NAVLE Respiratory

Equine Recurrent Airway Obstruction Study Guide

Recurrent Airway Obstruction (RAO), also known as heaves or severe equine asthma, is one of the most common chronic respiratory diseases affecting mature horses worldwide.

Overview and Clinical Importance

Recurrent Airway Obstruction (RAO), also known as heaves or severe equine asthma, is one of the most common chronic respiratory diseases affecting mature horses worldwide. This inflammatory, obstructive airway disease is characterized by reversible bronchoconstriction, excessive mucus production, and neutrophilic airway inflammation triggered by exposure to inhaled organic dusts and molds. RAO represents a significant category on the NAVLE and understanding its pathophysiology, diagnosis, and management is essential for clinical practice.

The condition shares many similarities with human asthma and is now classified under the umbrella term equine asthma syndrome, which encompasses mild-to-moderate equine asthma (formerly Inflammatory Airway Disease or IAD) and severe equine asthma (formerly RAO/heaves). A related condition, Summer Pasture-Associated Obstructive Pulmonary Disease (SPAOPD), affects horses on pasture during warm, humid months.

High-YieldThe term COPD is no longer used for equine respiratory disease as the pathophysiology differs from human COPD. The current accepted terminology is equine asthma syndrome with RAO/heaves representing severe disease.
Parameter Clinical Details
Age of Onset Average 9-12 years; typically greater than 7 years old
Gender No gender predisposition; affects both males and females equally
Breed No breed predisposition; Thoroughbreds may be 3x more likely; affects all breeds
Heritability 10% incidence with healthy parents; 44% if both parents affected
Geographic Distribution Highest prevalence in Northern Hemisphere where horses are stabled and fed hay
Seasonal Pattern RAO: Winter/spring exacerbation (stabling); SPAOPD: Summer/early fall (pasture)
Prevalence 2-80% depending on study criteria; approximately 12% have some degree of allergen-induced disease

Etiology and Pathophysiology

Triggering Factors

RAO is initiated by inhalation of organic dusts containing a complex mixture of allergens and irritants. The primary offending agents include:

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