A key component of the plan is to determine treatment alternatives for exercise-induced pulmonary hemorrhage.
Getty ImagesIn an effort to help protect the health and welfare of racehorses and ensure the long-term viability and integrity of the horseracing industry in the United States, the American Association of Equine Practitioners (AAEP) recently unveiled a multipart initiative.
One of the central components of AAEP's Prescription for Racing Reform is the association's commitment to identifying non-race-day treatment alternatives for exercise-induced pulmonary hemorrhage (EIPH).
Here are the key points of the initiative:
According to AAEP, other points of the plan address compounded medication, veterinary list reciprocity and stiff sanctions for rules violators.
“Our desire to investigate non-race-day treatment alternatives for EIPH serves both the horse and the industry, and we are committed to developing a strategy that goes beyond the simple cessation of race-day medication,” says G. Kent Carter, DVM, AAEP president. “As doctors of veterinary medicine, we want to contribute to the success of the racing industry but must remain committed to protecting the health and welfare of the horse as our foremost priority.”
The initiative continues AAEP's commitment to health and safety issues. The association sponsored the first-ever industry Racehorse Medication Summit in 2001, co-sponsored the 2011 International Summit on Race Day Medication, and has developed numerous white papers with recommendations addressing health and safety.
Identifying an alternative to furosemide
The AAEP is dedicated to finding an alternative to furosemide within the guidelines of the Prescription for Racing Reform, says Nathaniel White II, DVM, DACVS, professor emeritus of equine surgery at Virginia Tech's Marion duPont Scott Equine Medical Center in Leesburg, Virginia.
White says the AAEP is gathering a group of scientists, both equine and human, this fall to discuss both past and current research on the effect of maximal exercise on equine pulmonary physiology. The agenda will include the current state of pulmonary research and potential alternatives to furosemide administration. “We will ask those scientists, no holds barred, to explore all the potential possibilities of how to eliminate furosemide use on race day while still protecting the horse,” White says.
The goal, he continues, is to develop an action plan concerning new research directions and a budget and then report back to the industry. “If we're going to do this properly, the racing industry will have to support this research with significant funding,” he says.
White will serve as moderator and liaison for the group of researchers. “It's time to look at all the pulmonary and cardiovascular research possibilities to explore this question further,” he says.
“The physiology of bleeding is thought to be a pulmonary vascular problem also associated with heart function,” White continues. “During racing, there's a backup of blood in the vessels in the lungs as the heart attempts to keep up with the demands of strenuous exercise. The increased pressure causes leaking in the pulmonary alveoli capillaries, i.e., EIPH bleeding.”
To date no drug other than furosemide has been identified that can decrease the severity of the bleeding to the benefit of the horse.1 The research meeting aims to change that.
Consensus from AAEP
Jeff Blea, DVM, AAEP's immediate past president, says that in recent years several interested professionals have gathered to discuss furosemide and EIPH. “What came out of that was a request for ACVIM to put together a consensus statement on EIPH, as the concern from the public and some in the racing industry is that furosemide is essentially a ‘performance-enhancing drug,'” he says.
The result was the ACVIM's Consensus Statement on EIPH in Horses.1 The objective of this statement was to review the evidence and provide recommendations that address each of the following questions:
The panel found high-quality evidence that furosemide is effective in the prophylaxis of EIPH, and it made a weak recommendation for its use in managing racehorses with this disease. The panel also made no recommendation regarding additional pharmacological interventions for the prophylaxis of EIPH because of the absence of studies or the very low quality of evidence.
“We realize EIPH is a disease,” Blea says. “And the best we have to therapeutically treat it is furosemide. It's been scientifically proven to be efficacious. That being said, we also realize that its use is a polarizing issue within the industry. Our concern as veterinarians is the health and welfare of the horse, though we also understand and are respectful and cognizant of the political issues within racing.”
Blea says AAEP administrators decided to take a leadership role on the issue. “Our first problem is that we don't know what we don't know, so let's start asking questions,” Blea recounts. “We decided to get together with a group of experts in the field, equine practitioners who have studied EIPH, and pharmacologists, respiratory and cardiology physiologists in both veterinary and human medicine.
“Our efforts are in the initial stages, and we don't have any real benchmarks,” Blea continues. “Our goal is not to be concerned with the politics … but to find a treatment for this disease that is as effective, or more effective, than furosemide, if possible.
“At the end of the day,” Blea concludes, “it might just be that the best therapeutic medication is still furosemide. But without pursuing research to look at alternatives, we'll never know. If we don't allow ourselves to ask, we're not going to learn.”
References and Suggested Reading
1. Hinchliff KW, Couetil LL, Knight PK et al. Exercise-induced pulmonary hemorrhage in horses: ACVIM consensus statement. J Vet Int Med 2015;29:743.
2. Hinchcliff KW, Morley PS, Guthrie AJ. Efficacy of furosemide for prevention of exercise-induced pulmonary hemorrhage in Thoroughbred racehorses. JAVMA 2009;235:76.
3. Birks EK, Durando MM, McBride S. Exercise-induced pulmonary hemorrhage. Vet Clin North Am EquinePract 2003;19:87.