Clinical study

Clinical study


Fischer Kerstin
Dr. med. vet. Kerstin Fischer, Specialist veterinarian for horses

If you have any questions regarding the following report, please always contact the Flexineb® team first – and not the doctor – thank you very much.


The focus of this recently conducted and clinically monitored follow-up study was the 9-year-old Quarter horse gelding Laredo owned by the Western rider Tasja Berger (Western Sport: Pleasure, Horsemanship..). The objective of the study was to determine whether and to what extent we can help our patients with regular inhalation using the Flexineb® nebuliser.


For several years, the horse had been known to our clinic as a recurring “cough patient”. It was suffering from allergic bronchitis, which repeatedly worsened in spring. Before the start of our study, this diagnosis was confirmed by clinical examination of the respiratory tract, blood gas analysis, endoscopy and an allergy test. As the horse was to continue competing on account of its outstanding abilities, we tried to find a way to treat our patient for his lung disease under the best possible conditions despite his lung problems and without coming into conflict with the “doping regulations”. In addition to desensitisation therapy, the possibility of inhalation was chosen for this objective. In this regard, the inhalants were selected as ADMR-compliant in accordance with the time period up to the start of the next competition.


Monitoring and results control were carried out at regular intervals (approx. every 4 weeks) within the scope of a bronchoscopy on the unsedated horse. In addition, blood gas values were checked several times.


The first tests were carried out in April 2013, at a time when there were many allergenic substances in the air. At the initial examination, blood gas showed a reduced oxygen value of 84 mm Hg (pCo2 45 mm Hg, A-aDO2 20.3). Endoscopically, more than 1/3 of the trachea was covered with thick mucus; the tracheal mucosa showed distinct redness; the area around the larynx was also reddened. (M5, V3-4; cf. Diekmann, 1987). The horse exhibited a pronounced coughing stimulus during the examination. The allergy test revealed clear allergic reactions to a variety of allergens, both perennial (Aspergillus fumigatus) and seasonal (e.g. birch). Accordingly, desensitisation therapy was initiated in parallel with the other treatments.

Prior to nebulisation therapy, acetylcysteine, Ventipulmin® and prednisolone were fed for 14 days. At the start of nebulisation therapy, the patient was first nebulised daily with liquid acetylcysteine. A first bronchoscopic follow-up (May 2013) already showed significantly more fluid mucus and a quantitative reduction. However, the mucous membrane was still reddened (M3-4, V2-3).

A repeated endoscopy after 4 weeks (June 2013), and after nebulising with saline solution only, showed a significantly lower cough stimulus, a reduced amount of mucus in the trachea and continuously less viscous mucus than at the initial examination (M2, V2). At this time, blood gas values were almost unchanged from those of the initial examination.

The next examination in July 2013, this time after regular nebulisation with acetylcysteine, fortunately showed no further cough stimulus during the examination and again a less reddened mucous membrane in the patient. In addition, it was found that again, there was less thin mucus present. The mucus appeared more fluid than with nebulisation of saline solution alone (M2, V1-2).

After a further 4 weeks and repeated treatment with saline solution only, the August 2013 examination also revealed less thin mucus in the trachea. The redness of the mucous membrane was less pronounced (M1-2, V1-2), and the blood gas values (pO2 95 mmHg and pCO2 38 mmHg; A-aDO2 16.3) had improved.

At the final examination at the end of September 2013 and treatment phase with acetylcysteine nebulisation, there was only very little thin fluid secretion present in the trachea (M1, V1). The horse did not exhibit coughing stimulus during the examination. The blood gas result had improved again (po2 100 mmHg, pCo2 42 mmHg, A-aDO2 7). Treatment could therefore be concluded.


Evaluation of tracheal secretion according to Dieckmann (1987; dissertation; Zur Wirksamkeit von Ambroxolhydrochlorid (Mukovent®) bei lungenkranken Pferden)

Evaluation of blood gas parameters according to Klein and Deegen (1986, Beurteilung von Blutgasparametern des arteriellen Blutes von Pferden unter besonderer Berücksichtigung der alveoloarteriellen Sauerstoffdifferenz, Pferdeheilkunde 2, 331-336)

Reaction Class 3 Allergens (according to Laboklin): Plantain, Birch, Willow, Aspergillus fumigatus, Dermatophagoides farinae, Lepidoglyphus, Tyrophagus G. Niedermaier, H. Gehlen (Pferdeheilkunde25, 327-333):

Möglichkeiten der Inhalationstherapie zur Behandlung der chronisch obstruktiven Bronchitis des Pferdes

K.A. von Plocki, Kerstin Gorn und K.-W. von Salmuth (Pferdeheilkunde 12, 759-764): Die Laufbandinhalation – eine alternative Therapieform beim Pferd mit chronisch obstruktiver Bronchitis


Following the successful nebulisation therapy with the Flexineb® nebuliser, Laredo can once again be seen at shows together with Ms Berger. During the last shows; he was able to win the following:

2x Winner Halter Open

1x Reserve Champion

2x Winner Halter Amateur

2x Grand Champion

2x Winner Halter Novice Amateur

Hunter under Saddle Amateur 2nd and 3rd Place

Hunter under Saddle Novice Amateur 2nd and 3rd Place

Pleasure Novice Amateur 2nd and 5th Place

2x Winner Pleasure Amateur

Laredo also won Circuit Reserve Champion in Western Pleasure!

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