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BLEEDERS T H E FA C T S , F I C T I O N A N D F U T U R E D I R E C T I O N Dr. David Marlin
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e are now approaching half a century since Bob Cook pioneered the use of the flexible fibreoptic endoscope, which allowed examination of the respiratory tract in the conscious horse. One of the important outcomes of this technique was that it opened the door to the study of “bleeding” or exercise-induced pulmonary hemorrhage (EIPH). But nearly 50 years on the irony is perhaps that whilst we have become good at describing the prevalence of EIPH and some of the factors that appear to increase the severity of EIPH within individual horses, we still lack a clear understanding of the condition and how to manage it. I use the term manage rather than treat or prevent as our knowledge of EIPH
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Giles Anderson, Shutterstock must show us that EIPH cannot be stopped entirely; it is a consequence of intense exercise. The other irony is that in the past 50 years, by far the majority of research into the management of EIPH has focused on the use of the diuretic furosemide. Whilst we have good evidence from controlled studies that furosemide reduces the severity of EIPH on a single occasion, we still lack good evidence to suggest that furosemide is effective when used repeatedly during training and or racing; and there is also evidence to the contrary. Let’s review some basic facts about EIPH, which should not be contentious. • EIPH is the appearance of blood in the airways associated with exercise. • EIPH occurs as a result of moderate to intense exercise. In fact, EIPH has been found after trotting when deep lung
