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Flashcards in ACVIM Required Literature - Respiratory Dz Deck (148)
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1

Define Exercise Induced Pulmonary Haemorrhage (EIPH) as reported in horses.

- EIPH is defined as the presence of blood detected on tracheobronchoscopic examination after exercise, presence of red blood cells in BAL fluid, or both.
- There is no consensus about the concentration of red blood cells in BAL fluid that is diagnostic of EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

2

Does EIPH produce clinical signs?

- The CSx of EIPH often are considered to include: blood in the airways detected by either tracheobronchoscopy or examination of TTA or BAL fluid, poor performance, epistaxis, abnormalities detected on u/s or radiographic examination of the thorax, coughing, increased RR, respiratory distress or changes in behaviour.
- There is very low quality evidence of consistent clinical abnormalities in horses with EIPH, with the exception of presence of epistaxis after exercise for which there is moderate quality evidence.

Ref: ACVIM Consensus Statement (2015) - EIPH.

3

Does EIPH affect blood-gas exchange?

There is very low quality evidence of an adverse effect of EIPH on arterial oxygen tension during exercise. There is very low quality evidence of an assoc b/w higher blood lactate concentrations and EIPH during strenuous exercise.

Ref: ACVIM Consensus Statement (2015) - EIPH.

4

Is EIPH a cause of sudden death?

- There is low quality evidence that EIPH is causally associated with sudden death in race horses.
- There is no evidence of increased risk of sudden death in horses with EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

5

Does EIPH shorten the career of racehorses?

- There is moderate quality evidence that EIPH Grade 1-3 is not assoc with a shorter racing career of TB horses.
- There is moderate quality evidence that TB horses with epistaxis or Grade 4 EIPH have shorter careers.

Ref: ACVIM Consensus Statement (2015) - EIPH.

6

Is EIPH associated with inflammation in the lung?

- There is low quality evidence that EIPH leads to inflam in either the pulmonary parenchyma or airways.
- There is very low quality evidence that inflammation causes EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

7

Does EIPH cause lesions in the lungs?

- Gross and microscopic EIPH lesions are bilateral and most prevalent in the caudodorsal region of the lung; extend variably along dorsal border but never cranioventral.
- Gross lesions include discoloration of the pleural surface with underlying firm parenchyma that does not fully deflate.
- Pleural discoloration is a consequence of hemosiderin accumulation that is accompanied by pleural and septal fibrosis and angiogenesis.
- Vascular lesions include extensive remodeling of small pulmonary veins charac by accumulation of adventitial collagen and, in some vessels, smooth m hyperplasia.
- Electron microscopy of lungs from recently exercised horses shows breaks in the capillary endothelium and basement membrane, interstitial and intra-alveolar accumulations of erythrocytes, and interstitial edema that are compatible with capillary stress failure consequent to high intravascular pressure.
- There is high quality evidence that some horses with EIPH have extensive and characteristic pulmonary lesions.

Ref: ACVIM Consensus Statement (2015) - EIPH.

8

Is EIPH a progressive condition?

- There is moderate quality evidence that age is a risk factor for epistaxis/tracheal blood when confounding factors are not taken into account.
- When career duration was included in analyses, years spent racing was a significant), whereas age was not.
- There is moderate quality evidence that EIPH is progressive and related to load of racing.

Ref: ACVIM Consensus Statement (2015) - EIPH.

9

Does EIPH contribute to the pathogenesis of other diseases?

There is no evidence that EIPH is associated with development of other lung diseases.

Ref: ACVIM Consensus Statement (2015) - EIPH.

10

Is EIPH heritable?

- There is no published evidence regarding the heritability of EIPH.
- There is very low quality evidence of an association of pedigree with occurrence of epistaxis

Ref: ACVIM Consensus Statement (2015) - EIPH.

11

Is EIPH associated with the finishing position in a race?

There is moderate quality evidence that mod to severe EIPH in Thoroughbred race horses is assoc with increased likelihood of inferior finishing position in a race.

Ref: ACVIM Consensus Statement (2015) - EIPH.

12

Is EIPH associated with the finishing time in a race?

There is very low quality of evidence that EIPH in SB racehorses is not assoc with finishing time in a race.

Ref: ACVIM Consensus Statement (2015) - EIPH.

13

Is EIPH associated with the distance a horse finishes behind the winning horse in a race?

There is mod quality evidence that TB racehorses with more severe EIPH finish farther behind the winning horse.

