What's in a name? Inflammatory airway disease in racehorses in training

The term 'inflammatory airway disease' (IAD) is often used to describe the syndrome of lower airway inflammation that frequently affects young racehorses in training around the world. In practice, this inflammation is generally diagnosed using a combination of endoscopic tracheal examination, including grading of amounts of mucus present and tracheal wash sampling. However, a recent consensus statement from the American College of Veterinary Internal Medicine concluded that bronchoalveolar lavage (BAL) sampling, rather than tracheal wash (TW) sampling, is required for cytological diagnosis of IAD and that tracheal mucus is not an essential criterion. However, as BAL is a relatively invasive procedure that is not commonly used on racing yards, this definition can only be applied routinely to a biased referral population. In contrast, many practitioners continue to diagnose IAD using endoscopic tracheal examination and sampling. We argue that, rather than restricting the use of the term IAD to phenotypes diagnosed by BAL, it is important to distinguish in the literature between airway inflammation diagnosed by BAL and that identified in the field using TW sampling. We suggest the use of the term brIAD for the former and trIAD for the latter. It is essential that we continue to endeavour to improve our understanding of the aetiology, pathogenesis and clinical relevance of airway inflammation identified in racehorses in training using tracheal examination and sampling. Future studies should focus on investigations of the component signs of airway inflammation.     

Local airborne particulate concentration is associated with visible tracheal mucus in Thoroughbred racehorses

Reason for performing study: Accumulations of tracheal mucus assessed by endoscopic examination are associated with poor performance in racehorses. The air quality in horses' stalls may contribute to this visible tracheal mucus. Objectives: To determine whether the concentration and number of airborne particulates in stalls are associated with visible accumulations of tracheal mucus and with the number of inflammatory cells in tracheal aspirates. Methods: We studied 107 racehorses from 3 stables, in 3 different months, and measured airborne particulate matter 3 times daily in each of the stalls. On each monthly visit, horse airways were examined endoscopically and assigned a mucus score, and tracheal lavage was performed. Bivariate procedures, general estimating equations and linear mixed models were applied to estimate the association between PM and the presence of accumulations of mucus and number of inflammatory cells. Results: Stable, stall, month and PM were all significantly associated with the presence of accumulations of tracheal mucus, which had an overall prevalence of 67%. The odds of horses having visible accumulation of mucus were increased when horses occupied enclosed stables or stalls with higher particulate concentrations, and when concentrations of larger particles (≤10 µm in diameter) were elevated. Sixty‐eight percent of tracheal wash samples contained more than 20% neutrophils. Increased numbers of neutrophils were associated with the concentration of smaller particles (≤2.5 µm in diameter). Potential relevance: Careful consideration of stable construction and management practices focused on maintaining the lowest possible dust concentrations throughout the day should reduce the prevalence of visible accumulations of tracheal mucus, potentially improving racing performance.     

Effect of tracheal mucus and tracheal cytology on racing performance in Thoroughbred racehorses

REASON FOR PERFORMING STUDY: Accumulations of mucus within the trachea are often found during endoscopic examinations of the airways of poorly performing racehorses, but the clinical importance of this finding is unknown. OBJECTIVES: To determine the effect of tracheal mucus, pharyngeal lymphoid hyperplasia (PLH) and cytological indices of tracheal aspirate on racing performance in Thoroughbred horses assessed by race place and whether the horse was raced. METHODS: Endoscopic examination of the nasopharynx, larynx and trachea was performed, and a tracheal aspirate obtained monthly at Thistledown racetrack from April to December, 2002 and 2003. Horses received a score of 0-4 for the degree of PLH and 0-4 for the amount of mucus visible in the trachea. The tracheal aspirate was assessed for turbidity, and total and differential cell counts. Generalised estimating equations models were used as repeated measures models for each risk factor and the level of association assessed through the risk factor's P value in the model. RESULTS: Moderate to severe tracheal mucus (2-4) was a risk factor for poor racing performance. There was no association between degree of PLH, cell counts or turbidity of tracheal wash fluid and racing performance. However, horses that raced had higher total neutrophil counts in tracheal wash aspirates than horses that did not race. CONCLUSIONS: Grades 2-4 tracheal mucus should be considered a potential cause of poor racing performance in Thoroughbred horses. CLINICAL RELEVANCE: Because moderate to severe tracheal mucus accumulation, and not increased tracheal neutrophils, was a risk factor for poor racing performance, functionally significant airway inflammation may best be confirmed by the presence of mucus rather than increased number of neutrophils in the trachea.     

