Efficacy of three corticosteroids for the treatment of heaves.
Authors: Robinson N E, Jackson C, Jefcoat A, Berney C, Peroni D, Derksen F J
Journal: Equine veterinary journal
Summary
# Editorial Summary: Corticosteroid Treatment in Equine Heaves Recurrent airway obstruction (heaves) remains a significant respiratory disease in stabled horses, yet evidence comparing different corticosteroid protocols has been limited. Robinson and colleagues conducted a rigorous crossover trial in nine affected horses to evaluate three corticosteroid regimens against untreated controls, using objective measures of airway function and inflammatory markers via bronchoalveolar lavage fluid analysis. Intravenous dexamethasone solution (0.1 mg/kg daily) proved most effective, restoring lung function to pasture levels within three days and significantly reducing neutrophil percentages in BALF; the depot formulation dexamethasone-21-isonicotinate (0.04 mg/kg every three days) was equally rapid in eight of nine horses, whilst oral prednisone (1 mg/kg daily) showed delayed and inconsistent responses, with only five of nine horses improving by day ten. These findings have clear practical implications: whilst pasture turnout remains the gold standard, practitioners managing horses that must remain stabled should consider intravenous dexamethasone as the first-line pharmacological choice for rapid airway obstruction relief, though the inconsistent response to oral prednisone suggests it should not be relied upon for acute management unless administration continues beyond seven days. The marked variation in individual responses—particularly one horse's non-response to dexamethasone-21-isonicotinate—underscores the importance of reassessing respiratory function objectively rather than assuming all corticosteroids will be equally effective.
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Practical Takeaways
- •IV dexamethasone is the most reliable rapid treatment for acute heaves episodes, producing lung function improvement within 3 days during stabling
- •IM dexamethasone-21-isonicotinate offers convenient dosing every 3 days but expect treatment failure in approximately 10-15% of cases
- •Oral prednisone is unreliable for acute relief and requires at least 10 days to show effect in some horses—not recommended for acute crisis management
Key Findings
- •Daily IV dexamethasone solution (0.1 mg/kg) improved lung function within 3 days to pasture levels in all 9 horses
- •Dexamethasone-21-isonicotinate (0.04 mg/kg IM every 3 days) was rapidly effective in 8 of 9 horses but one horse showed no response
- •Oral prednisone tablets (1 mg/kg daily) showed inconsistent effects with only 5 of 9 horses demonstrating improvement by Day 10
- •IV dexamethasone significantly decreased neutrophil percentage in bronchoalveolar lavage fluid while other treatments had no effect on airway cytology