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Equine Client Meetings

Equine Client Meetings are held regularly, covering a variety of subjects.

Equine Client Evening

Wednesday 6th October 2010

 

"Whistling In The Wind" 

 

Advances in the diagnosis & treatment of performance     

limiting problems in the upper airways of the horse

Guest Speaker

Cedric C-H. Chan, BVSc CertES(Orth) DiplECVS MRCVS

Diplomate of the European College of Veterinary Surgeons

RCVS & European Recognised Specialist in Equine Surgery

Alnwick Rugby Club

Refreshments 6.30pm

Start 7.00pm

Raffle

 

Gastroscopy Clinic  - 24^th May 2010     

Rachel Conwell BVetMed, Cert EM, MRCVS, our visiting internal medicine specialist will be performing a gastroscopy clinic at Bolton Woodhall Stables, Alnwick NE66 2EJ courtesy of Craig Anderson and Selby Friar.

 This is sponsored by Merial

• 9.30am     Demonstrations begin

 

• 12.30        Light lunch (provided)

 

• 1pm           Workshop by Merial and Rachel Conwell

 

Places must be booked for morning or afternoon slots.

see www.gastriculcerrisk.co.uk

There are limited places available for a free gastroscopy on your own horse, if you are interested. Please contact the surgery on 01665 510999 or email wagonway@alnorthumbriavets.co.uk  for further details.

Laminitis Workshop on 19th April at the Pegasus Centre, Tranwell

weight management, metabolic syndrome

First come, first served!

 

The next Yard Weigh In Sessions will be held at:

Benridge           11th March 2010

Hope Farm         12th March 2010

 

Report on February 2010 Equine Client Evening, Longhirst

 

Many thanks to Merial Animal Health, CEVA, Fort Dodge, Dechra and Norbrook for providing the sponsorship for this event.

 Also thank you to all our raffle prize providers, we had 29 in total which gave us much entertainment and importantly raised £321 for The Brooke; the charity of choice by Mark Johnston

 We are also grateful to Farmway Morpeth and Silvermoor Haylage for bringing stands as it added an extra dimension to a great evening.

 Mark Johnston BVM&S MRCVS race horse trainer was our first speaker who had everyone spellbound by the fascinating story about his road to success. Life had its ups and downs but Mark is a man who believes in putting systems in place that gives his employees responsibility and involvement in the yard success. The systems are based on a very large spreadsheet, as he currently trains 236 horses exclusively on the flat. The spreadsheet contains daily information about each horse, work level, numbers of coughs at morning exercise, vet report which allows Mark to see at a glance any abnormal patterns emerging which may cause a problem with the training regime.

 

If a coughing pattern emerges in horses that is suggestive of respiratory infection the whole yard is vaccinated as a way of provoking  an immune response to fight the virus.

 He employs two full time vets in order to provide early detection of any health problems. Mark believes that good husbandry and management of the horses plays a vital role in his success as a trainer and his training fees include veterinary treatment.

 These and many more fascinating bits of information could have easily kept us all listening intently all evening. For more information about Mark Johnston visit his website http://www.markjohnstonracing.com/  and look out for the Kingsley House, Middleton open days.

 Our second speaker of the evening was David Mountford MA, VetMB, MRCVS, who gave a clear explanation of how superficial flexor tendon injuries occur. He outlined how the tendon strength and healing ability is at its peak at 2 years of age and thereafter there is a natural aging process which increases the risk of tendon injury the older the horse. As well as age, the amount of fast work that we impose on a horse also increases this degenerative process. He then explained how a core lesion in a tendon would normally heal by laying down disorganised collagen fibres (plate of spaghetti) which leaves a more rigid structure than the normal healthy tendon which has nicely aligned (dry spaghetti in packet!) collagen fibres that provide a stronger elasticated (crimp) tendon that absorbs the load imposed on the extended tendon during galloping.

 The principle of the newly emerging treatment of core lesions in tendons with stem cell therapy was then described. The mesenchymal stem cells are harvested from the sternal (chest) bone marrow of the sedated horse soon after the injury has occurred, those cells are then sent to ACell laboratory where the stem cells from the horse are cultured over 2 – 3 weeks before being returned to the vet in charge of the case. The stem cell preparation is then injected into the core lesion (elliptical hole in SDFT) under ultrasound guidance to ensure accurate placement.

 The horse then goes onto a rehabilitation programme and the stemcells develop into new healthy collagen fibres which is proving to provide a greater success in terms of much less risk of reinjury of the tendon on return to athletic work.

