What's in a name? Inflammatory airway disease in racehorses in training.
Authors: Cardwell J M, Christley R M, Gerber V, Malikides N, Wood J L N, Newton J R, Hodgson J L
Journal: Equine veterinary journal
Summary
# Editorial Summary: Inflammatory Airway Disease Nomenclature in Racing Thoroughbreds A diagnostic divide has emerged in equine respiratory medicine: the American College of Veterinary Internal Medicine advocates bronchoalveolar lavage (BAL) as the gold standard for confirming inflammatory airway disease (IAD), yet most racing yards continue diagnosing the condition via endoscopic examination and tracheal wash (TW) sampling due to BAL's invasiveness and impracticality in field settings. Cardwell and colleagues analysed this inconsistency in a 2011 study, highlighting that relying solely on BAL-derived definitions creates a biased referral population and excludes the vast majority of racehorses assessed on-site with tracheal examination and mucus grading. The authors propose establishing distinct terminology: brIAD for BAL-diagnosed bronchoalveolar inflammation and trIAD for tracheal-wash-identified inflammation, acknowledging these may represent different phenotypes rather than the same disease entity. This distinction is crucial for practitioners, as it clarifies that field-based diagnoses using endoscopy and TW sampling remain valid and clinically relevant, whilst encouraging future research to investigate whether these diagnostic approaches identify the same underlying pathology or separate conditions requiring different management strategies. For equine professionals working on racing yards, this framework validates existing diagnostic practices whilst emphasising the need for continued investigation into how tracheal inflammation signs correlate with performance and athletic capacity.
Read the full abstract on PubMed
Practical Takeaways
- •Understand that IAD diagnosed on your yard using tracheal wash and endoscopy (trIAD) may differ from referral-based BAL diagnoses (brIAD), affecting how you interpret results and clinical significance
- •Be aware that current consensus definitions exclude many field diagnoses, meaning routine yard-based IAD identification needs further validation regarding its clinical relevance and aetiology
- •Focus on investigating individual components of airway inflammation rather than treating IAD as a single syndrome until clearer diagnostic and prognostic criteria are established
Key Findings
- •Current IAD diagnosis in racehorses uses either bronchoalveolar lavage (BAL) or tracheal wash (TW) sampling with endoscopic examination, but ACVIM consensus recommends BAL only
- •BAL-based diagnosis is restricted to referral populations due to the invasive nature of the procedure and lack of availability on racing yards
- •The authors propose distinguishing brIAD (BAL-diagnosed) from trIAD (tracheal wash-diagnosed) to improve clarity in literature and research
- •Tracheal mucus grading should not be considered an essential criterion for IAD diagnosis, contrary to traditional field practice