathogenesis of RAO is unknown although pulmonary hypersensitivity to inhaled mold antigens may be involved. Recent work in our laboratory demonstrating elevated levels of IL-4 and IL-13 mRNA in the airways and peripheral blood of horses with RAO is consistent with an atopic component to RAO. Little is known regarding the earliest phases of RAO in horses. Here we describe the development of a novel airway model for equine RAO that utilizes ovalbumin-coated polystyrene beads for airway sensitization and challenge. Aerosol challenge of sensitized ponies with OVA-coated microbeads resulted in decreased airway compliance, increased percentage of lymphocytes and neutrophils in the bronchoalveolar lavage fluid, and evidence of a Th2 cytokine response in the bronchoalveolar cells. These results suggest that this approach may be useful in describing the initial stages of RAO development in the horse.     

Comparative efficacy of inhaled albuterol between two hand-held delivery devices in horses with recurrent airway obstruction

Reasons for performing study: Studies investigating the clinical efficacy of albuterol administered with the same propellant and commercially available delivery devices in horses with recurrent airway obstruction (RAO) are not currently available. Objectives: To determine the efficacy of aerosolised albuterol administered to horses with RAO by means of 2 commercially available, hand‐held delivery devices. Methods: Ten horses with RAO were kept in a dusty environment and fed mouldy hay to induce airway obstruction. Lung mechanics were measured before and after the procedure. ΔP_max was measured 5 min after administration of 180 µg of albuterol from a pressurised metered dose inhaler, using an aerosol delivery device chosen randomly. This process was repeated every 5 min until maximal bronchodilation was achieved. After a 24 h washout period, lung mechanics data were again collected using the other aerosol delivery device. Results: Aerosolised albuterol induced a significant and rapid bronchodilation in the horses using both aerosol delivery devices. No statistically significant difference in pulmonary function was observed in response to albuterol therapy between the 2 devices. The dose required to achieve 50% of maximal bronchodilation was not statistically different between the 2 devices (173.35 ± 78.35 µg with Device 1 and 228.49 ± 144.99 µg with Device 2, P = 0.26). The decrease in lung resistance tended to be more pronounced after albuterol administration with Device 1 (P = 0.066). Conclusions: Aerosolised albuterol is an effective bronchodilator in horses with recurrent airway obstruction. There is no statistically significant difference between the 2 commercially available aerosol delivery devices in terms of efficacy. Potential relevance: Aerosolised albuterol is effectively delivered using currently available devices leading to maximal bronchodilation in horses with RAO at an average dose of 540 µg.     

Neurokinin receptors in recurrent airway obstruction: A comparative study of affected and unaffected horses

The purpose of the study was to compare in vitro airway responses to neurokinin A & B (NKA and NKB) and expression of NK-2 receptors in airways of horses affected and unaffected with recurrent airway obstruction (RAO). Neurokinin-A, an inflammatory mediator belonging to the tachykinin family of neuropeptides, causes bronchoconstriction by binding to NK-2 receptors. Neurokinin-B is a lesser-known neuropeptide that acts on NK-3 receptors. Horses were placed into RAO-affected and RAO-unaffected groups based on their history, clinical scoring, and pulmonary function testing. Lung tissue from each lobe was collected for immunohistochemical staining for NK-2 receptors. Cumulative concentration-response relationships were determined on bronchial rings (4-mm wide) collected and prepared from the right diaphragmatic lung lobe to graded concentrations (half log molar concentrations 10⁻⁷M to 10⁻⁴M) of NKA and NKB. The results showed that NKA caused significantly greater contraction than NKB in both groups. In RAO-affected horses, both agents produced significantly greater bronchial contractions than those in the RAO-unaffected horses. Immunohistochemical staining showed that the overall NK-2 receptor distribution was significantly increased in bronchial epithelium and smooth muscles of bronchi and pulmonary vessels of RAO-affected than RAO-unaffected horses. The findings indicate that NK-2 receptors are up-regulated in RAO, suggesting that NK-2 receptor antagonists may have some therapeutic value in controlling the progression of airway hyperreactivity in horses affected with RAO.