Heaves is a chronic, non-infectious airway condition that affects horses. Also called recurrent airway obstruction or RAO, the condition usually occurs in horses over 6 years of age.¹ Some other names for conditions presenting with similar symptoms include inflammatory airway disease (IAD), chronic bronchitis, allergic airway disease and small airway disease. These conditions were formerly referenced as chronic obstructive pulmonary disease or COPD; this is not to be confused with COPD in humans, which is of differing etiology.

All of the above conditions are included under the umbrella of equine asthma.² Horses with any of these have airway inflammation that gives rise to identifiable signs, ranging from decreased performance to a cough, nasal discharge or significant respiratory distress.¹ A horse that stands in its stall with nostrils flaring and sides heaving is almost certainly suffering from heaves. 

More often than not, heaves or equine asthma is the result of an allergic reaction to inhaled particles related to the environmental conditions in which a horse is kept. These are usually environments with high levels of dust. Once dust particles are inhaled, an allergic reaction takes place, which causes the small airways in the lung tissue to become narrowed and eventually obstructed.^1,2

Symptoms of Heaves

In cases of heaves (RAO, equine asthma), one of the first clinical signs noted by an owner or manager will be an occasional cough. As this condition progresses, the symptoms will become more pronounced and will include an increasing intolerance to exercise, an increased respiratory rate, wheezing, flaring of the nostrils and nasal discharge. The horse begins to work harder to breathe due to obstruction of the small airways. This will cause the horse to use its abdominal muscles more strenuously while breathing, resulting in the visible enlargement of these muscles and the formation of the distinctive “heave line.”¹ Even mild cases of heaves tend to be easy to identify in performance horses (e.g., Thoroughbreds, Quarter Horses, barrel racers) due to the increased demand for oxygen.

While asthma is often associated with allergies in humans, very often, horses with heaves have no signs of allergies. Rather, IAD in horses is similar to what is called occupational asthma.² Poor air quality, agricultural environments and farms that horses share are often brimming with organic dust and other particulates that can cause significant irritation to the airways of even non-allergic horses. It should be noted that in some of the available literature IAD is differentiated from heaves, with the latter reported as having an allergic cause.^1,2

Horses from the southeastern USA have been seen to evidence clinical signs of heaves in the late summer. This probably reflects a sensitivity to molds or grass pollens, and is often referred to as summer pasture–associated obstructive pulmonary disease. The management of this condition is similar to that of a horse with heaves, with the addition of pasture avoidance.

A diagnosis of RAO is usually determined based on a horse’s history and characteristic physical examination findings. Radiographic findings in horses with RAO often include peribronchial infiltration and overexpanded pulmonary fields (e.g., flattening of the diaphragm). Radiographs are generally of limited benefit in confirming the diagnosis of RAO however, they can help to identify differential diagnoses, including interstitial pneumonia, pulmonary fibrosis, or bacterial pneumonia.²

Fluticasone for RAO in Horses 

Whatever the designation, these conditions are treatable, but not curable.² With accurate diagnosis, proper treatment and environmental improvements, heaves or RAO can be successfully managed in most horses. At present, corticosteroids are the most effective treatment available to control heaves, and systemically-administered corticosteroids have been shown to alter the immune response in horses.³

Where to buy Fluticasone Propionate

Fluticasone is available in the U.S. through several pharmaceutical manufacturers and through veterinary custom compounding companies. 

Please consult your veterinarian prior to beginning any treatment regimen.

FOR RX ONLY: A valid prescription from a licensed veterinarian is required for dispensing this medication.

¹colostate.edu.

²tufts.edu.

³Dauvillier J., et. al. Effect of long-term fluticasone treatment on immune function in horses with heaves. J Vet Intern Med. 2011 May-Jun; 25(3):549-57.

⁵mayoclinic.org