Coughing in thoroughbred racehorses: risk factors and tracheal endoscopic and cytological findings

A matched case-control study was made of 100 thoroughbred horses which were coughing and 148 control horses which were free of clinical signs of respiratory tract disease. The variables identified by multivariable conditional logistic regression as being significantly associated with coughing included age (the risk decreased with age), the stage of training (horses in early training were at greatest risk), the time since the last race (horses that had never raced were at greatest risk) and the time since they were last transported (horses transported more than 14 days previously were more likely to cough than those transported within the last week). The coughing horses were significantly more likely to have high scores for upper and lower tracheal mucus and pharyngeal lymphoid hyperplasia. In addition, the tracheal aspirates of the coughing horses had increased odds of neutrophilia and were more likely to have intracellular bacteria than the control horses. However, a considerable proportion of the control horses had cytological and/or endoscopic evidence of airway inflammation.     

Lower respiratory tract disease in Thoroughbred racehorses: analysis of endoscopic data from a UK training yard

REASON FOR PERFORMING STUDY: There has been much research directed at potential causative agents and the epidemiology of lower respiratory tract disease (LRTD), but few reports of the clinical progression and outcome. OBJECTIVES: To define clinical features of LRTD in racehorses, including association with age and average duration of disease, through the analysis of endoscopic data. METHODS: A retrospective analysis of records from a single training yard of endoscopic examinations undertaken over a 2-year period was performed. Horses were subjected to regular endoscopic examination for a variety of reasons, and all horses placed on antibiotic therapy for lower respiratory tract disease were rescoped following treatment. Data analysed included a 0-8 tracheal mucus score based on visible endoscopic mucus and gross tracheal lavage turbidity, as well as age and treatment duration and type. RESULTS: A total of 522 endoscopic examinations undertaken on 123 horses and tracking 169 episodes of lower respiratory tract disease were recorded. Mean duration of disease episode was 15.5 days (median = 11 days, range = 4-61 days). Horses age 2 years were significantly more likely than those age > or=3 years to have at least one episode of respiratory disease (P<0.001). There was a direct association between initial tracheal mucus score and rescope score after treatment. CONCLUSIONS: Lower respiratory tract disease was more common in 2-year-olds than in older horses. Affected horses had endoscopic evidence of increased tracheal mucus accumulation for an average of 15.5 days per episode, a considerably shorter period than that suggested by previous studies. POTENTIAL RELEVANCE: Endoscopic examinations permit longitudinal tracking of lower respiratory tract disease in Thoroughbred racehorses. A prolonged duration of disease, sometimes extending for months, can be expected in a small proportion of cases, some of which appear to be refractory to treatment. There is a clear need for evidence-based analysis of treatment regimes to assist clinicians in decision making when managing disease in both individual and group situations.     

Tracheal Endoscopic and Cytological Findings and Blood Examination Results in Thoroughbred Racehorses Suspected to have Lower Respiratory Tract Disease

Cytology of tracheal aspirates, tracheal endoscopic and blood tests were carried out to 86 Thoroughbred racehorses presenting coughs or poor performance which were suspected to have lower respiratory tract disease (LRTD) to assess the conditions of the disorders. Racehorses were classified into coughing (66 horses) and non-coughing (20 horses) groups based on clinical symptoms. Nine Thoroughbred racehorses without respiratory abnormality were used as controls. Assessment of grades of airway mucus, cytology of tracheal aspirates and serum amyloid A (SAA), fibrinogen (Fbg) and pulmonary surfactant protein D (SP-D) measurements were performed. Relationships between age, gender and racing careers were also investigated to understand the characteristics of LRTD in racehorses. Mean age was significantly higher in non-coughing group compared to coughing group. Existence of racing career and number of starts were significantly greater in non-coughing group compared to coughing group. On the other hand, grades of airway mucus were significantly higher in coughing group compared to control group. Percentages of neutrophils in tracheal aspirates were significantly higher in coughing group compared to non-coughing and control groups. SAA, Fbg and SP-D were higher in coughing group compared to non-coughing and control groups indicating that condition of coughing group is in the acute phase. Positive rate of inflammatory airway disease was significantly higher in coughing and non-coughing groups compared to control group. It was concluded that carrying out comprehensive evaluation including investigation on SAA, Fbg and SP-D analysis with airway assessment to Thoroughbred racehorses which were suspected to have LRTD are useful procedure to understand the pathological condition which aid to initiate appropriate treatment, prognosis judgment or to advise trainers to consider altering training regimen.     

