Coughing is a common clinical sign observed with many different diseases in horses. It can be seen in any age or breed of horse. Coughing is the result of the respiratory system trying to remove debris from the trachea and upper airways. Show
Symptoms of Coughing in HorsesCoughing may occur at the beginning of exercise, which can be normal. Persistent coughing through exercise, or at rest, indicates more serious inflammation or infection. Some horses may cough during eating, or if they’re stalled consistently. You may see coughing after a long trailer ride, or after contact with new horses. If your horse is coughing more often than a few times during exercise, exhibits any additional signs such as snotty nose, lethargy, or fever, placing your horse in quarantine and calling your veterinarian for a work-up is recommended. Causes of Coughing in HorsesSome causes of coughing are contagious between horses, whereas others are due to inflammatory processes. Pneumonia This can occur from bacterial or viral infections, or after aspiration during a choke episode. Rhodococcus is the number one cause of pneumonia in foals under six months old. Influenza and other respiratory viruses Similar to people, respiratory viruses in horses are usually highly contagious, and characterized by cough, fever, and nasal discharge. You may also see depression, decreased appetite, or edema (swelling) in the legs. Younger horses are more commonly infected, and outbreaks can occur easily where these animals congregate, like during races, shows, and sales. Horses may start to show signs in as little as 1-2 days after exposure. These horses also become at-risk for developing secondary concurrent bacterial infections. Heaves Formerly known as Recurrent Airway Obstruction, heaves is a chronic condition similar to asthma in humans. Inflammatory Airway Disease (IAD) IAD is similar to heaves, but is commonly seen in younger horses and does not typically include increased respiratory effort/rate at rest. Hypersensitivity to an allergen like mold or dust causes an influx of inflammatory mediator cells and white blood cells to flood the lungs repeatedly, causing inflammation. If left untreated, IAD can progress to heaves in later years. Parasites In foals, Ascarids can create lung damage. In adults, lung infestation is rare, but can occur primarily by transfer from infected donkeys. These worms can cause damage to the lungs and inflammation as the body reacts to the foreign visitors. Congestive Heart Failure Severe heart failure can lead to fluid backing up into the lungs. How Veterinarians Diagnose Coughing in HorsesYour veterinarian will perform a thorough physical exam, including lung auscultation (listening through the stethoscope) to check for crackles and wheezes, which can be signs of inflammation or fluid present. They may also perform a “rebreathe” exam, which involves placing a bag over your horse’s nose for 30-45 seconds. When they remove the bag, this will make your horse take a few big breaths, which allows for better auscultation. Additionally, a CBC may be evaluated for the presence of increased white blood cells, which will be seen with infection. Other diagnostics might include:
Treatment of Coughing in HorsesIf your horse has a bacterial pneumonia, your veterinarian will start them on antibiotics. Supportive care should be administered as needed, which might include anti-inflammatories (Banamine) or antipyretics (Dipyrone) to help lower fevers, and IV fluids if your horse is dehydrated. Horses with severe pneumonia may benefit from nebulized bronchodilators, antibiotics, or steroids to help open the airways and increase penetration to the lungs. If there is fluid build-up in the lungs, chest tubes may need to be placed to facilitate drainage. Viral-induced coughing is typically treated with supportive care as well, and antibiotics if a secondary bacterial infection occurs. For heaves and IAD, treatment is aimed at reducing inflammation; this is primarily done with steroids (Dexamethasone, Prednisone), anti-inflammatories, bronchodilators (Ventipulmin), and environmental management. For parasitic infections, appropriate deworming and potential steroids to minimize inflammation during the die-off process will be used. Horses with congestive heart failure may be put on diuretics such as Lasix to help reduce the excess fluid sitting in the body. Other medications can be implemented to help decrease blood pressure. Recovery and Management of Coughing in HorsesRecovery from an infectious respiratory disease may take up to several weeks to months, if severe. Exercise should be limited, and work introduced gradually once your vet gives the all-clear. Horses that have an inflammatory process causing their cough, such as IAD or heaves, may require long-term management to stay in comfortable, rideable condition. Medications such as bronchodilators and maintenance steroids may be used in addition to changes in husbandry (housing/feeding) practices. Husbandry practices that are commonly recommended to reduce coughing include:
