Thursday, March 25, 2021

COPD Explained, Part 1: An Introduction to Respiratory Conditions

As stated in previous blog posts, I wanted to take the opportunity to sit down and write out a mini-series of my journey with a COPD horse and what information I have come to find, understand, and follow. I wanted to take the time to talk about nebulizers, medications, and other supplements that I have tried, used, and trusted as I have worked my way through Annie's diagnosis, subsequent flair ups and navigated her way back to becoming a normal riding horse again.

I don't claim to have all the answers - in fact, the very first suggestion I have for anyone facing COPD/ RAO/ asthma/ heaves/ allergy related issues with their horse is to join the following Faceb00k groups that I found amongst my travels, because those wonderful people there are worth their weight in absolute GOLD. 

There is no one size fits all approach to this terribly frustrating and confusing condition, but the amount of support and love I felt from these communities was enough to keep me from completely losing whatever I had left of my mind when things were tough. While one of the three groups seem heavily British-based, there is a lot of good information (and relatively the same ideologies). I noticed there are a few newer technologies we have not implemented as hard over in the States/Canada (like the salt/ oxygen treatment rooms), but it's a good source of informational fodder, ideas, and support.

Salt Room Therapy

So for someone starting out - what does COPD even mean? And why is it that COPD, heaves, asthma, allergies, RAO, etc seem to be interchangeable terms when it comes to respiratory conditions in horses? Believe me, one of the very first things I did was get so overwhelmed with the terminology and the specifics of each condition.

COPD or Chronic Obstructive Pulmonary Disorder is essentially a catch all phrase for a multitude of respiratory ailments and conditions. But, I have found throughout my journey in this that the majority of terms are used interchangeably in both the amateur and professional level. For example, Annie was diagnosed with Recurrent Airway Obstruction by the first vet we saw, but diagnosed with asthma by the second. 

A normally functioning airway is tubular and open, able to 
receive air readily and easily. 
A damaged airway is inflamed, unable to regulate airflow and 
may also show signs of previous damage/stress.

So how do you distinguish the terms and what they mean?

Well - there are some subtle differences in the terminology. For example, asthma is a condition where the horse showcases exercise intolerance - often similar to humans. However, within the horse community and for most intents and purposes - the diagnosed word is not relatively important. In fact, I struggled over the fact one vet wrote "RAO" and another wrote "asthma" and tried hard to distinguish the two when in reality, respiratory illness in horses is not largely explored and a lot remains unknown. And for that reason, most terms are just sitting on the top of a very large umbrella that has yet to be studied and documented. 

The idea of respiratory illness can be categorized by several symptoms - most of which fall in to multiple categories, which is why it makes diagnosing and treating these horses exceptionally difficult. A true asthmatic horse should be exercise intolerant, but my personal mare, who was diagnosed as just that, is not. It can be confusing, because there is no consistency across the board for any of these horses and it makes finding a treatment plan doubly frustrating.

Each time a horse flairs, or reacts to it's environment/ trigger, the lungs
continue to become damaged. The sensitive cilia (hairlike projections on the 
cells), are damaged, broken, or paralyzed. This makes it even harder for a respiratory
compromised horse to recover and lead a normal lifestyle.

Throughout my journey with learning more about COPD, I have found the best way to describe it and all the other associated acronyms and names is simply this: it is a sensitivity to a specific trigger/ allergen that causes an adverse reaction. Full stop. There is no other rhyme or reason for the symptoms, period. For these respiratory sensitive horses, any trigger (whether it be alfalfa hay, dust, mold, or pollen) will evoke any of the reactions I have outlined below. The key, of course, is finding what the trigger is.

Like all conditions, respiratory distress can vary from mild to severe and can include a variety of symptoms. Sometimes, this can be confusing given that chronically severe horses may not exhibit all symptoms, but rather a singular symptom in a critical capacity. 

Difficulty Breathing 
Of course, the main and often most associated symptom with COPD or heaves is the inability for the horse to get a full, deep breath. These horses often have flared nostrils and a distinctive "lurching" of their abdomen as they attempt very hard to pull air in - more notably known as a "heave line". These horses often sound like they are gasping and/or wheezy, as it is similar to someone trying to suck air through a straw. Some horses are affected so severely that they will not eat, drink, or otherwise engage in their paddocks while others can be affected only during exercise - in severe circumstances, weight loss is prevalent. 

A severe heave line.

Most breathing issues worsen during the hotter and more humid parts of the day, which makes it difficult to manage horses who live in desert-like climates. Simply stabling them during the hottest portions of the day is not often helpful, as stagnant air with dust from bedding, hay, and surface molds in the barn can further aggravate their condition.

Respiratory rates can double - even triple - during an intense flair and it's important to know what your horses resting rate is. A good rule of thumb is 8-12bpm, but it is not always an accurate representation of the individual horse. For example, both Annie and Spud hover consistently around 12-14bpm at rest.

Flared nostrils at rest is a very concerning sign.
It's always best to know your horses regular
breathing rates.

The coughing can range from moderate to severe - in more moderate cases it sounds like a simple attempt at clearing the wind-pipe, and the horse is happy enough to continue wandering their paddock as they do so. In more severe cases, the horse will be unable to walk and the head and neck are thrown downwards as a very large (or several large) coughs come to the surface. In some situations, mucus and/or food will expel from the mouth. In the cases of mucus, you need to be very careful you are not dealing with infection.

An accumulation of mucus that Annie coughed out 
Fall of 2019. The white-ish color is indicative of an 
allergic response and the slight yellow-ish tinge
also is signalling the beginning of an infection.
(PSA: This is why it's important to trust your Vet - I texted these photos
and was told "not to worry". I should've trusted my gut.)