Inflammatory airway disease, nasal discharge and respiratory infections in young British racehorses

REASONS FOR PERFORMING STUDY: Respiratory disease is important in young Thoroughbred racehorses, but the variation in the rates of occurrence between different ages and training groups has not been characterised. OBJECTIVES: To determine the rates of respiratory disease, particularly inflammatory airway disease (IAD), as well as evidence of infection, and their variation between age and group. METHODS: Horses were examined monthly in 7 British flat training yards over a 3 year period. IAD was defined as increased mucus in the trachea with increased proportions of neutrophils in tracheal wash samples. Frequencies of disease outcomes were estimated from the data. RESULTS: The prevalence of IAD was 13.8% and the incidence was 8.9 cases/100 horses/month. Rates varied with training and age groups, decreasing in older animals. The prevalence of nasal discharge (ND) was 4.1%. Rates of bacterial isolation were more common than viral infections. The incidence and prevalence of several bacterial species decreased with age. CONCLUSIONS: IAD and ND were common in young racehorses, varying significantly between training groups and decreasing with age, consistent with infection playing a role in aetiology. POTENTIAL RELEVANCE: The high prevalence of IAD in 2-year-old horses in Britain suggests that routine endoscopic examination may be helpful in providing early diagnosis and appropriate therapy. The transmission of bacteria and viruses within and between groups of young animals and the role of infection, stable environment and factors inherent to each horse, including their genetic make-up, in the multifactorial aetiology of the disease all merit further study.     

Descriptive epidemiology of fracture,tendon and suspensory ligament injuries in National Hunt racehorses in training

Reasons for performing study: While fractures and tendon injuries are known to be important diseases in National Hunt (NH) racehorses during racing, there are no accurate estimates of their incidence in NH training yards. Objectives: To estimate the incidence of fractures and tendon and suspensory ligament injuries (TLIs) in NH racehorses in training; to describe the injuries incurred and to compare injury incidence rates by horse age, trainer, gender and background (ex‐flat vs. ex‐store horses). Methods: Cohort data were collected from 14 UK NH training yards for 2 racing seasons. Daily exercise regimens and details of fractures and TLIs occurring in study horses were recorded. Results: Data were gathered from 1223 horses that spent 9466 months at risk of injury. The fracture incidence rate was 1.1/100 horse months and varied significantly by trainer (P<0.001) but not by gender, age or background. The pelvis and third metacarpal bone (MCIII) were the most common fracture sites, although this varied between racing and training. The TLI incidence rate was 1.9/100 horse months and varied significantly by trainer (P = 0.05) and age (P<0.001) but not by gender or background. However, exstore horses were significantly more likely to have a TLI on the racecourse than ex‐flat horses (P = 0.01). Superficial digital flexor injuries accounted for 89% of all TLIs, the remainder being suspensory ligament injuries. Conclusions and potential relevance: Fractures and TLIs are important causes of morbidity and mortality in NH racehorses in training in England. This study provides accurate estimates of their incidence in this population and provides a baseline against which to monitor the effect of future interventions.     

Prevalence of pharyngeal and laryngeal abnormalities in Thoroughbreds racing in Australia, and their association with performance

REASONS FOR PERFORMING STUDY: Little information is available regarding the prevalence of abnormalities of the upper airway and their association with performance in the general population of Thoroughbred racehorses. OBJECTIVES: To describe the prevalence of selected abnormalities of the upper airway and their association with performance in Thoroughbred racehorses in Australia. HYPOTHESIS: That abnormalities of the upper airway of Thoroughbred racehorses are associated with poor race performance. METHODS: Rhinolaryngoscopy was performed after racing and presence and characteristics of abnormalities of the larynx and pharynx were recorded in a prospective cross-sectional study of Thoroughbred horses racing in Victoria, Australia. RESULTS: Rhinolaryngoscopy was performed once on each of 744 horses over 35 months. Fifty abnormalities of the upper airway were detected in 47 horses (6.3%, 95% confidence interval [CI] 4.7-83%). Epiglottic entrapment was detected in 7 horses (0.9%, 95% CI 0.4-1.9%) and was significantly (P = 0.015) associated with superior performance. Grade 2 asymmetry (4 grade scale) of the left arytenoid cartilage was detected in 9 horses (1.2%, 95% CI 0.5-2.4%) and was also associated with superior performance (P<0.001). Ulceration or erosion of the mucosa of the axial surface of one or both arytenoids was detected in 18 horses (2.4%, 95% CI 13-3.8%) and was not associated with alterations in exercise performance (P = 0.31). CONCLUSIONS: Epiglottic entrapment, Grade 2 laryngeal asymmetry and mucosal erosions detected in Thoroughbred racehorses were not associated with impaired performance; therefore, surgical correction and concern over laryngeal function in horses with Grade 2 asymmetry may not be necessary in individuals performing to expectation.     