If not managed well, coughing will lead to exercise intolerance, increased risk for respiratory infections, and chronic, irreversible inflammation of the lungs. Coughing in Horses FAQsWhy is my horse dry coughing? Coughing is a respiratory mechanism to help rid the airway of debris, dust, and other irritants. Coughing a few times during warm-up before exercise is common, as the horse begins to exert more effort. Can worms cause coughing in horses? Yes. Larvae of the lungworm Dictyocaulus arnfieldi, typically harbored by donkeys or mules, can be ingested by horses. Once the larvae mature, the females will reside in the lungs and cause inflammation and irritation. This can be difficult to diagnose, since eggs won’t always show up on a fecal exam. Typically, coughing caused by worms will be determined through a history of living with mules/donkeys, and a lack of improvement of cough with antibiotics. Lungworm infestation can be treated with Ivermectin or Moxidectin. Featured Image: iStock.com/klosfoto
All horses cough from time to time during the warm-up. But what should you do if your horse starts coughing like crazy? Or if he is coughing in the stable? Which types of cough are harmless and when should you call the vet? Dr Cornélie Westermann from the Faculty of Veterinary Medicine in Utrecht describes various different types of coughs and explains what you can do to help prevent them.
 'Coughing in horses is so common that many people have come to think it’s normal, but actually it’s not.' Dr Cornélie Westermann is a specialist in equine internal diseases at the University Clinic for Horses (UKP) of the Faculty of Veterinary Medicine in Utrecht and an expert in lungs and airways. 'A horse's lungs are ‘designed’ for walking outside 24 hours a day, always in the fresh air. As a result, it’s unnatural for us to keep horses indoors. In a stable, horses are exposed to dust, viruses and bacteria. This can irritate the airways and make them cough.'
Coughing is a defensive reflex system for the lungs, she explains. 'There are so-called cough receptors in lots of places in the airways and lungs. These receptors react to irregularities, such as dust particles, bacteria, mucus and viruses. As a reflex, the horse starts coughing in order to clean its lungs and airways. Coughing has the great advantage of protecting the lungs. It helps to expel rubbish that doesn’t belong in the lungs and airways. But if a horse coughs frequently and intensely, this will have adverse effects. It’s tiring and uses up a lot of energy. And because a horse can’t cough and eat at the same time, he may lose weight. Although the lungs have a great capacity for repair, chronic coughing can damage them permanently. That’s why it’s important to treat a coughing horse in good time and to eliminate the cause of the coughing as much as possible.' A horse can have many different coughs. Sometimes they seem the same, and sometimes one cough can turn into another. Dr Westermann: 'The least serious cough is the ‘I'm outside’ cough. When you take your horse out into the fresh air on a cold day and start working, a lot of cold air suddenly flows past the cough receptors. This gives the lungs an incentive to cough. It's rather like going for a run yourself on a chilly day.' There is no need to worry about this kind of cough. And if your horse has a bit of a cough every time you warm him up, there’s no need to call the vet either. 'If you take an endoscopy of the airways of a healthy horse, you will usually find a few bits of mucus. These are worked outside through the airways and this triggers the cough. It’s nothing to worry about.' Autumn coughIn the autumn and winter, more viruses start to circulate in the stables because horses are often kept inside for longer periods. Many viruses are harmless and the accompanying cough will often go away after a few days. Gentle exercise in the open air can help to get rid of the mucus. To be on the safe side, a horse with wet nasal discharge should be separated from other horses. If in doubt, you can always call the vet. Dr Westermann is very clear about when coughing does form a cause for concern: 'If your horse is not only coughing but also stops eating, is lethargic and/or has a fever, be sure to contact your vet. If a watery discharge comes out when the horse coughs, it will be flu or another viral infection. If pus-like mucus comes out, bacteria are probably involved and the horse may have a lung