 David’s company A Cell http://www.acell.com/ has developed a safe procedure for harvesting and growing the stem cells of horses and provided materials that have been involved in the pioneering work on this revolutionary technique by Prof Roger Smith at the Royal Veterinary College London.

 Further research is now being carried out into the use of this stem cell therapy in selected suspensory ligament injuries, stifle meniscal tears, distal sesamoidean ligament damage.

On behalf of all our clients attending the evening I would like to thank both of our speakers for coming to talk to us with no charge for their attendance in order to raise money for The Brooke  registered charity and to provide useful informative material to our horse owners.

Profits from the Raffle went to "The Brooke"

The Brooke is the UK’s leading overseas equine welfare charity and their aim is to improve the lives of horses, donkeys and mules working in the poorest parts of the world. These animals form the backbone of the economy in many developing countries, supporting countless poor communities where many people earn less than a dollar a day.

The Brooke’s mobile vet teams and community animal health workers, and their partner organisations worldwide, provide free treatment to animals and train animal owners, local healers, farriers, saddlers, feed sellers, harness and cart makers. They currently operate across ten countries in Asia, Africa, Central America and the Middle East.

The enormous difference the Brooke makes is thanks to the kindness of their supporters and the dedication, care and compassion of their local vets and community workers.  Their work is underpinned by unique and proven methods developed with Bristol University Veterinary School. They have over 800 highly-skilled staff working directly in the field.

Notes from 3rd Alnorthumbria Client Workshop
Equine Emergencies

An emergency is a problem that needs immediate veterinary attention regardless of the time of day and includes many different problems, some of which are discussed below.

Colic
Colic describes abdominal pain, of which there are many different causes, including problems with the guts, the bladder, the liver, the kidneys or the reproductive organs. 
Signs include rolling, off food, depression, lying down more or reduced faeces.  Those with very mild signs may be monitored for 10-15 minutes but if the signs persist, or if the signs are moderate to severe, then the vet must be called immediately. 
Before the vet arrives:  
 Consider the history – when did it start?
Has there been any change in management recently?
Have routine teeth and worming treatments been kept up to date?
 Remove the food
 Put somewhere safe and can allow to roll
 Not all horses need walking – some can roll or injure themselves on colic; so take veterinary advice
 Monitor pulse rate and respiratory rate
The vet’s assessment:
 Demeanour
 Heart rate, respiratory rate and temperature
 Gut sounds
 Rectal examination
 Stomach tube
 Peritoneal tap
Treatment can be medical or surgical, depending on the cause.  Commonly horses will be treated medically initially, using non-steroidal anti-inflammatories, anti-spasmodics, opioid pain-killers or fluids via stomach tube or intravenously.  We consider referral for possible surgery if:
 Heart rate consistently above 60 beats per minute
 Unrelenting or increasingly severe colic signs
 Limited response to medication
 Positive rectal findings
 Gastric reflux via the stomach tube
Referral to a surgical facility does not definitely mean the horse will have surgery, but they are then in the right place should need it.  Careful consideration must be given to the practicalities and costs that referral entails, eg diesel in the horse lorry, can the horse travel, surgery may cost in the region of £3000. 
Success of colic treatment depends on accurate history and prompt, appropriate treatment.

Choke
Choke is an obstruction in the oesophagus (food pipe) not the trachea (wind pipe) and although it is distressing for horse and owner, it is not immediately life-threatening.  The obstruction is usually caused by food such as unsoaked sugar beet, racing to eat hard food due to competition in the field or a very greedy pony. 
Signs of choke: 
 Distress
 Coughing
 Arching back and clenching neck
 Saliva or food pouring from both
 Many pass within 5-10 mins but if the persist beyond this time, or the horse is very distressed, then call the vet
Before the vet arrives, bring the horse into a stable or well lit area, keep him calm and remove all food.  Don’t be tempted to give butter, liquid paraffin, grease or coca cola and don’t bang the throat area. 
The vet will then assess the horse and provide medical treatment, which includes sedation and anti-spasmodics.  These drugs alone often result in enough relaxation that the obstruction passes on its own; however, anti-inflammatories and antibiotics are often given to prevent secondary complications.  Stomach tubing is less frequently used as it can cause more damage to the oesophagus.  Some chokes may take 24-48hours to clear and it is only after this time that stomach tubing and flushing is used.
Risks of choke: 
 Dehydration
 Inhalation pneumonia
 Scarring, diverticulum or rupture of the oesophagus 
Choke can be prevented by routine dental care, feeding adequate fibre, avoiding competition during feeding time and using methods to slow eating such as a large stone in the feed bucket.