Ref: ACVIM Consensus Statement (2015) - EIPH.

14

Is EIPH associated with race earnings?

There is mod evidence that severity of EIPH in TBs is negatively assoc with a horse’s race earnings.

Ref: ACVIM Consensus Statement (2015) - EIPH.

15

Is there a dose response relationship between the severity of EIPH and performance?

There is low quality evidence of a dose-response relationship between severity of EIPH in Thoroughbred racehorses and severity of impaired performance.

Ref: ACVIM Consensus Statement (2015) - EIPH.

16

Is furosemide effective prophylaxis for EIPH?

There is high quality evidence that furosemide (0.5–1 mg/kg administered IV 4 hours before strenuous exercise) decreases the severity and incidence of EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

17

Does furosemide affect pulmonary vascular pressure?

There is moderate quality evidence that furosemide reduces pulmonary vascular pressure during strenuous exercise (treadmill studies).

Ref: ACVIM Consensus Statement (2015) - EIPH.

18

Is aminocaproic acid an effective prophylaxis for EIPH?

- There is very low quality evidence that aminocaproic acid affects EIPH severity.
- Two treadmill studies show no effect on tracheobronchial bleeding but small numbers and bias.
Ref: ACVIM Consensus Statement (2015) - EIPH.

19

Are bronchodilators effective prophylaxis for EIPH?

There is very low quality evidence that bronchodilators affect EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

20

Are corticosteroids effective prophylaxis for EIPH?

There is very low quality evidence that corticosteroids affect EIPH severity.

Ref: ACVIM Consensus Statement (2015) - EIPH.

21

Are nonsteroidal anti-inflammatory drugs effective prophylaxis for EIPH?

There is very low quality evidence that nonsteroidal anti-inflammatory drug treatment affects EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

22

Is pentoxifylline an effective prophylaxis for EIPH?

There is very low quality evidence that pentoxifylline affects EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

23

Are there other medications that are effective for prophylaxis of EIPH?

- Carbazochrome, equine serum concentrate, conjugated oestrogens, endothelin 1-A antagonist, nedocromil, nitric oxide and sildenafil have been investigated as prophylaxis of EIPH in single studies for each drug.
- The studies provided very low quality evidence that these drugs affect EIPH severity

Ref: ACVIM Consensus Statement (2015) - EIPH.

24

Do nasal strips prevent EIPH?

There is low quality evidence that nasal strips decrease severity of EIPH.

Ref: ACVIM Consensus Statement (2015) - EIPH.

25

Are there other miscellaneous nonpharmacological treatments to prevent EIPH?

The studies provided very low quality evidence that herbal preparations or inhaled water vapor affect EIPH severity.

Ref: ACVIM Consensus Statement (2015) - EIPH.

26

Does furosemide affect performance of horses running on a racetrack?

There is moderate quality evidence that furosemide administered IV 4 hours prior to racing is associated with improved racing outcomes in TB and SB racehorses.

Ref: ACVIM Consensus Statement (2015) - EIPH.

27

Does furosemide affect performance of horses running on a treadmill?

There is low quality evidence that furosemide administered IV 4 hours before treadmill exercise results in delayed onset of fatigue and improved energetic cost of locomotion.

Ref: ACVIM Consensus Statement (2015) - EIPH.

28

How can a definitive diagnosis of Rhodococcus equi bronchopneumonia be made?

Bacteriologic culture or amplification of the vapA gene using PCR from a tracheobronchial aspirate (TBA) obtained from a foal with one or more of the following:
(1) Clinical signs of lower respiratory tract disease;
(2) Cytological evidence of septic airway inflammation; or
(3) Radiographic or u/s evidence of bronchopneumonia.

Ref: ACVIM Consensus Statement (2011) - R. Equi.

29

How can a definitive diagnosis of an extrapulmonary Rhodococcus equi infection be made?

- Bacteriologic culture or PCR amplification of vapA from samples from the site of infection if sampling possible.
- If from site which cannot be sampled e.g. uveitis, dx should be based on isolation of R. equi from a TBA or other
primary sites of infection.

Ref: ACVIM Consensus Statement (2011) - R. Equi.

30

Is a positive culture of R. equi from a nasal swab or faeces diagnostic for R. equi infection in foals?

- No.
- R. equi can be cultured from the faeces of healthy horses even if they live at farms w/o a Hx of R. equi pneumonia.

Ref: ACVIM Consensus Statement (2011) - R. Equi.