Gastric ulcers in standardbred racehorses: prevalence,lesion description,and risk factors

This study was performed to estimate the prevalence of gastric ulcers in Standardbred racehorses, to describe the lesion score and location, and to identify potential risk factors. Two hundred seventy-five (275) Standardbred horses from 5 training centers and 2 racetracks in Quebec, Canada, were studied. Historical data for the 2 months before examination were recorded for each horse, and the presence of gastric ulcers was determined by gastroscopy. A previously reported scoring system that used grades 0-3 for gastric lesions was used. Overall, 121 horses (44.0%; 95% CI, 38.1-50.1%) had gastric ulcers. The prevalence of gastric ulcers was significantly higher (P < .0001) in actively racing horses (63.3%; 95% CI, 54.7-71.2%) than in horses at rest. Multivariate analysis defined that horses in racing (OR = 9.29; 95% CI, 3.55-24.3) were significantly more likely to have gastric ulcers than horses at rest and that trotters (OR = 2.23; 95% CI, 1.28-3.86) were more likely to have gastric ulcers than pacers. The number of lesion sites (P < .0001) and poor body condition (P < .0001) were significantly associated with lesion scores. Gastric ulcers are highly prevalent in Standardbred racehorses. Furthermore, actively racing horses and trotters are more likely to have gastric ulcers. Also, poor body condition in Standardbred racehorses may be an indication that gastric ulcers are present and that lesion scores are high. The cause-and-effect relationship between poor body condition and the presence of gastric ulcers is unclear.     

A novel treatment for dynamic laryngeal collapse associated with poll flexion: the modified checkrein

Reasons for performing the study: Dynamic laryngeal collapse (DLC) associated with poll flexion is a performance limiting dynamic upper airway disorder commonly diagnosed in Coldblooded trotters. An inspiratory obstruction occurs when affected horses are driven with tension on the reins, inducing poll flexion. To date, surgical treatment and conservative management have failed to improve racing performance in affected horses. Objectives: To test the efficacy of an external device, the modified checkrein, in limiting poll flexion, diminishing laryngeal collapse and improving airway mechanics when horses are driven on a treadmill with tension on the reins and test the hypothesis that the modified checkrein will limit poll flexion thereby improving endoscopic appearance of the larynx and reduce airway obstruction in harness racehorses affected with DLC. Methods: Fourteen Norwegian Coldblooded trotter (NCT) racehorses previously diagnosed with DLC associated with poll flexion exercised on a high‐speed treadmill at speeds that resulted in heart rate >200 beats/min. Upper airway videoendoscopy recordings, tracheal pressures and video recordings of the head and neck position were collected while horses exercised with the conventional checkrein on Day 1 and the modified checkrein on Day 2. Results: The modified checkrein successfully limited poll flexion as measured by no change in head position parameters between phases of no rein tension and phases of rein tension. Endoscopic scores were significantly improved (arytenoids cartilage collapse P<0.0001; vocal fold collapse P<0.0001) and tracheal peak inspiratory pressures were significantly less negative (P = 0.0162) when horses were fitted with the modified checkrein compared to the conventional checkrein. Conclusions and potential relevance: The modified checkrein successfully limited poll flexion and also prevented upper airway obstruction in NCT horses affected with DLC associated with poll flexion. The modified checkrein seems promising in offering a method of conservative management in harness racehorses affected with this disorder.     

Prevalence of ulcers of the squamous gastric mucosa in standardbred horses

This study was performed to determine the prevalence of ulcers in the gastric squamous mucosa in Standardbred racehorses. Observations were performed at monthly intervals between the beginning of their training season and their 1st qualifying race. This study also identified risk factors at different levels of race training. Forty-eight Standardbred racehorses from 3 training stables in Quebec, Canada, were studied. Baseline historical information and gastroscopic findings were recorded at the beginning of the trial, and once a month thereafter, between December 2001 and June 2002, until the horse's 1st qualifying race or the end of the training. Intensity of training ranged from jogging to intensive training just before the 1st race and was assigned an ordinal score. Location of squamous ulcers and their appearance were observed on gastroscopy, and an ordinal score was assigned. Prevalence of squamous ulcers from the 2nd through the 4th month (72-88%) of training remained at a significantly higher level (P = .002 to .04) than at the onset of the study (38%) and was also higher in intensely trained horses than in joggers (93% versus 56%). Moderate or more intensive training increased the odds (odds ratio [OR], 3.39; confidence interval [CI], 1.34-8.56; and OR, 11.4; CI, 3.21-40.5, respectively) of detecting ulcers with higher scores. These odds were also higher in trotters (OR, 2.17; CI, 1.07-4.43) than in pacers and generally increased with the duration of training. Duration of training, training level, and gait type also influenced the number of sites with ulcers in the same way. Ulcers had higher scores along the lesser curvature (LC) and the margo plicatus (MP) areas of the stomach. It was concluded that squamous ulcers appeared early in the training of Standardbred racehorses, that the number of sites affected and the ulcer score are related to the intensity of training, and that trotters are more prone to squamous ulcers than pacers.     