Eye problems
Eye problems can rapidly result in loss of sight and signs of eye pain include closed or swollen eyelid, blinking, weeping and a change in colour of the eye surface.

Corneal ulcers are a break in the surface of the eye, usually from a scratch, which causes intense pain.  These can become infected and bacterial products can result in the ulcer deepening and the eye rupturing within a short period of time so are considered a veterinary emergency. 
In order to diagnose the problem and check carefully for any foreign bodies remaining in the eye, the vet usually will need to:
 Sedate
 Nerve block the eyelids as horses have a very strong blink reflex
 Use a fluorescein stain to identify the ulcer
With antibiotic eye drops and pain relief, many ulcers will heal within a few days.  If they do not heal, we can use subpalpebral lavage systems to deliver medication long term or place a contact lens to act as a bandage.

Uveitis is another intensely painful condition of the equine eye, usually caused by the horse’s own immune system attacking the front portions of the eye.  Uveitis can also occur with corneal ulcers.  Signs include a small pupil, excessive blinking and weeping eye and a blue cornea.  This can ultimately result in cataracts, a fixed, small pupil and blindness.  Uveitis can become more aggressive with each episode, so prompt treatment is vital and usually involves systemic and topical anti-inflammatories.

 

 

Wounds
Wounds that need immediate veterinary attention include:
 Severe bleeding
 Wounds near joints, tendons or other synovial structures
 Size of wound
 Wounds that seem to be causing severe pain or lameness
If you’re in doubt, call us out!
If a wound can be treated at home
1. Clip the hair – better visualisation and prevents further contamination
2. Clean the wound – dilute hibiscrub or salt water
3. Inspect for other damage
4. Moist healing principles are better – e.g. dermisol, vetalintex, flamazine
5. Bandaging if possible – protects the wound, speeds healing and reduces proud flesh

Severe bleeding can be stopped or reduced by applying pressure pads directly onto the wound, while waiting for the vet to arrive.  If the pad soaks through, add another on top rather than removing and replacing it, as this can dislodge a blood clot that is forming.  Tourniquets are occasionally used but can be difficult to place correctly and must be removed every 20mins to allow blood flow to the rest of the limb.

Synovial structures
Joints and tendon sheaths are synovial structures.  These sterile structures have limited immune protection and limited antibiotic penetration so it is vital to treat any infection appropriately.  Untreated, an infected joint can become severely arthritic within weeks and end a horse’s career.  The optimum window for treatment is within the first 8 hours after injury. 
An infected joint is suspected if the wound is near the joint, there is joint swelling and severe or rapidly developing lameness. 
Infected synovial structures can be diagnosed by:
 Sample of joint fluid analysed in a lab
 Injecting fluid into the joint to see if it flows out of the wound
 Radiographs – can inject joint with contrast to see if the joint is intact
Also important to check for other damage or foreign bodies
Treatment options include sedating the horse and flushing the joint with sterile saline through needles, which should have a reasonable prognosis if there is no gross contamination of the joint and it is performed within 8 hours of the wound.  The gold standard is arthroscopy under general anaesthetic, which allows the surgeon to visualise the joint and remove any debris present.  Both methods will be followed with antibiotics directly into the joint and systemic antibiotics.

Wire wounds can be deceiving as the tissue dies back after a few days due to the burning action of the wire.  These wounds will often look worse after a few days and any severe lameness associated with these wounds should be carefully investigated.

Solar penetrations
Any sharp implement penetrating the sole can cause severe lameness and an abscess to develop subsequently; however, the most dangerous area is the back half of the frog as the deep digital flexor tendon, navicular bursa, navicular bone, pedal bone and coffin joint are underlying.
Until the vet arrives:
 Don’t remove the nail if possible – can bandage in with wedges either side to prevent it going further into the foot
 If you have to remove the nail – keep it and note the angle and depth of penetration
Treatment
Once the vet arrives, they will decide if it is appropriate to remove the nail, or if the horse needs to be x-rayed with the nail in place.  Radiographs can also be taken using contrast medium to see if any of the synovial structures are breached. 
 Some nails just need to be removed, the track dug out and poulticed
 If any synovial structures are affected, they will require flushing
 Antibiotics are given if the vet feels this is necessary

Suspected fractures
If you suspect a fracture e.g. sudden trauma, non-weight bearing lameness, instability of the limb, don’t move or transport the horse until the vet arrives.  Keeping the horse as calm as possible is the most important thing you can do for him. 
Remember that not every fracture requires euthanasia.

