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HEAVES/COPD BREATHING

Click HERE to purchase Equine Heave Ho Powder.

See Dr. Reilly lecture on the link between COPD and Insulin Resistance at The Equine Affair in Springfield, Massachusetts November 7 - 10, 2019. Learn More.

Proper diet and exercise is essential for horse health. This product is a supplement to help maintain horse health. This product is not intended to diagnose, treat, cure, or prevent disease.

Equine Heaves/Equine COPD - Many Names For The Same Airway Problem:
1. Equine Heaves/Equine COPD has many names for the same condition:
  - Equine Recurrent Airway Obstruction (RAO)
  - Equine Small Airway Inflammatory Disease (SAID)
  - Equine Asthma
  - Equine Allergic Airway
  - Equine Chronic Obstructive Pulmonary Disease (COPD)
  - Broken Wind
2. Equine Heaves/Equine COPD in horses, as they age, COPD signs become more and more evident. Average age of a horse starting to show signs of Heaves is 8-10 years old. Horse COPD/Asthma and Human Asthma have the same signs – thick mucus in airway, labored breathing.
3. Equine Heaves/Equine COPD is worldwide with usual onset at 8-10 years old with both sexes equally affected. It can effect any breed equally.
Click here to see Dr. Mazan’s study in Horse on Breathing Easy: Managing Horses with Asthma.
* A staggering 25-80% of stabbed horses in the USA are estimated to have COPD/Asthma according to a Tufts University Veterinary School report.
Equine Heaves/Equine COPD - Diagnosis of Equine Heaves/Equine COPD
1. First of all, there are 2 forms of Equine Heaves/Equine COPD:
- Year Round – In winter and spring, signs seen more strongly, but struggles all year. Horse can get problems with 3 inches of snow on the ground.
- Summer Heaves – also known as pasture-associated Heaves – trees, grasses blooming, and horse starts showing signs. Seen more strongly in early summer and early fall (leaves dying so allergens up). In winter is normal.
2. Stages of Equine Heaves/Equine COPD
- Early Stage:
  - Exercise intolerance at end of race, end of trail ride when did not have problem prior. No energy at the end of the ride and seems to get worse with time.
  - Coughing more.
  - No fever, blood work all normal, looks healthy. Cultures for bacteria are usually negative unless a secondary infection has occurred where there is a bacterial growth in the mucus created by Horse COPD.
  - Mild nasal discharge but very watery, thin mucus – not yellow, green.
  - Breathes about two times the normal rate at 24-30 times a minute.
  - Reactions to vaccines more often than other horses – probably due to hypersensitive immune system.
  - Many horses with skin allergic conditions like hives from bites or Equine Summer Eczema appear to be more prone to Equine Heaves.
- Chronic Stage (Often called Heaves or COPD)
  - Exercise ability much less – can overheat, exhausted due to so much energy used to breath. Why? Due to less oxygen in blood. Your horse can’t get proper oxygen to muscle, and other parts of the body. Low oxygen levels due to COPD is proven. Click here to see Dr. Dixon’s study in Equine Vet J., on Pulmonary artery pressures in normal horses and in horses affected with chronic obstructive pulmonary disease.
  - Coughs more and more.
  - No fever, blood work normal, but mucus is a good media for bacteria to grow in, so mild lung infections on top of mucus of Heaves. Antibiotics help a little but never clear up cough or nasal discharge. Sometimes nasal discharge colored but usually just large amounts of clear, thin mucus.
  - Even at rest is “puffing” just like ran Kentucky Derby.
  - Weight loss
  - Grunt – exaggerated exhale – trying to force air out of airway. Also, will see exhale, and then exhale again – a double exhale later on. Finally, see a line along the rib cage of hypertrophied muscle – “Heave Line” from this constant forceful exhaling.
  - Condition worsens when exposed to allergens – hay/bedding. Worse when indoors due to higher counts of allergens. Worse with round bales in the field due to higher allergens. Horse Heaves also worsens in humid/hot weather – above 80% humidity, cases will increase. Many horses are already too hot from strenuous exercise of breathing too hard and hot weather on top makes it worse.
  - Scoping – “Excess neutrophils seen on cytology and confirm presence of lower airway ROA” – Dr. House, AAEP. In most cases of allergic airway in other animals, mast cells and eosinophils are seen, but in horses it is neutrophils. Dr. Lavole, University of Montreal Equine Professor, Geneva Conf. 2009.
  - Chest X-rays/Ultrasound – May see lung changes but tests are not specific enough to diagnose Equine Heaves/Equine COPD.
  - Heredity – “Incidences of ROA in horses with healthy parents is approximately 10% which increases to 44% if two parents are affected.” Dr. House, AAEP.
  - Age – Average horse, according to literature, is between 9-12 years old, but we have seen cases much earlier (5-7 years old).