Airway inflammation in Michigan pleasure horses: prevalence and risk factors

REASONS FOR PERFORMING STUDY: Although subclinical airway inflammation is thought to be common in horses, there is little information on its prevalence and none on risk factors. OBJECTIVE: To determine the prevalence and risk factors for an increased number of inflammatory cells and for mucus accumulation in the trachea of pleasure horses. METHODS: Horses (n = 266) in stables (n = 21) in Michigan were examined endoscopically, once in winter and once in summer 2004. Visible tracheal mucoid secretions were graded 0-5 and inflammatory cell numbers counted in a tracheal lavage sample. Information collected about each horse included age, gender, presence of cough, percent time indoors and source of roughage. The repeated measures were analysed by generalised estimating equations and linear mixed models. RESULTS: Horses eating hay, especially from round bales, had the most neutrophils, whereas horses feeding from pasture had the fewest. Being female and being outdoors in winter were associated with increased numbers of inflammatory cells. Older horses had fewer macrophages than young horses. More than 70% of horses had >20% neutrophils in tracheal lavage. Twenty percent of horses had a mucus accumulation score >1; 17% had both a mucus score >1 and >20% neutrophils. The significant risk factors for mucus accumulation >1 were age >15 years, feeding on hay as compared to pasture, and being outdoors for more than 80% time in winter. Even though mucus accumulation score >1 was a risk factor for cough, only half of such horses coughed. Cough and mucus accumulation were associated with increased number of neutrophils. CONCLUSIONS: In comparison to pasture feeding, hay feeding, particularly from round bales, was associated with an increased number of neutrophils in the airway. Being outdoors in winter was associated with increased numbers of inflammatory cells and with mucus accumulation. Because 70% of horses have >20% neutrophils, this value should not be used as the sole indicator of airway inflammation. POTENTIAL RELEVANCE: The study reinforces the importance of hay feeding and older age as risk factors for inflammatory airway disease. Horses that do not have 'heaves' may be best kept indoors when winters are cold.     

Characteristic of Inflammatory Airway Disease in Japanese Thoroughbred Racehorses

Inflammatory airway disease (IAD) is a common cause of poor performance, interruption of training and premature retirement in racehorses. It is also reported that up to 80% of horses are affected at some point in the first years of training in UK and Australia. However, no studies with regard to the information on occurrence of IAD in Japanese Thoroughbred racehorses have been reported. To investigate the occurrence and the characteristics of IAD, epidemic research including endoscopic examination of the airway tract and trachea wash was conducted for Thoroughbred racehorses presenting coughs or poor performance which airway tract disease was suspected stalled in training facility managed by Japan Racing Association. Fifty-six out of 76 Thoroughbred racehorses (73.7%) presenting coughing or poor performance were diagnosed as IAD. Mean incidence rate of IAD was 0.3% and it has been confirmed that constant number of IAD exists in Japan. Up to 35.7% of IAD horses showed upper airway abnormalities in some extent. There was a trend for IAD horses to use wood shavings for bedding and fed hay from the ground compared with the control group. Therefore, improvement of stabling environment may aid in preventing IAD. This study demonstrated that Japanese Thoroughbred racehorses are affected by IAD likewise other countries as well as demonstrated the characteristics of IAD which may contribute to the clarification of the pathogenesis of IAD.     

A case-control study of respiratory disease in Thoroughbred racehorses in Sydney, Australia

In order to investigate the role of infectious agents in the aetiology of lower respiratory tract disease in Thoroughbred racehorses, a matched case-control study was conducted. Cases were identified by the presence of coughing, and were compared to a control population matched on time of sample collection and location within the same training establishment. Tracheal wash samples were collected from 100 cases and 148 controls. Case horses were more likely than controls to have endoscopic and cytological evidence of airway inflammation. There was no significant association between serological evidence of infection by commonly implicated respiratory viruses and coughing. Similarly, mycoplasma were rarely isolated and were not associated with disease. In contrast, there was a strong association between isolation of greater than a total of 10(3) colony-forming units/ml of tracheal wash and coughing. Individual bacterial species associated with disease included Streptococcus zooepidemicus, Streptococcus pneumoniae, Streptococcus suis, Streptococcus sanguis, Pasteurella spp and Bordetella bronchiseptica. This study provides evidence of the role of bacterial infection in the aetiology of lower respiratory tract inflammation in racehorses. However, in 58% of cases, few or no bacteria were isolated. Hence, at the time of identification of disease, there was no evidence of viral, bacterial or mycoplasmal infection in the majority of coughing horses. The aetiology of the signs observed in these horses requires further investigation.     

