Received: 26 January 2024 | Accepted: 13 March 2024 DOI: 10.1111/eve.13976
R E V I EW A R T I C L E
Respiratory emergencies in adult horses Bettina Dunkel
Department of Clinical Science and Services , The Royal Veterinary College, Equine Referral Hospital , Hatfield, Hertfordshire , UK
Correspondence: Bettina Dunkel Email:
bdunkel@rvc.ac.uk
Summary Although respiratory distress is encountered infrequently in equine practice, it can be serious and potentially fatal, requiring immediate and decisive intervention. History and physical examination can often give sufficient clues to identify the cause of respiratory distress and initiate emergency treatment. Ultrasonography can also be invaluable when assessing distress caused by lower respiratory tract issues. Upper respiratory tract ob- struction, tension pneumothorax and occasionally pulmonary oedema can be rapidly fatal and require immediate intervention by emergency tracheotomy, thoracocentesis and evacuation of pleural air or administration of furosemide and oxygen, if available. Acute severe asthma and substantial pleural effusion are often not an immediate threat to life but nonetheless require fast intervention including administration of bronchodilators and corticosteroids or pleurocentesis, respectively.
K E YWORDS horse , pleural effusion , pleuropneumonia , pneumothorax , pulmonary oedema , severe asthma , tracheostomy
INTRODUCTION
While respiratory emergencies are not particularly common in horses, they can be frightening and extremely distressing for horse, owner and attending veterinarian alike. Accurately diagnosing the underlying problem, understanding the underlying pathophysiology and initiating effective treatment quickly can be lifesaving. Causes of respiratory distress in horses and a flow chart of the diagnostic approach are summarised in Figures 1 and 2 . Diagnostics, the under- lying pathophysiology and management are discussed in the article below. Drugs commonly used in the treatment of respiratory dis- tress are listed in Table 1 .
Diagnostic tools for respiratory distress
The combination of history and physical examination findings fre- quently points towards a certain diagnosis and might be enough to initiate emergency treatment.
Externally visible swelling of the head and throat area points to-
wards upper airway tract obstruction. Breathing is often associated with a characteristic high- pitched inspiratory noise and laboured in- spiratory breathing pattern. Airflow is palpably reduced at the level of the nostrils which can be appreciated by holding both hands in front of the nostrils, feeling for airflow. Bilateral nasal discharge sug- gests guttural pouch or lower airway disease. Profuse mucopurulent discharge can be associated with strangles (upper airway tract ob- struction), severe asthma or bacterial pneumonia or pleuropneumo- nia. Malodourous red- brownish discharge can be seen with severe necrotising pneumonia and frothy, white discharge or sputum can occur with severe pulmonary oedema. Auscultation of the lungs is neither sensitive nor specific but can give an indication whether lower respiratory tract disease is likely and what might be expected. Unfortunately, the absence of abnormal lung sounds does not rule out significant lung disease. In contrast, the presence of abnormal lung sounds is strongly suggestive of lower respiratory tract disease. In an acute asthma attack, widespread wheezes and crackles might be audible. The complete absence of any breathing sounds over the
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Authors. Equine Veterinary Education published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Equine Vet Educ. 2024;36:607–616.
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