  - “Skin tests do not predict allergens that will cause Heaves.” Dr. Robinson, Michigan State University College of Veterinary Medicine, July 2012, Veterinary News.
Equine Heaves/Equine COPD - Aerosols (Inhalers) in Equine Heaves/Equine COPD.
1. There are pieces of equipment that go over your horse’s nose or are placed up to a nostril in order to apply inhalers. These are special order items that are an expense to you.
2. Your doctor may ask you to have some for daily use, some for possible emergency use – there are three main types:
- Steroids – “Fluticasone inhaler after induction of severe Heaves resulted in complete resolution of clinical signs, normalization of pulmonary function tests and significant decrease in BAL neutrophils.” Dr. Giguere, University of Florida Veterinary School., Vet Immunopath, 2002.
- Bronchodilators
- Mast cell stabilizers
3. It is extremely important to get the right inhaler – there are two types and if you get the wrong type it will not go one (1) inch up your horse’s nose and just cost a lot of money.
- Aerosolized – for horses
- Diskus powder – requires strong inhalation – not for horses
4. Inhaler steroids have the advantage of sending medications right to the problem area of the airway without having to treat the whole body as in oral or IV meds. This allows a lower dose of steroid to be used.
WARNING:
Inhaled steroids, just like oral or injectable steroids, can create Insulin Resistance (IR). If your horse is already IR, you need to know these can make IR worse/Laminitis trigger. See article showing 1 single dose of Flumethasone created hyperinsulin levels in blood in animal studies. Click here to see Dr. Sternbauer’s article in Zentralbl Veterinarmed A., 1998, Fluemethasone-induced insulin resistance in calves.
5. Cost of inhalers is an important subject – need to look at prior to buying equipment. 8/2013 – CVS Pharmacy.
- Advair (steroid/bronchodilator mix) – $348.99
- Albuterol – $54.99
- Steroid (Flovent) – $158.99
Veterinarians have advocated 8-12 puffs a day of Fluticasone for 2 weeks then go to every other day – so you can go through two of the Flovents in less than 3 weeks at the cost of over $300.00. Yearly use runs over $2500.00 for just the Flovent Steroids.
6. For most owners, the cost and labor of doing this on a daily basis is too much – a great concept but difficult in the usual world of horse owners.
Horse Anhidrosis/Non-Sweating in COPD: Prevalence in the population
1. Important Fact: 65% of your horse's ability to release it’s body heat is in sweating.
2. Veterinarians see that horses who are overweight have a greater tendency to have Anhidrosis. Estimates from Virginia’s veterinary school has approximately 50% of the horse population as overweight, so it’s now seen more frequently.
3. There are many studies showing a connection between IR (insulin resistance) and COPD - so these laminitic IR horses are more likely to have COPD and Anhidrosis.
4. COPD horses all have heat stress issues from anhidrosis. With different degrees of COPD, there are different severities of Anhidrosis.
5. Research at the University of Florida points to approximately 2-6% of horses have Anhidrosis. So, 160,000 - 480,000 horses in the USA. Click here to see Dr. Mallicote’s Article.
6. Research in Glasgow puts cases of Anhidrosis at 10-15% of the population. 800,000 to 1.2 million horses. Click here to see Dr. Jenkinson’s Article.
7. One study finds horses moved from the midwest to the south are 2x more likely to get Anhidrosis. Click here to see LSU ag center
8. The 4 step Heave Ho program for COPD horses helps control Anhidrosis in several ways.
Horse Anhidrosis: What is Happening?
1. Sweating is required to help cool your horse - this includes cooling muscle to be able to exercise in warmer/humid weather. Any alteration in sweating will contribute to overheating in the body - at early stages this leads to heat stress.
2. Heat Stress Signs: Respiratory rates can double, triple, up to 4x-6x. Normal rates of breathing are 12-14 respirations a minute - can go to 60,70,80 a minute - puff like a freight train. Nostrils flared, pegged open even, wide-eyed, stressed. Rectal temps up to 101, 102, exercise ability drops. May be wobbly.
3. Heat Stroke Signs: Respiratory rates 2-6x, gums start to turn brick red instead of pink, can’t oxygenate body well, falls/collapses, possible coma, death.
4. Sweat pattern in Anhidrosis: Some will sweat but not enough, sme sweat only in patchy areas, some look like almost no sweating even after exercise and even though horses around them are sweating a lot.
5. Important fact: All COPD horses have some form of Anhidrosis, inability to handle heat like regular horses, stress more, puff more when more humid.
6. The 4 step Heave Ho program for COPD horses helps control Anhidrosis in several ways. Heave Ho alone will fail - Heave Ho powder is one step in four ESSENTIAL steps of our 4 step program!
