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Prescribtion medication

Ref. In:  Equine Respiratory Diseases, Lekeux P. (Ed.)
International Veterinary Information Service, Ithaca NY (www.ivis.org), 2001; B0331.1101

 

Class

Substance

Dose

Frequency

Anticholinergic

Ipratropium bromide

1 mg

q 8h

β2 Agonists

Albuterol

720 µg

q 3h

 

Clenbuterol
Salmeterol

200 µg

350 µg

q 8h

q 8h

Mast Cells Stabiliser

Na Cromoglycate

80 mg

q 24h

Corticosteroids

Budesonide

800 µg

q 12h

 

Beclomethasone
Fluticasone

500 µg

1mg

q 12h

q 12h

Antibiotics

Ceftiofur

 

Gentamicin

 

(For the Nequilizer 2 ml Gentamicin has to be diluted in 3 ml natrium saline)

250 mg

250 mg

q 12h

 

q 12h

Mucokinesis

Acetylcysteine

 

(For the Nequilizer0,7ml Acetylcysteine has to be diluted in 3,5 ml natrium saline)

1 g

q 12h

 

The proposed drugs do not take into account whether these drugs have been approved for use in horses by the national authorities.

 

 

Anticholinergic drugs - These substances, acting as parasympatholytic agents, are competitive inhibitors of acetylcholine at its receptor sites [35]. The parent compound of this class of drugs is atropine. In the horse, systemic use of atropine has been shown to induce or maintain gastrointestinal stasis [36], increasing the risk of colic. Moreover, its duration of action is short [37]. At a dosage of 0.02 mg/kg body weight, atropine was found to cause identical changes in pulmonary parameters when given systemically or by inhalation, but because of its undesirable side effects (e.g., tachycardia, mydriasis, increased viscosity of bronchial secretions) it is not suitable as a long term therapeutic agent [38]. However, as a cholinergic component has been identified in the bronchospasm observed in equine heaves [39], atropine is used to treat punctually this kind of respiratory disorder. Ipratropium bromide, a compound chemically derived from atropine, is virtually free of central effects when aerosolized since, when given by this route, its rate of absorption from the airways is greatly decreased and its blood concentration is very low [40]. In heaves-affected horses, ipratropium bromide nebulisation causes bronchodilation lasting about 6 h at a dosage of 2 mg/kg body weight [19]. Dry powder inhalation of this agent has also been shown to improve pulmonary function of affected horses at the same dosage [41]. This substance may be potentially beneficial to treat airway inflammatory disease since there is some evidence that vagally mediated bronchoconstriction also occurs in this pathology [42].


b2 agonists - These substances act by binding to adrenoreceptors on the smooth muscle cell surface, inducing relaxation of these muscles. They may also have a role in the control of mucus transport in the airways of patients suffering from obstructive lung disease. Some studies have demonstrated a stimulatory effect of b agonists on pulmonary mucociliary clearance in human medicine [28] and in horses [29]. The most important use of b2 agonists is to induce or to maintain bronchodilation in horses affected with heaves and small airway inflammatory disease. In heaves-affected ponies, aerosolized pirbuterol, at cumulative doses  2400 - 3200  mg, produced sweating, trembling and excitement [30]; however at a dose of 800 mg, its bronchodilator effects lasted for at least 30 min with minimal side effects. In heaves-affected horses, another study by Derksen et al., [25] concluded that pirbuterol could be inhaled via an MDI and caused bronchodilation at an optimal dose of 600 mg/horse without appearance of side effects. The duration of action was approximately 1 h. The same observation was reported after inhalation of 360 mg of albuterol sulfate [31,32]. On the other hand, contradictory results have been reported about the potential ability of inhaled albuterol sulfate to improve performance in healthy horses [33,34].


Mucokinesis; Drugs Acting on Mucociliary Clearance
The rate of removal of mucus from the airways is determined by a number of factors, such as mucus viscosity, the amount of mucus produced, and ciliary activity. These processes may be influenced by a variety of diseases including heaves [67].
Mucokinetic drugs are used in the treatment of equine pulmonary diseases. There is, however, still limited scientific evidence as to the clinical value of many of these agents both in man and horses, even though it has been shown that several agents significantly increase mucociliary clearance. Mucociliary drugs can be divided into 5 groups according to their mechanisms of action:

 

  • Mucolytic drugs (sterile water, sterile saline, acetylcysteine, sodium bicarbonate, propylene glycol);
  • Surface-acting drugs (glycerol, ethyl alcohol);
  • Bronchomucotropic agents (expectorants such as bromexhine, potassium iodide, etc);
  • Cilia augmentors (b sympathomimetics);
  • Bronchodilators (b sympathomimetics, xanthines).


Most of the effective mucolytic and surface-acting agents and some bronchomucotropic drugs must be given by aerosol to horses [47]. As the action of these drugs is often subtle, their efficacy is not clear and is difficult to assess.


Antibiotics

Aerosol administration has been suggested for the delivery of antibiotics that are not orally active. The inhaled route is an attractive alternative to the oral route because, in general, high blood level of antibiotics can increase the chance of systemic side effects but are necessary to attain adequate concentrations in respiratory secretions. Aerosol administration of gentamicin induced antibiotic concentrations in equine bronchial fluids higher than those obtained after IV administration [68].
Bacterial pneumonia in mature horses is frequently the result of stress that produces some degree of immunocompromise in the lung and may be secondary to viral respiratory disease [69]. In foal pneumonia, nebulisation of gentamicin, kanamycin sulphate and polymyxin sulphate has been reported to be effective [70]. For infectious respiratory disease in mature horses, practitioners sometimes use ceftiofur (Excenel®) by nebulisation. This antibiotic must to be mixed with 10% ethanol before use for aerosol therapy. Its clinical efficacy has been demonstrated in bovine bronchopneumonia [71] but not yet in horses. In fact, there appears to be no published studies on the efficacy of antibiotic inhalation in mature horses. It should mentioned that the pollution of the surrounding air must be taken into account before nebulizing horses with antibiotics.

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