Abstract
PICO question
 In horses with severe equine asthma syndrome, is inhaled immunotherapy compared to environmental reduction of allergen exposure more effective in disease modification?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 12 papers were critically reviewed. Nine clinical trials; one crossover study; one split-plot design study; and one cross-sectional study
 Strength of evidence
 Low
 Outcomes reported
 Four studies found inhaled immunotherapy to improve the clinical signs associated with equine asthma and the lung function of horses with asthma. Three papers found environmental modification by improved lung function and the clinical signs associated with equine asthma but two studies provide moderate evidence that environmental management alone is insufficient to permanently cure asthma
 Conclusion
 There is a low level of evidence to support the use of inhaled immunotherapy as a treatment for equine asthma
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 
Highlights
Intervention details: Horses assigned into treatment groups considering age, housing management and breed Treatment groups, each received a total of 10 inhalations:
Horses were assessed at the following time points:
CpG inhalation improved 70% of clinical, endoscopic and cytological variables evaluated between Time points I and III
Summary
Amy Leather BVSc PGDip (Clinical Veterinary Practice) MRCVS 1* Sarah Smith MA VetMB MVetMed DACVIM MRCVS 1. Three papers found environmental modification improved lung function and the clinical signs associated with equine asthma but two studies provide moderate evidence that environmental management alone is insufficient to permanently cure asthma Conclusion There is a low level of evidence to support the use of inhaled immunotherapy as a treatment for equine asthma. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. The owner would like to know more about inhaled immunotherapy as an option for treating equine asthma and if inhaled immunotherapy will result in better disease modification compared to environmental management alone for the pony
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