Horse Anhidrosis: The Role of the Thyroid
1. Sweating in your horse is a complicated process - neural, hormonal, glands, temperature sensitive, genetics.
2. A study of thyroid function found there are differences in Anhidrosis horses - the response of TSH to TRH hormone is different/altered in Anhidrosis horses - Dr Brewhause, NC state vet school, 2004. Click here to see study. Click here to see study
3. Important Fact: In COPD horses, they ALL have low thyroid function and will test at the bottom of normal range = SUBOPTIMAL. We need them to be at the top of the normal range to help Anhidrosis - Why? COPD horses will test at 1.2 and the range at cornell of T4 is 1-3 - we need it at the top of normal ranges near 2.5, addin Thyrol helps in sweating better, reduces secondary lung infections due to the immune stimulant, helps muscles of breathing to aid in recovery.
  Consult your veterinarian to add low dose Thyrol (1 scoop = 12 mg in under 500 lbs, 2 scoops = 24mg in over 500 lbs) given once a day in the morning and retest TY levels in 30 days to see if it results in high normal levels. On For Life - cheap/easy. Insert thyrol pic (Low dose Thyrol can help avoid Anhidrosis.
  Low does Thyro-L can help avoid anhidrosis.
4. Does my horse hay Hypothyroidism with Anhidrosis? No, not true Hypothyroidism, horses are at the bottom of the normal range. Imagine it as a c+ in school, a passing but not ideal grade, we want it at the top of the normal range. We are not creating Hypothyroidism, very high doses of thyroid meds would be counter productive due to increased body temperatures. We want only to increase sweating and to stay in the normal range.
5. That's Interesting! In Europe and India, COPD is called “puff disease,” because the horses are breathing so quickly.
6. Thyroid Testing - Get The Numbers.
  -In testing, do not accept “it’s a normal” on any test - we know that - Get the range, get the T4 number of your horse.
  -Best T4 test lab? Cornell University provides quick and accurate results. Your vet can send samples there easily.
Horse Anhidrosis: What to do in a Crisis
1. Your horse is puffing like a freight train just standing in the field on a hot/humid day or your horse has only trotted a few hundred yards with you on a trail ride and is really struggling to breathe or your horse is wobbling around, about to fall over.
2. Puffing/Heat Stress, Walks Well
  - Get in shade
  - Run cold water over your horse's body for 10 minutes,
  - Offer cool water to drink. Put the hose in their mouth, and let them drink.
  - After 10 minutes, scrape off, towel dry, and get them in front of a fan.
  - Do these steps, respiration rate drops in ½ after 10 minutes of fans.
3. On A Ride
  - Get in shade
  - Stop riding
  - Give your horse water if there is a stream or your carrying it with you.
4. Heat Stress moving into Heat Stroke, signs of potential collapse. CALL YOUR VET IMMEDIATELY.
  - Keep outside - easier to help them when not in the aisle.
  - Keep in shade
  - Cold water hose
  - Hose in mouth
  - Scrape off/towel off or use fans
  - MEDS
    Vet may give Banamine to help reduce or stabilize body temperature. Vet may give Dexamethasone, if this helps it is important to understand, it is often mistaken as helping an allergy attack when in fact Dex will reduce body temperature by 1-2 degrees,which helps recovery. Vet may drench 3-4 gallons of electrolyte water to cool the core, and replace needs.
    
    Need Heave Ho Program Owners are very stressed when they feel that their horse is not able to breathe comfortably. This is when a plan is needed: “ok, this happened, what are we going to do so it doesn’t happen again?”
Horse Anhidrosis: Does Beer Really Help?
1. My wife has a COPD Icelandic with Anhidrosis - Beer does help this horse.
2. So how do you do it? ½ can of cheap beer (we use busch) in their morning feed, they love it. Yes this horse is also an IR horse, but Icelandics’ are very small (horses gets 20,000 + calories a day, ½ can is 60 calories, a drop in the ocean.
3. Old race track trick - some owners use Guinness stout and see great results.
4. Thoughts on why this works?
  -Increases B Vitamins
  -Yeast in beer can help gut
5. Get ready - They will knock you down to get to their breakfast once they know there is beer in it.
  Click here to read an article on beer for horses with Anhidrosis
Horse Anhidrosis: Why Heave Ho Program Works
The Heave Ho program is 4 steps:
1. Hay “flash soaked” to remove organic dust - helps to breathe better, that means cooling effects are better.
2. Omegas - adding chia seed to increase ALA omega 3 - Reduces coughing in a study - again, breathe better and cool better.
3. Thyroid function brought to high end of normal. Helps immunity to aid in less secondary lung infections. Less temperature problems in the body without infections. Helps breathing muscle, that helps cooling.