 

 

 

Notes from 2nd Alnorthumbria Client Workshop
Performance limiting lameness in the horse

Poor performance – describes a movement or action that becomes difficult despite the horse completing it easily previously
Sometimes our expectations exceed our horses’ ability!

There are many presentations of poor performance, including:
 Behaviour or attitude changes
 Resistance
 Vices
 Falling in on corners
 Wrong strike off in canter
 Refusing or knocking down jumps
Lameness is not commonly observed

Simple things to consider are:
 Tack fitting
 Bitting
 Fitness
 Feeding
 Teeth
 Rider
 Physiotherapy
… but 74% of poor performance is attributed to lameness

We complete an initial examination to exclude heart, lungs, teeth and eye problems.  We then concentrate on the musculoskeletal system at rest by checking conformation, symmetry and pain response of the back, muscles and limbs.  Following this, we do a lameness examination which can include:
 Walk and trot in a straight line
 Flexion tests
 Lunging
 Comparison of movement on hard and soft surfaces
 Ridden work
Lameness evaluations are often begun at the yard, but continued at the clinic in Alnwick where there is a controlled environment and continuity of the handler and conditions.  We also aim to isolate the problem, diagnose it and begin treatment on the same day.

Ridden assessment:
 It can be useful to see a horse ridden by a more experienced rider
 It can be useful to see a horse ridden by a more novice rider as the experienced jockey may be masking a problem inadvertently
 May continue riding while medicating with anti-inflammatories (painkillers) to see if any bad behaviour or poor movement improves or changes

Quick reminders!
Forelimb lameness:
 Assess with the horse coming towards you
 Head up with the lame leg weight-bearing
 Shorter stride and reduced fetlock drop can be helpful but occasionally misleading
 Can be very subtle and may be heard better than seen
Hindlimb lameness:
 Assess with the horse going away from you
 Mostly look at the point of hip, gluteals and sacro-iliac region
 Don’t rely on a shorter stride length – can be misleading
 Lunging is very useful

How we can diagnose the problem?
95% of forelimb lameness is due to problems originating in, or below, the knee

‘Nerve blocks’ are used to regionalise the problem
Local anaesthetic is injected over a nerve to ‘numb’ the area – if the lameness improves significantly then the region ‘numbed’ is the source of the problem
Can also inject directly into a joint - a ‘joint block’

Once the problem is isolated, the area is imaged:
Radiographs (x-rays) – are best for bony problems
Ultrasound scan –for soft tissues such as tendons, ligaments and cartilage
Magnetic Resonance Imaging (MRI) - very useful for soft tissue foot and fetlock problems

If the horse can’t be nerve blocked, or there are likely to be multiple problems, then scintigraphy can be useful
The horse is injected with a radioactive marker which is emitted from the horse and collected by a gamma camera
Problem areas have increased activity so will show as radiation ‘hot spots’
For the future:
MRI higher up the limb (some clinics already imaging hocks)
Gait analysis (will become more widely available)

Treatment options are numerous and depend on the diagnosis, the horse’s job and the budget available for treatment.

EXAMPLE CASES

The dressage horse performs repeated movements so they are more likely to get low grade, intermittent problems e.g. high suspensory ligament desmitis
High suspensory desmitis
Can be difficult to diagnose as it is often bilateral (both hindlimbs), resulting in a loss of impulsion.  This requires nerve blocking to diagnose, but there can be some cross-over with hock osteoarthritis (spavin) as the lowest hock joint lies very close to the attachment of the suspensory ligament.  Scanning is then usually performed the following day once the local anaesthetic has diffused away from the area. 
Treatment: Rest and anti-inflammatories in the acute stages
Controlled exercise programme
Shockwave therapy – repeated pulses of energy stimulate healing
Local anti-inflammatory injection – eg steroids
Platelet rich plasma – growth factors, to stimulate healing, injected into the ligament if there is any ‘hole’ present
Neurectomy – surgically cutting the nerve that was previously blocked by local anaesthetic

The showjumper is subject to extremes of flexion of the forelimbs on landing, and extremes of pressure on the hindlimbs on take-off.  Common problems include foot lameness in the forelimbs and hock associated lameness in the hindlimbs. 
Coffin joint osteoarthritis
This often occurs in both forelimbs and results in subtle shortening of the stride length.  It can be confirmed using ‘joint blocks’ and radiographs, but care must be taken as there can be some cross-over with other structures. 
Treatment: Often joint medication and corrective farriery are successful, but this is a degenerative condition so needs repeated treatment
Interleukin-1 Receptor Antagonist Protein (IRAP) can also be successful - a sample of the horse’s blood is cultured for the IRAP molecule.  IRAP is injected into the joint to counteract IL-1 which is a precursor of arthritis.

