Approach to the treatment
Treatment is best broken down into 3 stages:
- Relief of acute signs.
- Antiinflammatory treatment.
- Long-term control.
1. Relief drugs
These remove the stimulus for cough and bronchospasm, thus
enabling the horse to breathe easier immediately. For horses in the early stages
of SAID, bronchodilators can help the horse continue to work. For horses having
difficulty breathing (e.g. heaves), bronchodilators are used to open their air
passages and give immediate relief.
by Trudell Medical Group
2. Antiinflammatory Agents
The next stage of treatment is aimed at reversing the inflammatory
cascade. Removal of allergens (e.g. hay which contains mold spores) is the most important
factor. Corticosteroids are the most effective drugs to reverse inflammation. Once there
is significant improvement noted in clinical signs, aerosolized (inhaled) drugs can be
started for long term control to prevent recurrences. Antiinflammatories are generally
used for long term control. The inhalation route allows reasonably high doses of
corticosteroids to reach the airways with minimal spill-over into blood. This reduces the
likelihood of side effects (e.g. laminitis, immunosuppression, or adrenal gland
3. Long-Term Control
Of course, the most important aspects of long-term control have
nothing to do with drugs. Avoidance of dust, hay, and air pollutants, and
lowering the incidence of viral infections by vaccination are the most important facets to
prevent SAID. Even with these efforts, much SAID and COPD in New England and other regions
is seasonal--hay can not be implicated as the primary cause, so environmental control
alone is not sufficient.
Click here to see
video of an SAID racehorse after treatment
Current Treatments Used for SAID
ALWAYS get a correct diagnosis before treating horses
for SAID. The most common cause of treatment failure is misdiagnosis! SAID may not
be the only problem. Your horse may show exercise intolerance because it is sore, in
which case there may be a musculoskeletal injury.
Treating your horse for SAID can be a test of SAID, but it is better to
have a diagnosis of exclusion based on a CBC, endoscopy, and TTA, or a definitive
diagnosis with BAL and lung function tests.
EFFICACY AND SAFETY OF TREATMENTS:
***Most of these treatments have not undergone
controlled clinical trials.*** However, based on their use in hundreds of patients, we've
gone out on a limb to publish guidelines in this WebSite.
As recommended withdrawal times become available, we shall provide them
to you. For now it is your responsibility to withdraw the horse from treatment at a
reasonable interval before competition. See governing bodies for recommendations (FEI, AHSA).
All horses with a diagnosis of SAID initially receive a bronchodilator
to facilitate training. At the same time, an anti-inflammatory agent is
started to treat the primary problem, airway inflammation. Bronchodilators do nothing to
reverse inflammation, which is at the heart of SAID; rather, they simply help the horse
breathe, work, and stay fit, until it can get back on its feet.
Anti-inflammatory agents are essential to reverse the disease. The
combination of a bronchodilator and an antiinflammatory agent is ideal, but the exact
combination of drugs and their doses depends on a number of factors, such as the results
of lung function tests, type of inflammation (e.g. BAL cytology), the duration of the
problem, presence of cough, size/body weight of the horse, and horse's occupation.
EDUCATIONAL PRIMER ON TREATMENTS:
Typical drugs used to treat SAID are given below:
1. Bronchodilator (at least 30 minutes before exercise) is used in all horses with a diagnosis of
SAID. They are only used in the firs cople weeks of treatment, then only as needed ask
your veterinarian). The following bonchodilaors are listed in order of the author's
Albuterol: (5 inhalations = 450 mcg)
Combivent: (5 inhalations = 550 mcg albuterol + 100 mcg ipratropium
Ipratropium bromide (5 inhalations, 90mcg)
Salmeterol (SereventR, 5-10 inhalations once or twice per day, only for
horses with heaves that need 24 hr - 7 day/wk control).
For mild SAID without increased neutrophils: mild
exercise intolerance, occasional cough, near normal baseline lung function, airway
hyper-reactivity, and increased mast cells (>2%) in BAL fluid:
- Nedocromil sodium (TiladeR) 8-12 puffs twice per day.
- Disodium Cromoglycate (IntalR) 8-12 puffs twice per day.
For mild SAID with increased neutrophils (>5, <15%):
Weeks 1 and 2:
- Fluticasone inhaler (FloVentR 220) 8-12 puffs once per day.
Weeks 3 and thereafter:
- Fluticasone inhaler (FloVentR 220), 8-12 puffs every other
day, or contiue on once/day if signs recur.
For moderate to severe SAID: moderate to severe exercise
intolerance, persistent cough, abnormal baseline lung function, response to
bronchodilator, and increased neutrophils (>15%) in BAL fluid.
***Note: When giving oral Prednisone, we suggest mixing
prednisone tablets with a liquid, as straight tablets may not be absorbed well.***
- 0.8 mg/kg Prednisone orally twice per day,
- 0.6 mg/kg Prednisone orally twice per day,
- 0.4 mg/kg Prednisone orally twice per day,
- Fluticasone inhaler (FloVentR 220, 8-12 puffs per day; Use 8
puffs per day for 800 lb horse, and 12 puffs per day for 1500 lb horse).
- 0.4 mg/kg orally once per day.
- Continue Fluticasone inhaler (FloVentR 220, 8-12 puffs every
After Week 4:
- Continue Fluticasone at 8-12 puffs every other day.
- Use a bronchodilator (albuterol or ipratropium bromide + albuterol) to
control cough and bronchospasm.