4. Heave Ho Powder -
  - High in vitamin E - 5800 IU/scoop in Heave Ho, is a validator that helps in cooling skin. Click here to see Dr. Wu’s 2005 study. Click Here to see Dr. Wu’s 2005 Study
  - Tea in Heave Ho is a validator Click Here to see Dr. Grassi 2013 Study
  - Adding vitamin E to a group of Anhidrosis horses helped in recovery. Click Here to seeDr. Rasheed 2010 Study
  - Lemon balm in heave ho is a diaphoretic herb that helps induce involuntary perspiration to cool the body. High dose vitamin E in Heave ho helps to avoid Anhidrosis.
Equine Heaves/Equine COPD Management and Treatment – Why Thyroid Powder Can Help
The Goal is to lower the amount of exposure to allergens (hay, bedding, mold, dust). Dust is not just powdered dirt – it contains many items such as bacteria, mold, organic plant allergens like hay, straw, endotoxins, and is called “organic dust”.
1. Eating hay outside/soaking hay if possible:
- Horses, even on inhalers given daily, still had lung inflammation when fed hay indoors, but “once moved outside, the horse’s lung function continued to improve and inflammation resolved”. Dr. LeClare, University of Montreal, The Horse, 2013.
- Hay outside can further be managed to lower allergens.
  - Soak hay 10 minutes prior to feeding in a Rubbermaid container. Do not use flakes of hay to soak. First must tear up flakes into loose hay, then vigorously shake out hay to lower dust, then place in a hay net, then put in tub to soak with a brick on top.
  - “No additional benefit from prolonged soaking. We found immersing hay until thoroughly wet had virtually the same effect as 16 hours soaking.” (on particle count) Click here to see Dr. Pirie’s abstract in Vet Sci Res., 2007, Respirable dust concentrations in equine stables. Part 2: the benefits of soaking hay and optimising the environment in a neighbouring stable.
  - Colder weather or boarding – may not have the ability to soak. Still take hay outside (do not do in the shed row) and tear up the flakes, shake out the dust, then bring back in if in the stall or leave outside in the field.
  - “Soaked hay reduced respiratory particle number by 60%.” Dr. Clements, University of Edinburgh.
  - • Round bales have more allergens and can really be a problem in horses even on full turn out. “Round bales high in endotoxin and organic dust content and prevalence of round bales is potential cause of treatment failure in horses on pasture.” Dr. House, AAEP.
- Hay steamers reduce allergens. This can help to avoid frozen hay.
2. Bedding: (#2 cause of Horse Heaves)
- Fluffy pine shavings is the best bedding for horses with Heaves. NO Sawdust. NO wood pellets (too dusty) NO straw, even clean straw. Full of allergens. The worst bedding possible in COPD horses.
- 20 times less dust particles with shavings versus straw. Click here to see article on Dust Concentrations in Equine Stables.
- Another option is using shredded cardboard. Click here to see a company selling this product. Airlite Animal Bedding.
3. Medicines:
- Oral Bronchodilators – Ventipulmin Syrup is given to open airways and lower spasms. Often, riders will give the 1-3 days on trail/shows (unsanctioned shows) – two times per day.
  * Note: After 5 days of continual use, this medication down regulates – its action stops or slows, so giving Ventipulmin for weeks/months in a row is a waste of time/money.
  - “Regular use of Beta-Agonists leads to tolerance to their bronchodilator effects.” Dr. Sarah Haney. Click here to see Dr. Haney’s article in Respiratory Medicine, 2004, Rapid onset of tolerance to beta-agonist bronchodilation.
  - “It is inappropriate to treat heaves with bronchodilators as solo therapy. Bronchodilators do not address underlying inflammatory problem and tolerance develops rapidly to Beta-Agonists (5 days) when administered along to horses with heaves.” Dr. Rush’s book. Equine Respiratory Diseases, 2004, page 193, Kansas State Veterinary School.
    Clenbuterol (Ventipulmin): USE WITH CAUTION IN INSULIN RESISTANT AND PAST LAMINITIS CASES.
1. Bronchodilator will increase Insulin in horses. “Insulin levels were higher in the group that received Clenbuterol.” Click here for article by Dr. Ferraz, J. of Equine Veterinary Science.
2. Human study showed it had profound effect on raising Insulin. “Raised serum glucose by 174% and Insulin to 379% of control.” Over three times the control! Within 30 minutes of administering. Click here for article by Dr. Edwards, Life Sciences
3. “Clenbuterol and exercise decreased blood volume by an average of 10% resulting in a DECREASE of aerobic performance.” Click here for article by Dr. Kearns, Med. Science Sports Exercise. So when on it, take it easy on the horse.
Dr. Reilly Comment: Good for short-term use of no more then 5 days in a row. I have seen an Insulin Resistant pony being controlled on Insulin for years, flip into Laminitis after on Clenbuterol for 30+ days in a row.
- Oral Antihistamines, NSAIDS (Bute, Banamine)
  - “NSAIDS/Antihistamines have failed to demonstrate therapeutic benefit in horses with Heaves“. Dr. Rush, Kansas State Veterinary School.