The event horse is usually older so is more likely to have arthritic conditions such as hock osteoarthritis. 
Hock osteoarthritis
This often presents as back pain and can even occur in young horses if they have had poorly formed hock bones at birth.  Again, diagnosis relies on ‘joint blocking’ and radiographs.  Repeated treatments can often result in the horse competing successfully for many years.   
Treatment: Systemic anti-inflammatories eg ‘bute
Intra-articular anti-inflammatories – response to local anaesthetic in the joint usually suggests that steroids injected into the joint will improve lameness
Tildren – improves density of bone to counteract the loss of bone density that occurs in arthritis
Remedial farriery
Joint supplements
Surgery – to fuse the lower hock joints

Back pain
Back pain is most commonly secondary to lameness but if there is primary back pain, it can have a severe impact on performance.  Back pain can have many causes, including muscle damage, ligament damage or over-riding dorsal spinous processes (kissing spines).  Treatment depends on the cause but can include medication of the affected area with anti-inflammatories, tildren, shockwave therapy, physiotherapy and surgery.  Surgery for kissing spines can be 80% successful but only if there is no lameness present, so commonly other, less invasive treatments are tried first.

Remember the context – many horses compete successfully with low grade, bilateral forelimb or hindlimb lameness so we need to interpret the effect lameness is having on performance.

 

Notes from Client Workshops
‘Essential Preventative Healthcare for Your Horse’

Owner’s role - essential to know what is normal for each individual horse or pony.  Grooming and routine footcare allow you to become familiar with your horse and detect any changes that may signify disease.

A lot of information can be gained from watching your horse at rest:
1. Demeanour – should be bright, alert and responsive
2. Posture and weight distribution – even weight distribution with hindlimbs occasionally resting but forelimbs should not be rested
3. Appetite and drinking
4. Faeces – 8-20 piles in 24 hours depending on diet
Also consider the colour and consistency of droppings
5. Urine – should have 2-5 wet patches in the stable overnight, but this is hard to assess!
6. Respiratory rate – normally 8-12 breaths per minute

Information can also be gained from examining your horse:
Skin elasticity, temperature and sweating
Swellings
Pulse rate – normally 30-40 depending on size of horse and fitness
Oral membranes – normally salmon pink and moist
Temperature – 100.5⁰F or 38⁰C

It is also useful to watch your horse walk and trot away from you and towards you and note any unusual movements such as swinging a limb or lameness.

Horse health planning covers all the important issues such as vaccinations, dental work, worming, foot care, fat scoring and nutrition.

Vaccinations
1. Tetanus vaccination is considered essential for any equine as tetanus can be fatal, however vaccination prevents the disease.  Vaccinations for tetanus are given every 3 years after the initial vaccination course; however, if they are given with influenza vaccinations, tetanus cover is usually given every 2 years.
2. Influenza vaccinations are required by most competing bodies and boosters are given annually after the initial vaccination course.  Horses that compete under FEI rules must be vaccinated every 6 months. 
3. Herpes vaccinations provide protection against herpes virus, which can cause coughs and abortions.  Boosters are given every 6months after the initial course and can be given at the same time as influenza and tetanus vaccinations.

Dental care
Routine dental treatments are essential to the welfare of the horse, but also can dramatically improve performance and acceptance of the bit.  We advise routine dentals every 9-12 months but individual horses may have different requirements.  Dentals also allow us to identify any painful mouth conditions such as diastemata (gaps between teeth), fractured teeth or loose teeth.  If these conditions are treated appropriately, the longevity of the teeth and therefore the horse, can be preserved.

Worming
Common problems associated with worms include spasmodic colic, surgical colic and diarrhea.