Evaluation of nebulised hay dust suspensions (HDS) for the diagnosis and investigation of heaves. 2: Effects of inhaled HDS on control and heaves horses

To evaluate inhaled hay dust suspensions (HDS) as a tool for the diagnosis and investigation of heaves, the pulmonary inflammatory and functional consequences of inhalation challenge with 3 different HDS were determined in 6 control and 7 asymptomatic heaves horses. Heaves horses given HDS challenge developed the characteristic features of heaves, including airway neutrophilia, obstructive airway dysfunction and mucus hypersecretion. While HDS challenge induced a mild airway neutrophilia in controls, the no-response threshold for controls was greater than that of heaves horses, and there was no overlap in BALF neutrophil ratio of controls and heaves horses. Furthermore, HDS challenge did not induce airway dysfunction or mucus hypersecretion in controls. Therefore, HDS challenges enabled differentiation of control and heaves horses. Interestingly, in both groups, the airway neutrophilia was a dose-dependent response rather than an 'all or nothing' response. This study suggests that HDS challenges are of value in the diagnosis and investigation of heaves.     

Stimulation of airway neutrophils following dexamethasone administration and equid herpesvirus-2 challenge in horses

The aim of this study was to investigate neutrophil stimulation following experimentally-induced airway inflammation in healthy horses. Six horses received dexamethasone and four were then inoculated with equid herpesvirus-2 (EHV-2). Significant neutrophilia was detected in tracheal wash and bronchoalveolar lavage fluid for up to 6 days. Concentrations of neutrophil elastase (NE) and myeloperoxidase (MPO) were significantly increased compared to baseline for up to 14 days in tracheal washes and both markers were significantly correlated with neutrophil counts. Serum levels of surfactant protein D were not significantly modified throughout the study. These results suggest that dexamethasone administration with or without EHV-2 inoculation is associated with a sustainable activation and degranulation of neutrophils in the trachea along with moderate modifications detectable in the lower airways.     

Comparison of the antioxidant status in tracheal and bronchoalveolar epithelial lining fluids in recurrent airway obstruction

REASONS FOR PERFORMING STUDY: Following a period of airway inflammation the clearance of inflammatory cells along the mucociliary escalator may impose a considerable oxidant load on the trachea. OBJECTIVES: To determine the degree of oxidative stress in tracheal epithelial lining fluid (ELF) in comparison to that present in peripheral airways after an acute exposure to organic dust. METHODS: Tracheal wash fluid and bronchoalveolar lavage fluid (BALF) were collected for cytology and antioxidant analyses from 6 recurrent airway obstruction (RAO)-affected horses and 6 healthy control horses before and after stabling on straw bedding for 24 h. RESULTS: In RAO-affected horses, organic dust exposure resulted in a significant decrease in ascorbic acid concentration in tracheal ELF (P<0.0001), which was greater than the decrease in bronchoalveolar ELF (P = 0.0003). The percentage decrease in tracheal ELF ascorbic acid correlated with the percentage decrease in bronchoalveolar ELF ascorbic acid (r = 0.76; P = 0.004) following exposure. CONCLUSIONS: Acute organic dust exposure results in significant antioxidant depletion in the trachea, which may reflect inflammation and oxidative processes in peripheral airways. POTENTIAL RELEVANCE: Further work is required to evaluate the role of ascorbic acid depletion in the pathogenesis of RAO.     

Retrospective trainer-reported incidence and predictors of health and training-related problems in standardbred racehorses

Information on the incidence of injury, illness, and unexplained loss of athletic performance of 2345 Standardbred racehorses was gathered from a telephone survey of 177 trainers during the 1996-1997 season. Trainer-reported incidence of infection and illness (18%) was higher than the incidence of musculoskeletal problems (10%) or unexplained athletic performance loss (6%). Older horses (>5 years) were more likely to develop musculoskeletal problems (odds ratio [OR] = 3.9; confidence interval [CI] = 1.8-8.2) and performance loss OR = 2.3, CI = 1.1-5.2) than 2-year-old horses. Horses were more likely to suffer musculoskeletal problems if fast-worked on tracks or surfaces with no banking compared with those fast-worked on tracks with banking similar to commercial racetracks OR = 4.6, CI = 2.0-9.9). Horses given no warm-up before high-intensity exercise were more likely to suffer a musculoskeletal problem than horses given a light warm-up of 1 to 9 minutes OR = 2.5, CI = 1.5-4.4). Horses trained for more than 164 min·wk⁻¹ were more likely to suffer musculoskeletal problems OR = 1.7, CI = 1.1-2.8) and athletic performance loss OR = 2.5, CI = 1.4-4.4) than horses trained for shorter periods. Horses given a moderate weekly exercise duration (132-148 min·wk⁻¹) had the lowest rates of infection and illness, but short (114-131 min·wk⁻¹) or very long (>164 min·wk⁻¹) weekly exercise duration increased the risk of horses suffering infection and illness OR = 1.6, CI = 1.1-2.2 and OR = 1.3, CI = 1.0-1.9, respectively). We conclude that Standardbred trainers could avoid many training and health problems by using well-banked tracks, providing a proper warm-up, and avoiding excessive training.