  - Many owners try them and most report little help. Even IV antihistamines in our practice do little.
- Antibiotics – The mucus accumulating in the airway is ripe to grow bacteria, so the horse can get a mild lung infection and horse Heaves together.
  - Naxcel is recommended in these cases. Dr. Orsini, 1998 Manual of Equine Emergency.
- Oral Steroids – Prednisolone used in Equine Heaves/Equine COPD can be effective short term (1-3 weeks). Care must be given for long use in Equine Cushings or Equine Insulin Resistant horses due to Laminitis issues.
  WARNING: Long term (just 32 days in a row) of steroids can lead to greater chance of EPM Neurological Disease. bluestar. Click here for Dr. Cutler’s study in Vet Parasitol. on Immunoconversion against Sarcocystis neurona in normal and dexamethasone-treated horses challenged with S. neurona sporocysts.
- Omegas for Horses with Heaves/COPD Airway Problems. – Proved to help your horse. There are many sources of Omega’s for your horse.
- Ground Flax Seed – need to grind. Click to see a whole section on Flax Seed – #1 source of Omega 3’s in plants. Great 4:1 ratio of Omega 3 to Omega 6. Good for Insulin Resistance and COPD horses.
- Whole Chia Seed – #2 source of Omega 3’s in plants. Good for Insulin Resistance and COPD horses. Great 3:1 ratio of Omega 3 to Omega 6. Give 2 Tablespoons a day. “Clinical improvement was noted in all horses involved in group receiving Omega 3’s. Cough score improved 60%. Respiratory effort decreased 48%.” Dr. Nogradi, 2015, J of Vet Internal Medicine. Click here for article on Omega-3 Supplementation helping COPD.
4. Need Thyroid Powder with COPD horses to overcome effects on Thyroid Gland:
- Cytokines actions on the Thyroid Gland
  - High IL-1 and TNF inhibited thyroid function. So the inflammation of COPD decreases thyroid function.
  - See the Dr. Rasmussen’s article in the Danish Medical Bulletin, 2000, Cytokine actions on the thyroid gland.
- Mechanisms of the non-thyroidal illness syndrome.
  - Changes in T4 and T3 thyroid hormones occur in sickness – they drop.
  - In the brain, TSH hormone that goes to thyroid gland decreased.
  - Malnutrition can cause a drop in thyroid hormones also.
  - See Dr. Warner’s article in J. of Endocrinology, 2009, Mechanisms behind the non-thyroidal illness syndrome.
- Endocrinological derangements in COPD
  - Patients with non-thyroidal illness have decreased biologically active T3 and T4.
  - Patients with severe COPD have reductions in T3 and T4.
  - Lots of Cytokines that inflammatory are in COPD and they inhibit synthesis of TSH in the brain and that leads to less thyroid gland stimulation.
  - Glucocorticoids will lower thyroid hormones.*** So if on steroids, you are affecting the thyroid gland.
  - Low thyroid directly damages muscles of breathing, so not just mucus in lungs, it is the muscles themselves that are damaged. Called Hypothyroid Myopathy – damages respiratory muscles.
  - See Dr. Laghi’s article in the European Respiratory Journal, 2009, Endocrinological derangements in COPD.
- COPD and Thyroid Dysfunction.
  - Low thyroid function patients had lower oxygen levels in blood. So terrible circuit of Hypoxia leading to inflammation, leading to brain changes, leading to thyroid lowering, leading to Hypoxia.
  - See Dr. Terzmo’s article in Lung, 2014, COPD and Thyroid Dysfunction.
- Effect of Thyroid Function on COPD
  - Low thyroid function has effect in exacerbation frequency of COPD.
  - Low thyroid decreases lung volume and increases upper airway obstruction.
  - See Dr. Ulasli’s article in Multi-disciplinary Respiratory Medicine, 2013, Effect of thyroid function on COPD exacerbation frequency.
- Assessment of thyroid functions in patients with COPD.
  - COPD affects not only the lungs, but pituitary in the brain and thyroid gland.
  - Severity of COPD air obstruction is associated with the impairment of thyroid gland.
  - See Dr. Yazed’s article in Journal of Chest Disease, 2013, Assessment of thyroid functions in patients with COPD.
- Immune function modulation by Thyroid hormones.
  - When thyroid hormone are low, white blood cell immunity is damaged.
  - See Dr. Hodkinson’s article in J Endocrinol, 2009, Immune function modulation by thyroid hormones.
- Thyroid hormones as modulators of immune activities.
  - Proinflammatory mediators found in hypothyroidism (low thyroid function).
  - See Dr. DeVito’s article in Thyroid, 2011, Thyroid hormones as modulators of immune activities at the cellular level.
