SAEVA Congress 2018 Proceedings | 12-15 February 2018 | ATKV Goudini Spa
aerosolized drugs via MDI devices, nebulization solution, or potentially, dry powder
inhaler.
The Equine Haler TM (Equine Healthcare APS, Hillerod, Denmark) is a spacer device
that fits over the entire left nostril of the horse, and is designed for administration of
aerosolized drug using any human MDI device. Drug deposition in the lower
respiratory tract is approximately 8.2 +/- 5.2% (fluticasone-CFC free propellant) of
the actuated dose with diffuse pulmonary drug delivery that is adequately distributed
to the periphery of the lung. Nasal trapping and retention of the drug in the spacer
contributes to medication wastage. Unlike the AeroMask TM , the Equine Haler TM can
accommodate any size horse without concern for creating an airtight seal over the
muzzle. Poor pulmonary drug delivery can occur if the administrator does not pay
particular attention to align the MDI with the spacer and the spacer apparatus with
the nasal passages of the horse during actuation. Movement of the head or
alteration of breathing pattern in response to actuation of the MDI can detract from
pulmonary drug delivery.
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•
Corticosteroids – Long-term management of most non-infectious respiratory
conditions requires evaluation of contributing environmental factors and
intermittent or daily administration of anti-inflammatory drugs the most commonly
used of which are corticosteroids. It is important to remember that corticosteroids
do not provide immediate improvement in pulmonary function, and therapeutic
benefit is not detected for 24 to 72 hours. Aerosolized corticosteroids are
effective in horses with mild to moderate airway inflammation with clinical signs
ranging from exercise intolerance to chronic coughing that is or is not associate
with exercise.
•
Beclomethasone (1500 to 3750 mcg, BID x 2-4 weeks)
•
Fluticasone (2mg, BID x 2-4 weeks)
In instances in which the degree of coughing or respiratory distress is severe
(e.g., hyperresponsive airways), a rapidly acting bronchodilator can be helpful.
Bronchodilator Therapy – Aerosolized bronchodilators provide immediate relief of
airway
obstruction,
provide
protection
against
irritant-induced
bronchoconstriction, and are an important component of treatment of non-
infectious respiratory disease. Administration of bronchodilators prior to exercise
may prevent exercise-induced bronchoconstriction. In addition, bronchodilators
can be administered prior to administration of topically-active mast cell stabilizing
drugs and corticosteroid preparati ons to improve pulmonary drug distribution and
prevent irritant cough and bronchoconstriction. In horses with more severe
disease, aerosolized bronchodilator administration allows the clinician to
determine the reversibility of airway obstruction. A short-acting (rescue therapy)
and long-acting aerosolized bronchodilator should be used in combination to treat
horses with severe airway obstruction. Recommended dosages are based on
administration with the Aero-Mask, but they might also be applicable the Equine
Haler.
•
Short-acting bronchodilators – rescue therapy
•
Albuterol (450 to 900 mcg, q 4 to 6 hrs x 14d) Powerful, rapid-onset (5
min) bronchodilation. Duration of action is 1 hour.
•
Fenoterol (1000 to 1500 mcg, q 4 to 6 hrs x 14d)
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