infection. Fortunately, this doesn’t happen very often.' Persistent cough while being riddenA cough during the warm-up isn’t too bad, but it’s not a good sign if your horse keeps coughing while being exercised. Dr Westermann: 'It means his body is trying to expel material from the deep airways, towards the outside. In this case, it’s important to establish the cause. A bronchoalveolar lavage (BAL) or lung wash is a simple and relatively horse-friendly way to find out. The horse is sedated for this examination and the cough reflex is temporarily dampened. A thin silicone tube is then inserted deep into the lungs. A small balloon at the end temporarily seals off a section of the lung. Using a physiological saline solution at body temperature, cells are then rinsed from the alveoli and prepared for the microscope in the laboratory, counted and interpreted by an equine internal medicine specialist at our clinic. This can be used to determine whether there is irritation of the lungs or an allergy, for example.' Equine asthmaMany horses are sensitive to dust and other airborne particles. This can cause mild coughing symptoms, but in serious cases can also lead to severe equine asthma. Dr Westermann: 'In horses with equine asthma, there is an inflammatory reaction of the airways. Every time they come into contact with an irritant or allergen, the reaction is triggered and the mucous membranes swell up. A chronic cough can cause the muscles in the airways to become thicker, leaving less room for air. If it is very bad, the alveoli can stretch (emphysema). This will make your horse short of breath. If you don't intervene, the lungs can get damaged.' You can tell if your horse is short of breath by checking its breathing. Stand diagonally behind your horse and look at its flanks. The abdomen should move a little, but shouldn’t be heaving. 'If a horse breathes faster than fourteen times a minute at rest, that’s not good. In addition, he shouldn’t ‘nostril flare’ or show anal movements when at rest. The nostrils should remain calm. We can conduct a lung pressure check in the clinic to see if the lungs are still ‘elastic’, which medication a horse still responds to and what the prospects are based on that.' At the clinic, the vicious circle of coughing can be broken by treatment in the special steam room. A physiological saline solution is nebulised in this room. The horse breathes it in, which loosens the mucus in the lungs and airways. 'However, treatment won’t help if you don’t take a critical look at your stable management at the same time. Medicines that dissolve mucus, inhibit inflammation or open up the airways can be administered by mouth or via inhalation masks. They will soothe the lungs and provide relief for your horse. But if you don't eliminate the cause of the coughing, it will start again as soon as you stop treating it.'
According to Dr Cornélie Westermann, nine times out of ten the horse is coughing because of the environment in which it is kept. 'If a horse doesn’t look sick but is coughing in the stable, call the vet. If he is expelling mucus, whitish slime, the cause can usually be found in the stable management. This means looking at the bedding, what the other horse owners in the yard are doing, where the hay/straw is stored and things like that. Once you have identified the cause of the coughing, you can look for a solution.' Then it’s time for what she calls ‘CSI Stable’. 'You may not realise it, but there is an incredible amount of dust in stables. A horse that may not be particularly sensitive to dust at first can become so if exposed to it for long enough. You should therefore join forces with the other horse owners at the stables and work together to make the stables as dust-free as possible. Good cough management pays off, it really makes for much happier horses.' Bird allergyDr Westermann also advises finding out step by step how you can make your horse's life more enjoyable. 'If it’s too hot in the stables, it’s not good for the lungs. The ideal temperature for a horse is ten degrees. A dust-sensitive horse will generally be less affected when it is cooler. The air humidity also plays a role, as does the removal of ammonia. Ammonia stimulates the cough receptors. This can lead to a dry cough. Initially, this won't cause any internal damage, but it is a nuisance for the horse.' Often, people don’t realise that horses can also be allergic to birds. Although a stable is a very nice environment for birds, if you have a pigeon perching above your horse and it is bothering him, the best thing you can do is try to remove it. 