Getting A Second Wind: Helping Equine Athletes Breathe

Are breathing issues slowing your horse down? Here are some surgical and management options that might help

It matters not how sound of foot and mind your barrel racer, show jumper, or trail horse is. If oxygen can’t pass through his nostrils and flow down his airways unimpeded, he’s not going to be able to turn those barrels, clear those fences, or handle a long-distance ride.  

While some breathing problems are temporary and can be corrected easily with the proper medication regimen, others might cause lifelong breathing difficulties and compromise the horse’s athleticism to the point that he can no longer perform.  

The good news is that management techniques and/or surgery can mitigate some of these problems, even at the highest competitive levels. For example, a Thoroughbred racehorse named Bolo, that ran in the 2015 Kentucky Derby, underwent surgery for a breathing problem last year. After seven months of recovery, he returned to win the $200,000 Arcadia Stakes at Santa Anita, in Arcadia, California, in February 2017.

Kathleen Anderson, DVM, is a partner at Equine Veterinary Care at the Fair Hill Training Center, in Elkton, Maryland. She says that in the crucial first step of diagnosing a respiratory issue, veterinarians must determine if the breathing problem is mechanical, inflammatory, or both.

Mechanical problems can include laryngeal hemiplegia (often called roaring, or recurrent laryngeal neuropathy), a displaced soft palate, an entrapped ep-iglottis, or arytenoid chondritis. All these conditions can make breathing more difficult and might impede oxygen exchange.

A horse with laryngeal hemiplegia suffers from paralysis of one of the muscles in the larynx. The epiglottis, which is a cartilage at the root of the tongue, can become entrapped when a membrane that usually underlies the epiglottis flips up over it. Arytenoid chondritis is a progressive inflammation affecting the laryngeal cartilage at the opening of the trachea.

Anderson explains that inflammatory conditions can be acute and short-lived, such as with viral or bacterial infections, or chronic, such as with equine asthma (formerly known as COPD, heaves, or recurrent airway obstruction).

The first indications of a problem might include noise coming from the respiratory tract when the horse exercises and/or decreased performance. Have your veterinarian examine your horse early to differentiate an inflammatory disease from a mechanical obstruction and to begin treatment before inflammation becomes chronic. Then you and your veterinarian can map out the best way to solve or manage the problem.

An endoscopic examination is a key step in the diagnostic process. An endoscope tube inserted into the horse’s airway transmits images to a screen via fiber-optics. Typically, veterinarians perform the examination while the horse is standing, sometimes immediately after exercise and sometimes after the horse has been at rest.

Dynamic video endoscopy is a newer diagnostic tool, says Anderson. This technology allows the veterinarian to observe a horse’s respiratory tract during exercise. The information is transmitted wirelessly to a computer and can be reviewed later in more detail. Mechanical problems in the throat and larynx and inflammatory conditions lower in the respiratory tract can both be diagnosed with endoscopy.

Gary Priest, DVM, of Harthill and Priest Equine Surgery, in Versailles, Kentucky, has been at the forefront of video endoscopy diagnosis. “Dynamic endoscopy has allowed the equine veterinarian to understand the exact cause of the airway impairment,” he says, “and to better advise the owners and trainers as to what treatment options are available and are most effective.”

What Comes First?

Nobody likes a sky-high veterinary bill, so an owner’s first inclination when encountering a breathing problem might be to see if management techniques will resolve the issue. All horses can benefit from tactics such as reducing dust in and around the barn, making sure the barn has good ventilation, feeding from the ground, and providing plenty of turnout in a grassy area.

While it is tempting to adopt a wait-and-see attitude after instituting these types of changes, it is usually wise to get a veterinarian involved early.

Inflammatory conditions can be the result of viral or bacterial infections that, depending on the organism, can affect an individual or the whole herd, says Anderson. Most can be transmitted to other animals. Getting to the bottom of an inflammatory condition early might mean the difference between a quick cure and a more chronic ­situation (and even a barn full of sick horses).

If your horse suffers from a mechanical breathing problem, an exact diagnosis will help you decide on the next step, which might be surgery.

Surgery can be expensive and carries the possibility of unintended complications, such as food aspiration and pneumonia. Owners and their veterinarians need to weigh the costs and risks against the animal’s value (both monetary and sentimental) and athletic ability.

“There are two things to consider,” says Anderson. “Does the condition limit the horse only at speed or does it limit the horse at any form of exercise? The ­majority of these problems are limiting only at speed. So how important is speed in your given sport?”

Anderson oversaw a case where a 10-year-old Pony Club mount developed a bad case of arytenoid chondritis. While the owners loved their horse, they did not want to pursue surgery. Anderson treated the animal with antibiotics and anti-inflammatories, and the condition improved to about 40% airway capacity, which was enough for what the horse needed to accomplish, provided the condition does not recur.

Most mechanical obstructions cannot be treated with medications. With those that can, such as arytenoid chondritis, the process is slow-going, says Anderson.