There are 2 different approaches to worming – strategic or routine. 
1. Routine worming means that every horse or pony on the yard is wormed at set intervals according to the drug used.  Care must be taken as different drugs have different dosing intervals.  This strategy is often useful in large yards or places with large numbers of youngstock, but may result in over-worming and the worms becoming resistant to the drugs used. 
2. Strategic worming means only horses with a high faecal worm burden are given worming treatments.   It is worth remembering that most of the worm burden resides in a very small proportion of the horse population.  Testing of the faecal samples should be performed every 12 weeks, but can be done less frequently if results show a consistently low worm burden.  By only treating those horses with high worm burden, there is less likelihood of the worms becoming resistant to the drugs. 
With both methods of worming, it is vital to continue dosing for tapeworm in November and May unless blood samples are taken for tapeworm levels.  It is also important to worm for encysted small redworm between November and January, as these parasites are increasingly recognised as a cause of colic and diarrhoea.  With careful planning, both the autumn tapeworming and encysted small redworm can be treated using a single dose of Equest Pramox in November. 

Other strategies to reduce worm burden include clearing the fields of faeces 1-2 times per week, rotating pastures and grazing with other species. 

Foot care
Foot care is very important to maintain correct foot balance, length and conformation, which should reduce the incidence of foot associated lamenesses.  Some horses are able to go barefoot, whereas others require shoeing.  It must be remembered that even if horses are not shod, regular trimming is vital. 
Things to assess when you view your horses feet
1. Toe length
2. Evenness of feet size
3. Length of inside and outside of hoof wall
4. Size of heel bulbs
5. Evenness of feet landing

Condition Scoring
There are 3 different systems of condition scoring; 1-5, 1-9, 1-10, with low numbers denoting poor condition and higher numbers denoting obesity.  The best systems grade the neck, shoulders, withers, ribs, loin and tailhead separately, with the figures then averaged to give an overall condition score.  Although condition scoring systems were originally developed for light breeds, they provide a very useful monitoring tool for weight loss and gain. 
The weigh tape can be used and although this is not an entirely accurate measurement of weight, it is a useful monitoring tool.  It is important that measuring is done at the same time each day by the same person. 
Clients can also bring horses into Wagonway Road, Alnwick and use the horse scales for an accurate weight.

Overweight horses and ponies are at risk of
1. Laminitis (1 point increase in condition score increases the laminitis risk by 6 times)
2. Metabolic syndrome
3. Poor performance and lethargy
4. Delayed Onset Muscle Soreness (DOMS)
5. Skin problems

Laminitis is often related to obesity and results in hot, painful feet which can be very acute in onset.  Some cases are so severe that they necessitate euthanasia therefore every case should be treated seriously.
Equine metabolic syndrome is a relatively newly described condition which causes recurrent bouts of laminitis, abnormal fat distribution, a slow metabolism and poor fertility.  This condition is treatable by reducing feed intake, increasing exercise and occasionally medicating with metformin.

Diet
Feeding should be given at approximately 1.5-2% bodyweight if the horse is in light to medium work.  This equates to 10kg per day for a 500kg horse (5 slices of hay are approximately 10kg).  If the horse is on a diet, for every hour at pasture, the feed should be reduced by 1kg.

Skin Problems commonly seen
1. Lice – especially in youngsters with long coats
2. Ringworm – remember the contagious nature of this fungal infection, and that it can also affect humans
3. Mud fever  - can result in quite severe infection and cellulitis

 

 

 

 

 

4. Sweet itch – allergy to midges causes skin disease, usually in the neck and tailhead regions from spring to autumn
5. Sarcoids – can come in all shapes and sizes!
6. Warts – often on the muzzle of young horses, and will often drop off without any treatment

Respiratory problems commonly seen
1. Coughs – many causes including allergy, bacterial or viral infection
2. Nasal discharge
3. Strangles – a very infectious bacterial infection of the upper respiratory tract which results in bilateral nasal discharge, cough, reduced appetite, depression, although these signs can be very variable in severity.
4. Viruses – commonly herpes virus causing coughing.  A large proportion of horses are exposed to herpes virus, and can then exhibit clinical disease when they are stressed. 
5. Allergic respiratory disease – this is often seen more commonly in winter when horses and ponies are stabled and an allergic reaction to moulds and spores in the stable environment result in the horse coughing and the airways becoming constricted.

Yard strategies
On yards, it is important to have a strategy for new arrivals in order to prevent the spread of disease. 
1. All new-comers should be wormed on arrival for round and tapeworm. 
2. Isolation should be for at least 2 weeks to prevent the spread of disease, particularly strangles, viral infections, ringworm and influenza. Some yards also request a blood sample that is negative for previous strangles exposure.