EIPH

Question 1

Does EIPH produce clinical signs ?

Answer 1

very low quality evidence of consistent clinical abnormalities in horses with EIPH
moderate quality of evidence that causes epistaxis

Question 2

Does EIPH affect blood-gas exchange?

Answer 2

Very low quality evidence of an adverse effect of EIPH on arterial oxygen tension during exercise.

Very low quality evidence of an association between higher blood lactate concentrations and EIPH during strenuous exercise.

Question 3

Is EIPH a cause of sudden death?

Answer 3

low quality evidence that EIPH is causally associated with sudden death in race horses

no evidence of increased risk of sudden death in horses with EIPH.

Question 4

Does EIPH shorten the career of horses?

Answer 4

moderate quality evidence that EIPH Grade 1-3 is not associated with a shorter racing career of Thoroughbred horses.

moderate quality evidence that Thoroughbred horses with epistaxis or Grade 4 EIPH have shorter careers.

Question 5

Is EIPH associated with inflammation in the lung?

Answer 5

low quality evidence that EIPH leads to inflammation in either the pulmonary parenchyma or airways.

very low quality evidence that inflammation causes EIPH

Question 6

Does EIPH cause lesions in the lungs?

Answer 6

high quality evidence that some horses with EIPH have extensive and characteristic pulmonary lesions

Question 7

What pulmonary lesions are seen with EIPH?

Answer 7

Gross lesions
Discoloration of the pleural surface: a consequence of hemosiderin accumulation that is accompanied by pleural and septal fibrosis and angiogenesis
underlying firm parenchyma that does not fully deflate in excised lungs.

Vascular lesions:
Remodelling of small pulmonary veins (100– 200 lm outer diameter)
accumulation of adventitial collagen and, in some vessels, smooth muscle hyperplasia.
vascular lumen is markedly decreased.

Electron microscopy are compatible with capillary stress failure consequent to high intravascular pressure
Breaks in the capillary endothelium and basement membrane,
interstitial and intra-alveolar accumulations of erythrocytes
interstitial oedema

Question 8

Where in the lung are lesions seen in EIPH?

Answer 8

Caudodorsal

Question 9

Is EIPH a progressive condition?

Answer 9

moderate quality evidence that EIPH is progressive and related to load of racing.

Question 10

Does EIPH contribute to the pathogenesis of other disease?

Answer 10

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

Question 11

Is EIPH heritable?

Answer 11

no published evidence regarding the heritability of EIPH.

very low quality evidence of an association of pedigree with occurrence of epistaxis.

Question 12

Is EIPH associated with the finishing position in a race?

Answer 12

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

Question 13

Is EIPH associated with the finishing time in a race?

Answer 13

very low quality of evidence that EIPH in Standardbred racehorses is not associated with finishing time in a race.

Question 14

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

Answer 14

moderate quality evidence that Thoroughbred racehorses with more severe EIPH finish farther behind the winning horse in a race.

Question 15

Is EIPH associated with race earnings?

Answer 15

moderate evidence that severity of EIPH in Thoroughbred racehorses is negatively associated with a horse’s race earnings.

Question 16

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

Answer 16

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

Question 17

Is EIPH associated with performance?

Answer 17

Moderate evidence is associated with: finishing position, distance behind winning horse, race earnings

Low evidence: dose response relationship between severity of EIPH and performance

Very low evidence: EIPH is not associated with finid=shing time.

Question 18

Evidence for use of furosemide in EIPH

Answer 18

high quality that decreases severity and incidence (0.5-1mg/kg IV 4 hours before exercise)

Improvement demonstrated in: gross blood presence/absence, RBC in BALF, EIPH endoscopic grade

Question 19

Does furosemide affect pulmonary vascular pressure?

Answer 19

moderate quality evidence based on treadmill exercse. Pulmonary arterial/wedge pressures and transmural pressures reduced.

Question 20

Evidence for aminocaproic acid?

Answer 20

Very low quality that affects severity- 2 RCT, small numbers and indirectness.

Question 21

Evidence for bronchodilators

Answer 21

very low quality evidence that affects

Question 22

Evidence for corticosteroids

Answer 22

Very low quality evidence that affects severity

Question 23

Evidence for NSAIDs

Answer 23

Very low quality evidence

Question 24

Evidence for pentoxyfilline

Answer 24

very low quality

Question 25

Evidence for nasal strips

Answer 25

Low quality evidence: 4 small studies show decrease in postexercise BALF RBCs.

Question 26

Evidence for other miscellaneous non-pharmacological treatments

Answer 26

Very low- herbal/ inhaled water vapour
No evidence for rest or water restriction

Question 27

Does furosemide affect performance of horses running on the racetrack?

Answer 27

moderate quality evidence that furosemide administered IV 4 hours prior to racing is associated with improved racing outcomes in Thoroughbred and Standardbred racehorses

Question 28

Does furosemide affect performance of horses running on a treadmill?

Answer 28

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

Question 29

How does sex/ age affected performance response to furosemide?

Answer 29

Benefits of furosemide administration were more marked in males up to 6 years old.

Question 30

How does furosemide affect performance?

Answer 30

Unknown- no studies

Question 31

What difference in performance was demonstrated in the largest study investigating the effect of furosemide on racetrack performance?

Answer 31

0.56-1.09s faster per mile. n=22589

Question 32

Summarise current recommendations on the influence of EIPH

Answer 32

Is associated with pulmonary lesions and epistaxis. Poor evidence that has any further effect on health or wellbeing, but is considered a disease. Weak evidence that is progressive. Moderate evidence that is associated with decreased performance.

Question 33

Summarise current recommendations for EIPH prophylaxis

Answer 33

high quality evidence for the use of furosemide, but weak recommendation for use due to affect on performance. No reccomendaton for any other pharmacological interventions.