In my own horse, I dealt a lot with coughing episodes and mucus production. On the good days, the coughs were spaced out along the course of the day, and on the bad days, the coughs were repetitive and almost unwavering. There was a level of discomfort I could clearly observe in Annie as she had these coughing fits, and several times they produced a thick, white-ish/green globe of mucus that would be expelled from her mouth.

^ A short clip of the coughing we battled in the Summer of 2020.
This was prior to her lung wash/scopes.

Runny Nose/ Eyes
The nostrils may also be the victim of excessive semi-clear fluid or greenish mucus. The consistency is usually sticky malleable - it does not evaporate if you roll it between your fingers. Additionally, the eyes can show tear streaks that extend down the face or have a bit of "gunk" in the corner of the eyeball.

If there is a watery and clear discharge from the nostrils, it is most likely "normal". However, yellow and/or green globules of discharge is not normal and can be indicative of an infection. Of course, other conditions can cause colored discharge (ie. choke), so it's important to examine texture, frequency, and the horse's other external features. 

While this photo is of mucus accumulation when she 
was sick (horse cold) Summer of 2019, it is very similar to
mucus seen in COPD horses.

In my personal experience, Annie had only two symptoms - coughing and mucus production. However, there are horses out there who also have mild COPD that exhibit difficulty breathing and heave lines during times of flair ups.

Which brings me to the next question - what causes this condition? 

Essentially, horses who have lung damage (from environmental factors or illness) are all in the high risk category for getting COPD. 

There are certain horses who are at a higher risk of developing
respiratory conditions.

So what are some examples of this?
1. Excessively stabled horses in dusty environments (think bedding, lack of ventilation, etc.)
2. Horses fed moldy or dusty hay
3. Horses stabled in barns with lack of ventilation
4. Horses stalled or pastured in an area with excessive mold or pollen spores/ allergens
5. Horses who have gotten sick and/or have a compromised immune system.

 In Annie's case, a common horse cold that knocked her on her butt did enough damage to her lungs that she developed sensitivities to certain things in her environment and when exposed to these sensitivities, she simply reacts. 

For a lot of owners on the various Faceb00k pages, sometimes all
it takes is being fed one moldy roundbale to cause permanent damage.
I don't mean to scare people - but I don't think the general population
recognizes how frighteningly easy it is to cause this condition.

With all of this being said, the management of COPD conditions comes down to one thing - locating the trigger and either eliminating it or reducing it to a manageable level. It can be daunting to try to locate the source, especially if you've tried and tested the "obvious" suspects (ie. increasing turn out/ fresh air, removing moldy hay/ feed). No one horse will have the same trigger(s) and display the same symptom(s) - which is singlehandedly one of the most confusing and head-scratching things about this. And even more so - every horse responds differently to different medications, supplements, and tinctures. There is no one size fits all approach here, and it tends to take a lot of guess work to find the right formula (and then the season changes and you have a whole new ball game with the increase of pollen and/or fungi spores in the air). 

One thing to remember is that there IS light at the end of the tunnel - managing a COPD horse is very frustrating, but it also brings a lot of reward when things work out and go accordingly. 

The next installment is going to focus on diagnosing the COPD horse - what kinds of procedures are available, what information they provide, and what kind of diagnostics you can ask your Vet about. There is a definitive learning curve on understanding veterinary medicine and while I do not claim to be a Vet or have the amount of knowledge they do, as a horse owner, we need to be an advocate for our animal. I am passionate about researching and understanding procedures because if I hadn't of taken the time to get that knowledge and ASK for the procedures to be performed, Annie would still be suffering. Outwardly, she was relatively healthy, and the drugs we initially prescribed were working, but it wasn't enough for me. Knowing what the "next steps" were was immeasurably helpful and I hope some of this information lands in the lap of someone who really needs it.


  1. Interested to follow your journey with this - Phantom has asthma and I haven't been real happy with her respiration when under saddle of late, despite being given Ventipulmin. I might have to start looking at other options and testing for her.

    1. It is such a frustrating condition, that's for sure. I can't say that all horses can be managed - because there are those extreme cases, but for the most part, "most" can lead relatively comfortable lives. I am still bracing myself for Spring (and pollen), but crossing my fingers my girl can stay happy and healthy regardless of the season.

  2. Thanks for providing all this useful information in one place.

    1. Trying to :)
      I found it very overwhelming trying to get all the info I needed

  3. This is a frustrating condition and you're right when you say no one treatment can work for each horse. My daughter had a horse with this condition and he was treated with different meds at different times. He had nebulizer treatments, different feeds and she even tried straw bedding because it wasn't as dusty as shavings. We don't feed round bales but the bales with flakes, he had his soaked sometimes. He also had allergy tests and a lung wash. There was never really a definite diagnosis. She did everything she could for him and he managed to have a good life. Our horses spend all day outside and even stay out at night when they decide to because we think it's better than being in a barn all the time. So I know what you and Annie are going through and I think you have a very good handle on how to treat her. Good luck with her treatments.

    1. Isn't it just frustrating sometimes?!
      I admire you and your daughter for managing her guy - it isn't an easy condition to maintain in the slightest.

  4. excellent summary of information -- i had no idea how easy it is to trigger this sort of reaction in horse. in one way, i feel lucky to not have had to deal with it yet. in another way... i'm glad you posted this bc my horse has a tied back airway and thus an already compromised respiratory system. anyway, i know i said this to you a while back but i'll say it again: major kudos for trusting your gut in getting Annie the care she needed, esp in the face of pros who shrugged it off. Annie's lucky to have you!

    1. I didn't until I went through it with Annie!
      Quite literally the only thing that set it off was her being quite sick the Summer before - I would have never guessed she would've dealt with COPD as a byproduct of that "horse cold" she had.

      Thank you <3 I'm glad I trusted my gut too