Introduction

Racehorses suffer from a variety of health and training problems that may result in poor performance. Musculoskeletal injury is a major problem in Thoroughbred racehorses, accounting for as much as 53% of the lost training and racing days.[1 and 2] Thoroughbreds that race too often, [2 and 3] have insufficient training before racing, [4] or perform too much high-speed work [5] have a greater risk of musculoskeletal problems. Performance may also be affected by respiratory infection, which is responsible for 12% of lost training or racing days. [1]Poor performance can also develop in an otherwise apparently healthy horse. Such unexplained loss of athletic performance may arise from undiagnosed health problems or from too much training.[6] Overtraining described as a state of prolonged fatigue caused by too much training or insufficient recovery [7] has been demonstrated in horses in both cross-sectional and longitudinal studies, [8 and 9] but the incidence of athletic performance loss because of overtraining in the population is unknown. Recently reported prospective studies that used the same group of horses has found that overtraining appeared to be difficult to induce in horses, [10, 11, 12 and 13] which may indicate that overtraining accounts for little of the loss in athletic performance suffered by Standardbred racehorses.It is thought that lameness is the most important cause of poor racing performance in Standardbreds[14]; however, the incidence of musculoskeletal problems causing lameness in Standardbreds is lacking. There is also little information on the incidence of respiratory disease or athletic performance loss in Standardbreds. The purpose of this study was to determine the trainer-reported incidence of these problems in Standardbred racehorses and to reveal any association with factors such as sex, age, ability, training, track surface, and track design.

Materials and methods

A survey was administered by telephone to 177 Standardbred racehorse trainers randomly selected from a list of 300 trainers compiled by Harness Racing New Zealand. The survey was administered at the end of the 1996-1997 racing season, which lasts from about September through June, and questions asked during the survey related to the 1996-1997 racing season. Trainers were asked to recall the total number of horses that experienced an unexplained and consistent loss of athletic performance (“performance decrease that lasted for at least two weeks, which was not obviously as a result of tying up, infection, illness, or musculoskeletal problems”). Trainers were also asked for the total number of horses that suffered infection or illness (viral and bacterial infections and respiratory diseases but not bleeding from the lungs), and musculoskeletal problems (lameness caused by muscle, tendon, bone, or back injuries that resulted in lost training days). Pilot work involved testing the questionnaire on 10 local horse trainers; from their feedback and that of other colleagues and horse trainers, more than 11 revisions were made. The interview consisted of 65 questions and lasted approximately 20 minutes. The incidences of performance loss and health problems detailed in this study are trainer-diagnosed; however, in the majority of cases (80%), the horses were also examined by a veterinarian and their diagnosis was consistent with the trainer's. Unfortunately, full details of the veterinary examination were not obtained during this study.To examine the influence of track design and banking, trainers were asked to compare the banking of their training tracks to the banking of a commercial racetrack (Forbury Park Raceway, Dunedin, New Zealand, which had a banking angle of approximately 2.3 degrees). Trainers had to decide whether the banking of their track was more, less, or about the same as the banking of the commercial track. Because of the need to keep the questionnaire to a reasonable size, in-depth training data was collected on only one particular group of horses—qualified maidens. Qualified maiden racehorses (previously raced but unplaced) represent the largest group of racehorses in training in New Zealand. Trainers were also asked whether they trained their other horses (faster, slower, unqualified, 1-7, or >7 wins) any differently from the qualified maidens. Information on training type, duration, and intensity were gathered for each day of a typical training week. Exercise duration and total training workload was divided into quintiles (5 equal sections) and contrasts between the quintiles were then examined. Trainers were specifically asked about the duration of the warm-up, which was not included in the total training time. Warm-up was defined as the initial preparatory phase of a training session in which the horse is slowly accustomed to low-intensity exercise and prepared for further high-intensity exercise.Although it is acknowledged that career wins is a crude method of assessing racing ability, it was the most appropriate method available to the researchers during a phone interview that gave some indication of horses' ability. Trainers were therefore asked about the number of wins for each horse and horses were grouped according to the total number of career wins. The Human Ethics Committee of the University of Otago reviewed and approved this project (reference number 97/049).The survey data were analyzed using a repeated-measures general modeling procedure (Proc Genmod, SAS Institute, Cary, NC), which estimated the effect of age, sex, gait, number of wins, warm-up, track design, training duration, and workload as odds ratios ORs). The OR is a way of comparing whether the probability of a certain event is the same for two groups. An OR of 1 implies that the event is equally likely in both groups, whereas an OR of more than one implies that the event is more likely in the first group compared with the second. For example, the odds of a horse suffering a musculoskeletal injury if fast-worked on tracks with no banking is 0.52 (cases/noncases = 12 injured/23 noninjured), whereas the odds of a horse suffering a musculoskeletal injury on well-banked tracks is 0.11 (37 injured/329 noninjured). Therefore, the OR is 4.6 and is interpreted as: 4.6 horses suffer a musculoskeletal injury if fast-worked on an unbanked track compared with every 1 horse that suffers the same injury when fast-worked on well-banked tracks. Proc Genmod (SAS Institute) analyzed the total number of horses in a particular subgroup and the total number of problems in the same subgroup for each trainer. A type I error of 5% was chosen for declaration of statistical significance; precision of estimates was represented by the 95% confidence interval (CI), the likely range of the true value.To estimate the reliability of the trainer's responses, a second questionnaire identical to the first was administered to 17 randomly selected trainers from the same sample 8 months after the original survey. The trainers' responses to the same questions from separate surveys given 8 months apart were used to gauge reliability of the survey. Questions on the sex, gait, and number of race wins of the horses under the trainers' care that suffered health and training-related problems were analyzed. These variables represented population characteristics of the horses that could change with time as horses entered or left the trainers stables, and therefore affect the reliability of the reported data. Survey reliability was found by comparing the empirical standard error of the odds ratio from the initial (Main) and second (Rely) surveys after adjustment for sample size. When the empirical standard error was similar (within one decimal place) between studies, then reliability was considered low, but when the empirical standard error was smaller in the Rely survey compared with the Main survey, then the reliability of the survey was acceptable.