Tieback surgery

Surgical Options

If the veterinarian has diagnosed a mechanical problem that is significant enough to seriously impact a horse’s ability to breathe during exercise, surgery might be indicated. While surgery can often help, Priest says, it won’t always return a horse to his maximum athletic ability.

He says roaring is the most common mechanical breathing problem he sees in his practice.

“In my opinion, the tieback surgical procedure with bilateral resection (cutting out a portion) of the laryngeal ventricles (a pair of spindle-shaped depressions set between the folds of the throat) and vocal folds is the best treatment” for this condition, says Priest.

By suturing the paralyzed cartilage to the side, the surgeon in effect “ties it back” to keep it out of the way. This can increase the airflow and reduce the roaring noise.

Priest says the second-most-common problem he sees is intermittent dorsal displacement of the soft palate. He recommends the tie-forward surgical procedure if the affected horse is 3 years or older. With this method, the surgeon pulls the larynx forward so the epiglottis covers more of the soft palate to reduce the chances of displacement.

“In my opinion, if the horse is less than 3 years of age, it might be the best to turn him out for a few months and let him mature” before considering surgery, Priest says.

Anderson says that in her experience, surgery for a displaced soft palate is only successful about 60% of the time and probably only effective for about a year. Over a riding horse’s lifetime, she says, “that may not be a sufficient time frame to justify the cost.” However, if it means allowing a top-level performance horse to compete successfully during his futurity or Derby season, it might be worth it.

Priest and Anderson emphasize the importance of rest in some cases. Simple patience and letting nature do the work can sometimes be the best solution.

“Rest is also extremely important after surgery,” says Anderson. “If the horse comes back too quickly, the tiebacks might fail as a result of the activity irritating the sutured structures.”

For an entrapped epiglottis, Priest says surgery requires resecting the entrapment either via the nasal or oral route.

“I do all of these under a general anesthesia and give (horses) three to four weeks out of training to allow the incised tissue to heal,” he says. “Generally speaking, cases of entrapped epiglottis occur in horses over 4 years, and they have an excellent long-term prognosis if not complicated by poor airway conformation.”

For chondritis problems, Anderson says aggressive antibiotics, like those used in the Pony Club horse, are usually the first line of attack. “In the worst-case scenarios, the surgical solution is an arytenoidectomy, or removal of the affected arytenoid, which can predispose the horse to feed-aspiration complications,” Anderson says.

Management Options

Once a veterinarian diagnoses the breathing problem and the horse has either undergone surgery and treatment or the owner has elected to live with the situation, long-term management is the next step. What works and what doesn’t often depends on the diagnosis.

Wetting or steaming hay might help relieve general breathing problems. “Wetting hay is going to make it less dusty,” says Anderson, as will steaming, though steaming also changes the texture so that it’s more palatable for the horse with an inflamed throat and more beneficial for the horse with digestive issues.

Anderson says salt-vapor rooms, which first started popping up in Australia, are becoming increasingly common.

“The horses stand in a room and breathe in salt air, as if they were at the ocean,” she says. “It has remarkable effects on airway inflammation. We have seen a real significant improvement with racehorses that previously we might have treated with antibiotics.”

Anderson says she has also seen this treatment help horses with chondritis or postoperative inflammation. There is no scientific evidence of salt air’s benefits on horse’s airways, however.

Nebulizers and mask technologies are other management options. These facemasks typically fit over the horse’s muzzle, allowing him to breathe in medicated vapors delivered through the nebulizer.

“I think these have their place,” says Anderson. “A nebulizer without medication is like you living in a house with a humidifier. A nebulizer with ­bronchodilators will help with airway clearance. A nebulizer with an anti-inflammatory may have good impact on postop or pre-op cases to reduce the ­inflammation.”

A nasal strip is another tool that could help open the airway, depending on the individual horse’s nose conformation. Anderson says she believes nasal strips to be useful and likens them to a tongue tie in horse racing, which reduces tongue displacement over the bit and increases airflow. A nasal strip reduces the work of breathing by preventing nasal tissue collapse during inhalation.

“Any way you can give a compromised horse more air can be helpful,” says Anderson.

Nasal strips have been in the news surrounding the Triple Crown. In New York, where the third leg, the Belmont Stakes, takes place, authorities deemed nasal strips illegal in 2012. That would have kept I’ll Have Another, winner of that year’s Kentucky Derby and Preakness with a nasal strip, from wearing one, but he was sidelined by a training injury.

Two years later, when California Chrome likewise was trying to complete the Triple Crown while wearing a nasal strip, New York authorities allowed it. California Chrome finished fourth, but he ultimately earned more than $14 million throughout his career while wearing nasal strips.

Take-Home Message

Horses can develop a variety of breathing problems—either inflammatory and/or mechanical in nature. The effect of these conditions becomes obvious when horses exercise. Manage all horses using good husbandry to minimize dust and other air contaminants. If your horse develops problems, get a veterinarian involved early so he or she can diagnose the problem accurately and help you develop a treatment strategy, which might include medication. Surgical options are especially helpful for horses that must perform at top speed. Wetting or steaming hay or using nebulizers or nasal strips are other management options that can help in some cases.