- Thyroid Powder to help Breathing
  (Scoop is in the Thyro-L Container)
  - 1000+ pound horse – 2 Scoops a day = 24 mg
  - 500-1000 pound horse – 1 Scoop a day = 12 mg
  - 500 pound and below horse – 3/4 Scoop a day = 9 mg
  - Then after on these doses for 14+ days, can test Total T4 in blood if want to monitor. These amounts will keep your horse in the normal range – it will not cause Hyperthyoidism. Your horses can show and race on these amounts.
Typical Low Functioning Thyroid in COPD DO NOT accept “It is Normal” – Need Optimal.
5. Stall Management:
- “What we know for certain about Heaves is that in many horses it is precipitated by stabling.” Dr. Robinson, Michigan State Veterinary School, DVM magazine, 2012.
- Ammonia from urine is an airway irritant which can lead to more mucus accumulating – so less air flow. Sweet PDZ powder put on the stall floor after mucking is helpful.
  - Study shows partial mucking still creates the least amount of ammonia production over a complete mucking or no mucking. Dr. Fleming, University of Minnesota, J. Am Sci, 2012. The more you churn the stall up, the more ammonia, so light picking out of manure and wet spots is best. The worst choice is no mucking.
  - Studies show to reduce ammonia by 25-60% using Sweet PDZ in stalls.
  - Click here to see University of Kentucky Study on Controlling Ammonia in Horse Stalls.
- Shavings/shredded newspaper/cardboard has less allergens than straw. Straw is a problem.
- Increase ventilation to reduce particle exposure.
  - Attic Fan in Barn
  - Turnout more
  - Stall with window for air flow
  - Stall with fan for fresh air
  - Stall at the end of barn – more air flow
  - Higher ceiling in barn – more flow
  - No hay/stray in loft – showers all the allergens down
  - No tossing hay down from loft into stall aisle
  - Cobweb Barn – spider webs full of dust
  - If stacks of hay in the aisle or a stall, move Heave horse to other end
  - Keep horses in barn or turn out away from dusty road
  - Use fly spray – horses inside or outside create dust from stomping.
  - Click here to see top-rated fly spray in the USA.
- Clean stalls when the horse is not in the barn – you kick up lots of dust picking out stalls. You are kicking up dust when sweeping aisle. You kick up lots of dust even cleaning stall next to a Heave horse. Mold grows in the bedding.
  - 19 times more respiratory particles when stall is being mucked out. Dr. Clements, University of Edinburgh.
    Outdoor sheds need to be free of allergens
  - Use shavings, pea gravel, or mats to keep dirt down. Avoid stone dust.
  - Clean out sheds regularly. Old, dry manure kicked around no good.
  - Broom out cobwebs that hold dust.
- Hay Management
  - Tear flakes apart outside barn, shake out really good to reduce dust, put in hay bag, soak for 15 minutes. If winter or not able to soak, still tear up and shake flakes.
  - Baled hay density is 8 pounds/cubic foot versus 4 pounds/cubic foot in loose hay – let air get to it. Pennsylvania State Dept. of Agriculture, 2009.
  - ”Inflammation occurs in lungs within 6-8 hours when brought in from pasture into the barn.” University of Kentucky, College of Agriculture.
- Pelleted feed has less dust, so use these.
- Most horses do not do well on just hay cubes and pellets. They need hay, but you can reduce the hay amount from 20 pounds a day (2% body weight in hay in 1000 pound horse) to 15 pounds of hay and 5 pounds of cubes/pellets, to help reduce allergen load.
- Ponies – they are lower to the ground so are going to inhale larger number of allergens if bedding/management is not good. Open stall doors, apply webbings so air flow is better.
- Click here for University of Kentucky Equine Department article on Management of Horse Heaves.
6. Keep these Heave horses away from dusty roads.
7. In trail riding, keep up front – don’t eat the dust of 10 horses ahead of you.
8. Keep blankets clean – if full of dust/dirt are following horse all day.
9. Traveling – bring your own shavings so not at mercy of barn arriving at. Get windowed stall, get at end of barn, bring your fan.
10. Turned out or in stall use fly spray – stomping feet kicks up lots of dust.
- Click here to see top-rated fly spray in the country!
Equine Heaves/Equine COPD - Sudden/Dramatic Equine Heave/Equine COPD Attack Crisis
This information on Equine Heave Attack Crisis is only on our site – Original Case Management
Heave Crisis:
At times, a large antigenic load may severely compromise your horse’s ability to breathe. I have been called out on cases to see a horse for the first time on an emergency that was staggering around from not getting enough air and with mucus membranes on his gums the color of mud.
Hank was in crisis but in five minutes was a lot more comfortable and his breathing rate was reduced significantly after IV medications.
As an owner, you need to know:
1. Prednisolone Tablets and Clenbuterol (Ventipulmin syrup) will not help these horses in severe crisis – do not try to ride out the storm with these medications.