Results

Overall training and health problems

Horses were 2.1 times more likely to suffer from infections and illness than from musculoskeletal problems (CI = 1.4-2.8, P < .001) and musculoskeletal problems were 1.7 times more likely to occur than athletic performance loss (CI = 1.2-2.3, P < .001). Horses that had no recognized problems raced 12 ± 6 times (mean ± SD) over the main racing season (September 1996-June 1997).

Athletic performance loss

Sixty-eight trainers reported that a total of 146 horses developed a decrease in athletic performance not readily associated with musculoskeletal injury, illness, or tying-up during the season (6% of the 2345 horses sampled). Most horses (78%) that suffered athletic performance loss required at least 6 weeks to recover to normal form; the remaining 22% recovered within 4 weeks. In general, the decrease in athletic performance occurred towards the middle and end of the racing season. The incidence of athletic performance loss in the various subgroups of horses is shown in Table 1, and the ORs and confidence limits for statistically significant differences in incidence within each subgroup are shown in Table 2.     

Risk factors for and outcomes of noncatastrophic suspensory apparatus injury in Thoroughbred racehorses

OBJECTIVE: To evaluate effects of toe grabs, exercise intensity, and distance traveled as risk factors for subclinical to mild suspensory apparatus injury (SMSAI) in Thoroughbred racehorses and to compare incidence of severe musculoskeletal injury (MSI) in horses with and without SMSAI. DESIGN: Nested case-control study. ANIMALS: 219 Thoroughbred racehorses racing or in race training. PROCEDURE: Racehorses were examined weekly for 90 days to determine incidence of suspensory ligament injury and monitor horseshoe characteristics. Every horse's exercise speeds and distances were recorded daily. Conditional logistic regression was used to compare exposure variables between incident case (n = 25) and selected control (125) horses. Survival analysis was used to compare time to MSI for horses with (n = 41) and without (76) SMSAI. RESULTS: The best-fitting logistic model for the data included age (< 5 vs > or = 5 years old), toe grab height the week of injury (none vs very low, low, regular, or Quarter Horse height), and weekly distance the week preceding injury (miles). Although the 95% confidence intervals for all odds ratios included 1, the odds for SMSAI appeared to increase with the presence of a toe grab, higher weekly distance, and age > or = 5 years. Horses that had SMSAI were significantly more likely to have a severe MSI or severe suspensory apparatus injury than were horses that did not. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that pre-existing SMSAI is associated with development of severe MSI and severe suspensory apparatus injury. Modifying training intensity and toe grab height for horses with SMSAI may decrease the incidence of severe MSI.