SAEVA Proceedings 2018 4. Proceedings | Page 34

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. • • 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) 29