CURRENT TREATMENT OPTIONS

Approach to the treatment of SAID

Treatment is best broken down into 3 stages:

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.

Equine Aeromask^TM 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 suppression).

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.

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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 preference:

Short acting:

Albuterol: (5 inhalations = 450 mcg)

Combivent: (5 inhalations = 550 mcg albuterol + 100 mcg ipratropium bromide)

Ipratropium bromide (5 inhalations, 90mcg)

Long-acting:

Salmeterol (SereventR, 5-10 inhalations once or twice per day, only for horses with heaves that need 24 hr - 7 day/wk control).

2. Antiinflammatory treatments

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 (Tilade^R) 8-12 puffs twice per day.

                          OR

• Disodium Cromoglycate (Intal^R) 8-12 puffs twice per day.

For mild SAID with increased neutrophils (>5, <15%):

Weeks 1 and 2:

• Fluticasone inhaler (FloVent^R 220) 8-12 puffs once per day.

Weeks 3 and thereafter:

• Fluticasone inhaler (FloVent^R 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.***

Week 1:

• 0.8 mg/kg Prednisone orally twice per day,

Week 2:

• 0.6 mg/kg Prednisone orally twice per day,

Week 3:

• 0.4 mg/kg Prednisone orally twice per day,
• Fluticasone inhaler (FloVent^R 220, 8-12 puffs per day; Use 8 puffs per day for 800 lb horse, and 12 puffs per day for 1500 lb horse).

Week 4:

• 0.4 mg/kg orally once per day.
• Continue Fluticasone inhaler (FloVent^R 220, 8-12 puffs every day).

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.