'A horse that is allergic to birds and has a bird perching above its stall again after a quiet period can be back to square one, developing long-term coughing problems again. And if you’ve got everything in perfect order in the stable and your dust-sensitive horse is put in a stall with straw bedding at a competition, it can struggle for weeks afterwards. Also, don't forget to have your horse vaccinated against influenza every year. Equine influenza is a very nasty disease. It can kill your horse, but it also makes airways very sensitive to dust stimuli.' There is one type of cough for which Dr Westermann thinks management should be completely different: a coughing horse who is allergic to fresh grass, i.e. the pasture. 'While spending 24 hours a day outside is ideal for most horses, these horses need to be stabled.' Investing in healthy lungsHorse owners often spend a lot of money on all kinds of natural cough remedies that have not been proven to work, concludes Dr Westermann. 'My advice would be to save this money and put it into getting your barn management in order and buying a hay steamer, for example. If a horse continues to cough, even after you have changed your stable management, call the vet. Lungs have a great capacity for recovery, but prolonged coughing won’t do your horse's alveoli any good. If you take action in time, you can stop things getting worse.' BeddingWhen it comes to bedding, research has shown that straw is usually extremely dusty. 'Straw makes wonderfully soft bedding, but it's full of dust', says Dr Cornélie Westermann. 'You wouldn’t make a person who is sensitive to dust sleep on a bed of straw. Dust-free wood shavings are a much better alternative. All the same, you need to understand that a lot of dust is released into the air while you are mucking out and spreading/shaking out sawdust. If possible, you should therefore put your horse outside for an hour while you are sorting out the stable. And whatever you do, don’t put a dust-sensitive horse at the entrance to the stables where everything happens and passes. It’s better to put him in a quiet place with plenty of ventilation. In many stables, hay and straw are stored in the loft. This often creates an unnecessary amount of dust in the barn. It’s also a good idea to hose down the corridor before you sweep it. Also spray the container in dry weather. Common sense will already take you a long way.'
According to Dr Cornélie Westermann, there is often a lot to be gained in the area of feed management. 'For each individual horse, you will need to work out the most ideal solution. Dry hay is fairly disastrous for sensitive horses. A horse that has sensitive airways due to a previous virus or cold and has to raise its head to a hay net containing 53,000 dust particles per mg is bound to cough. As horse owners, it’s actually unkind of us to let that happen. It does make a difference to the amount of dust that is inhaled if the hay is placed on the ground or on an elevation rather than in a hay net or rack. If your horse would benefit from a hay net because of its stomach, for example, at least don't hang it too high, but make sure it is safe.' Silage is dust-free, which is why she recommends feeding it to a coughing horse. 'And if your horse really doesn’t like silage, you can soak the hay. This reduces the amount of dust by about sixty per cent. Soak it in water for 15 minutes before feeding. However, this is quite a task, especially in winter when it is cold and freezing. Furthermore, the soak also flushes nutrients out of the hay. As a result, a better alternative is to steam your hay. This is an effective way of making your hay dust-free. In a good hay steamer, dust is reduced by 96 percent and fungi and bacteria by 100 percent. This has been scientifically proven. Most horses like to eat steamed hay. Although a hay steamer is pricey, you get what you pay for. Invest in quality and consider a joint purchase with other people at the stable.' DiscoDraught-free ventilation is important for a good stable climate. You can easily test whether the stables are well ventilated. Simply buy a disco smoke machine for a few dozen euros, put all the horses outside and place the device where you would normally let the air in. Then see where the smoke goes. Cornélie Westermann: 'The air should circulate through the stables and get to all the stables and horses. A good stable builder can advise you on optimum ventilation. Interventions don’t have to be expensive, either. If the entrance to the stable faces the wind, this will cause a draught. This can be overcome with windbreak mesh. Air intake from under the eaves and ridge ventilation will ensure good air circulation.' The full article appeared in the Bit magazine in November 2018. For more information about the University Equine Clinic, visit the website of the University Veterinary Hospital. |
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