2. Get them in the shade, hose off with cold water, and then scrape off excess water. Many are half in heat exhaustion from laboring to breath. Repeat this every 15 minutes until Vet comes.
3. Get horse out of the barn. If it falls down, it is easier to work with in the field near the barn, and the barn is full of possible allergen triggers.
4. Do not feed any hay/grain – we need airway clear. Wash out mouth with water. Can allow him to drink if the horse wants.
5. If there is a lot of mucus in nostrils, wipe it out with paper towels. Will help airflow.
6. Stand still – do not keep walking around. Want quiet, calm. Keep in an area by himself. Do not want other horses poking at him.
7. If they go down, do not panic. All our cases of Heave attacks that were down, recovered well because we got there within 30-45 minutes of being called.
8. Your doctor may direct you to use aerosol inhalers for your horse prior to their arrival, but often people do not have these or the inhalers are all used up with no puffs left.
9. Your doctor may need to give oral or IV fluids if your horse is exhausted. Just because breathing is better, does not mean all is ok. Often, these horses get impaction colics 1-2 days later due to lack of water intake prior to Heave attack. We may give Banamine the day of a Heave attack but no more after that due to Banamine can slow gut motility when given many days in a row. We need to see normal manure production within a day of a Heave attack or may need another tubing of fluids.
10. Look around – what triggered attack? Probably hay or bedding. Bring in new hay from neighbor and strip out stall bedding if the horse was in the stall in the last 24 hours.
11. Steroids IV in Equine Cushings or Equine Insulin Resistance horses – We had several horses with these conditions get Heave attacks and, in a crisis, these medications are needed. Low dose Dexamethasone or Solu-delta Cortef did not trigger any Laminitis events in these horses.
12. Start Heave Ho Program.
Equine Heaves/Equine COPD - Weight Loss In Equine Heaves/Equine COPD
1. Extreme/moderate labored breathing overcomes horses need for food and water. They are too busy trying to catch their breath.
2. The labor of breathing more times a minute and trying to exhale stronger burns tremendous calories.
3. Exhaustion – your horse is so tired, they just lay down more and skip food and water.
4. Coughing is exhausting – it also burns tremendous amounts of calories.
5. Coughing can irritate the upper airways making swallowing painful.
6. Are on drugs that knock down their appetite.
7. Stressed, so higher cortisol which leads to tissues being broken down.
8. Helpful hint in older horses or horses with teeth problems:
  - Total immersion of hay for 10 minutes can increase water content of hay from 10% to 50%. This water increase can provide 10-20% of water needs and cut down on impactions. In older people, saliva can drop 50%, so in older horses soaked hay helps in chewing, swallowing, and nutritional access.
9. Older Cushings horses have higher ACTH, Cortisol hormones, and on Pergolide that all lead to some weight loss that layers on top of Equine Heaves/Equine COPD.
10. How to safely gain weight in your COPD/Asthma horse?
  - You will combine a ration balancer and a senior feed to bring back muscle, topline, and to help breathing muscles that are damaged in COPD.
  - Ration balancers have higher protein to help add muscle. Click here for Ration Balancer options for your horse.
  - Both ration balancers and commercial senior feeds are low carb. We need that due to many are COPD and are also Insulin Resistant.
  - See below for an example of what to feed, how much, and when to ladder up the volume:
For a thin 1000 pound horse (if 500 pound horse use 1/2, and if a 250 pound mini, use 1/4 of this) on an only hay forage.
Hay: 22 pounds a day. Remember, need the quick 10 minute soak prior to feeding.
Ration Balancer:3 cups AM and 3 cups PM (cup= 8 oz. cup) (3 cups = 1 pound).
Senior Feed (Give at the same time as when feeding the Balancer): 6 cups AM, 9 cups Noonish, 6 cups PM. Do this for 2-4 weeks.
If still need more weight:
Ration Balancer:3 cups AM and 3 cups PM (cup= 8 oz. cup) (3 cups = 1 pound). (same as now).
Senior Feed(Give at the same time as when feeding the Balancer): 9 cups AM, 12 cups Noonish, 9 cups PM
As the horse gains weight, can ladder back down if needed.
NOTE THE FOLLOWING:
1. Make sure teeth are floated 1 time a year.
2. Deworming with Equimax at least 2 times a year to get tapeworm. (Fall, Spring)
3. Has a quiet place to eat and not in fights for food with other horses.
Equine Heaves/Equine COPD - What Happens To Your Horses Airway In Equine Heaves/Equine COPD?
1. Your horse reacts to a level of stimuli from allergens that do not effect normal horses.
  - “Hyper-responsiveness to allergen for even a brief time and its effects can last for days.” University of Kentucky, College of Ag.
  - Even if remove offending cause, may still be effected in their airway days later.
