Equine recurrent airway obstruction: pathogenesis, diagnosis, and patient management
Authors: Davis Elizabeth, Rush Bonnie R
Journal: Veterinary Clinics of North America: Equine Practice
Summary
# Editorial Summary: Equine Recurrent Airway Obstruction Recurrent airway obstruction (RAO) predominantly affects mature horses kept in poor ventilation or high-dust environments, manifesting along a spectrum from subtle exercise intolerance and intermittent coughing to severe dyspnoea at rest. Davis and Rush examined the underlying pathogenic mechanisms, diagnostic approaches, and management strategies for this chronic inflammatory airway disease, highlighting how clinical presentation varies considerably between individual horses. Bronchoalveolar lavage (BAL) cytology emerges as the gold-standard diagnostic tool, with neutrophil counts typically ranging from 15–85% proving both sensitive and specific for confirming RAO in horses displaying mild to moderate clinical signs. The research emphasises that optimal disease remission requires an integrated approach combining environmental modification (reduced dust exposure, improved stable ventilation, increased turnout) with pharmacological intervention—specifically periodic administration of bronchodilators and inhaled corticosteroids—rather than relying on single-modality treatment. These findings remain clinically significant as they underscore for equine professionals the importance of investigating environmental triggers alongside airway assessment, and that aggressive dust exposure reduction often determines long-term prognosis more substantially than medication alone.
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Practical Takeaways
- •Horses with RAO kept in confinement require environmental modifications (reduced dust, improved ventilation) as the foundation of management—medication alone is insufficient
- •BAL cytology with neutrophil counts helps confirm diagnosis and guide treatment decisions in suspected RAO cases
- •A combined approach using bronchodilators and anti-inflammatory corticosteroids offers the best chance of remission, particularly in early-stage disease
Key Findings
- •Recurrent airway obstruction primarily affects older horses in confinement with clinical signs ranging from exercise intolerance to dyspnea at rest
- •Bronchoalveolar lavage cytology showing neutrophilic leukocytosis (15-85%) is the recommended diagnostic test for mild to moderate disease
- •Environmental management combined with periodic bronchodilator and corticosteroid therapy provides the best prognosis for disease remission