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Inhalation therapy – the optimal route of drug administration for the treatment of respiratory diseases

Retrospektive Studie der Pferde mit chronisch rekurrierender Blinddarmobstipation nach chirurgischer Versorgung mittels Erweiterungsplastik des Ostium caecocolicum

Sirous Sadeghian Chaleshtori , Shima Roayaee

Abstract

The purpose of this review was to introduce inhalation therapy as a suitable method for the consumption of medications in the therapeutic of equine respiratory diseases. Respiratory diseases can reduce the equine's athletic activities and lead to complications and deaths. Therefore, quick identification of respiratory disease and choosing the appropriate treatment method such as inhalation therapy should be prioritized. Inhalation therapy is a route for delivery drugs directly to the airways. The amount of drug deposition in the lung determines the effectiveness of inhalation therapy and pulmonary drug deposition in turn, depends on the size of produced particles. Inhalation therapy has some advantages like the direct delivery of the drug to the intended site of action, the use of a low dose of drug, lower side effects compared to parenteral administration and some disadvantages such as expense, frequency of drug administration and difficulty in determining the precise dose of a medication. Aerosol deployment within the pulmonary system is done under the influence of three main mechanisms of gravitational sedimentation, inertial impaction, Brownian diffusion. Three different types of commercially available inhalation drug delivery which is used in equine include dry powder inhalation, metered-dose inhalers, and nebulizers. Pharmacological agents used in equine inhalation therapy in cludes antimicrobials, glucocorticoids, mucolytic, bronchodilators and etc. In general, according to the points mentioned above, especially the existence of positive benefits, inhalation therapy in equine should be given more attention and prioritized in the treatment of respiratory diseases.

Keywords: inhalation therapy, drug, respiratory diseases, equine, horse

Pengliang Li, Xuyan Wu, Wei Wang, Cheng Zhang, Xiaochen Yang, Jixiang Li

Abstract

Impaction is one of the most common disease of the cecum in horses. It is important to distinguish between acute and chronic recurrent cases. Acute impaction occurs suddenly and resolves within a few days with medical and/or surgical treatment whereas in chronic cases the impaction within the base or the whole cecum occurs repeatedly at irregular intervals. The chronic recurrent cecal impaction (CRCI) is characterized by hypertrophy of muscle in the cecal base or entire cecum. The pathogenesis is not fully understood: hypothesis is that the cecal impaction induces a distension during the contraction of the circular muscle layer which is a stimulus of a hypertrophy of the circular and longitudinal muscle layer in the cecum. Furthermore, neuronal density in the plexus myentericus was found to be decreased significantly in the cecal wall of CRCI. Initially, in cases of CRCI the cecocolic orifice is not entirely blocked allowing partial transit of ingesta. Hypertrophy of the muscle layer (longitudinal and circular muscle) begins at the cecal base and as the disease progresses, the cecocolic opening becomes completely obstructed due to the automatic closure mechanism. The rectal and ultrasound exam are the most useful diagnostic steps while different degrees of cecal impaction and/or tympany, a marked thickening and cecal wall contractility due to palpation are found. The hypertrophy can be regarded as a pathognomonic sign. Treatment in our study was done by surgical enlargement of the cecocolic orifice (created by Huskamp 1990). Tissue samples of defined cecal regions were taken during surgery or necropsy: the circular and longitudinal muscle layer were significantly thicker, linear neuron densities were significantly lower each compared to clinically healthy horses. Based on smooth muscle thickening and neuron deficit, rectally palpable and ultrasound visible cecal wall thickening, horses suffering from CRI have a poor prognosis. Surgery by enlargement of the cecocolic orifice in horses with CRCI have a better prognosis if only the cecal base has a thickening and a normal cecal body wall.

Keywords: horses, chronic recurrent cecal impaction, surgical treatment enlargement cecocolic orifice, long-term survival

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