  - Hay and straw bedding are the usual allergens leading to Equine Heaves/Equine COPD. “Most common environmental entity precipitating an episode of airway obstruction in Heaves affected horses is organic dust of hay and straw.” Dr. Rush, Kansas State UNiversity, Equine Respiratory Disease, 2004.
2. Three things occur after exposure:
  - Constriction of airways – walls of airway become smaller so imagine breathing through a garden hose and then breathing through a straw.
  - Mucus accumulates in airway paths – this further blocks air flow. Imagine your horse sipping water through a straw and then having to sip pudding – extra effort.
  - Airway spasms – an already narrowed airway becomes super narrow as spasms further reduce airflow.
    See above how the area of airflow is less and mucus debris further blocks air. Picture by Dr. Laurent Viel, University of Guelph.
3. Horse COPD/Asthma proven to create abnormal heart changes – thickened walls, inflammatory cells going right into heart muscle. It is not just a lung thing.
  - Click here to see Dr. Decloedt’s article in the Equine Veterinary Journal on Right ventricular function during acute exacerbation of severe equine asthma.
Click here to see a Real World Story how Heave Ho/Health E Helped a Horse.
Equine Heaves/Equine COPD - Vitamin E Can Help With Equine Heaves/Equine COPD
Heave Ho has high dose Vitamin E – 5784 IU in each scoop – Rated #1 in highest levels. Vitamin E in horses is proven to increase immunity to help decrease chronic and constant lung infections. This can cut back on snotty noses, constant antibiotics of secondary bacterial infections. The Vitamin E has also been proven in horses to increase immunity via immunoglobulin protection increased.
Click below on Science Articles on Why Vitamin E helps COPD:
1. Blood Vitamin E levels lower in COPD. See Dr. Hanson’s 2016 below.
2. Supplementing with Vitamin E improved breathing components. “Positive association with dietary Vitamin E intake and lung function.” Tocopherol Levels in Lung Function, C. Hanson
3. “Vitamin E may be beneficial in the prevention and treatment of harmful effects of COPD.” Oxidative Stress of COPD Lowers Vitamin E, T. Tug
4. “Vitamin E supplements decreased DNA damage to white blood cells.” Long-Term Vitamin E Supplementation helps COPD, TC Wu
5. Patients on Vitamin E had greater lung capacity and produced less phlegm. Vitamin E Helps Reduce Phlegm of COPD, Y. Kelly
6. Long-term regular use of Vitamin E may help decrease risk of COPD. Increased Vitamin E Prevents COPD, American Thoracic Society
Protocol:
1. Heave Ho Powder: 1 Scoop AM and 1 Scoop PM for 7 day, Then 1 Scoop a day. 1 Container has 30 Servings.
2. Some horses are “finicky” about supplements in their feed. Heave Ho tastes good, but here is what to do to help them eat easier. Need to add volume and flavorings.
- Need to add Volume to your feed:
  - Add 2 cups of Senior Feed (low carb, tasty) or 2 cups Alfalfa or Timothy Pellets (low carb, tasty).
  - In addition to either Senior or Alfalfa or Timothy Pellets, add 2 cups soaked Beet Pulp – moisture helps with Heave Ho sticking to the feed.
- Flavoring – add to the volume ones above:
  - Sugar-Free Applesauce – helps Heave Ho stick.
  - Sugar-Free Pancake Syrup (near Aunt Jemima in store) – helps Heave Ho stick.
Equine Heaves/Equine COPD - Prognosis
1. “Depending on the clinical signs, severity of ROA, horses with this condition can be managed successfully for much if not most of their lives. Many of these horses are able to be excellent pleasure, trail riding, and even competition horses with dedicated owners that understand it is a chronic condition that will require life-long management.” Dr. A. House, AAEP.
2. Combining management with Equine Heave Ho Oral Therapy helps you be able to continue to enjoy your horse in many activities.
3. Many people have airway allergy issues and know that with daily, diligent care, can do very well.
4. Medicines and supplements are not going to work unless changes to the environment are done at the same time.
The 4 Easy Steps of the Heave Ho Program.
1. Hay – all hay has organic dust from normal production, but it can transfer asthma/COPD in many, so need to reduce load via FLASH SOAKING. Tear up hay, place in haynet, place in bucket of water and fully submerge for ONLY 10 minutes, pull out and hang up. Never use round bales – huge dust.
2. Omegas – See article on our site showing how omegas can reduce coughs 50% – add chia or flax seed that is high in ALA Omega 3 and great Omega 3 to 6 ratio.
3. Thyroid Function – low in all COPOD/asthma horses – it directly lowers thyroid gland output. Add Thyrol L to diet and test T4 levels in 30 days to see if need to add more. these horses run at low end of normal range = sub-optimal and need to be in high end of normal to reduce lung infections and help breathing muscle.
4. Heave Ho – 2x a day for 7 days, then 1x a day.
Equine Heaves/Equine COPD - The Link To IR Increasing COPD