Managing the risks of steroids

[NinjaPony]

How do you manage the increased laminitis risk that comes with steroid use? After trying to treat my pony’s asthma with management, then ventipulmin, then inhalers, none of which have made any difference, we have been left with little choice but to put him on oral steroids to reduce the inflammation. Vet has warned that it will increase his laminitis risk, which is why all other options were tried first. I’m already managing him as at risk, he is still on his winter grazing, all hay is portioned and soaked, feed has been cut back to a handful, but where his breathing has been so bad he has been out of work so put on a little bit more weight than usual. Rock and a hard place really as I can’t get him back in work without dealing with the breathing. So I was wondering if anyone else has experience of oral steroids, and what else I can do to try and minimise the risk.

 

[Fruitcake]

I was in exactly the same position a couple of years ago. I decided to go down the nebulised steroid route rather than oral as, apparently, the risk is negligible with nebulised steroids as they are more or less confined to the lungs and don’t tend to escape into the blood stream.

The difference with the nebuliser was incredible! I was sceptical at first, as inhalers had had minimal impact but, honestly, it was the best decision I made for the horse’s asthma.

As an aside, not long afterwards, the horse did have to have oral steroids due to a really nasty spontaneous skin infection which caused a hospital stay. I wasn’t at all happy to find they’d put him on steroids but the vet assured me a recent study had proved the risk was nowhere near what it had been originally thought. I was still very careful with him while he was on them but it sounds like you’re doing all that anyway.

Feel free to PM me if you want. I hope you get the asthma under control; I know how stressful it can be.

 

[be positive]

One of mine had problems breathing and the only thing that helped him was to give haylage, soaking hay was just not enough to reduce the symptoms, I would get yours onto haylage for a few weeks before using steroids if he is in at high risk of laminitis, if he gets that you will be in a far worse position than you are now with less treatment options.
Mine has been fine for years now living mainly out and only getting haylage if he is in at any time.

 

[NinjaPony]

Thanks for the replies. Haylage hasn’t really been an option- my yard doesn’t feed it, plus it makes him put on weight, but when I’m on diy next year I might be able to switch him over, particularly during the summer months when he will be out overnight and in during the day. For now, his hay is good quality and well soaked. I’m not convinced it is dust anyway as nose nets have made no difference and he has been kept dust free all the time I’ve had him. I’ll just have to be extra vigilant while he is on the medication!

 

[Fransurrey]

I was in exactly the same position a couple of years ago. I decided to go down the nebulised steroid route rather than oral as, apparently, the risk is negligible with nebulised steroids as they are more or less confined to the lungs and don’t tend to escape into the blood stream.

Inhaled drugs are often the preferred route precisely BECAUSE they more easily enter the bloodstream. Budesonide in particular is fat loving (lipophilic), which means that it crosses the cell layers very easily. It's subjected to first-pass metabolism (by the liver) when given orally, so much less available. Because you need a higher dose to get the same therapeutic effect, there is more risk of side effects with oral steroids. They're mostly given for IBD, as the dose doesn't need to make it through the intestine into the blood.

OP, the risk of steroids in laminitis is now only thought to be in the cases of horses with metabolic disease (PPID, IR, EMS). If your horse doesn't have any of those, the occurrence of steroid induced laminitis is rare. This is quite an old review, but still relevant:

https://onlinelibrary.wiley.com/doi/full/10.1111/j.2042-3292.2011.00320.x

I would discuss antihistamine options with the vet, as allergy-induced asthma is the most common type in humans and horses.

 

[Fruitcake]

Inhaled drugs are often the preferred route precisely BECAUSE they more easily enter the bloodstream. Budesonide in particular is fat loving (lipophilic), which means that it crosses the cell layers very easily. It's subjected to first-pass metabolism (by the liver) when given orally, so much less available. Because you need a higher dose to get the same therapeutic effect, there is more risk of side effects with oral steroids. They're mostly given for IBD, as the dose doesn't need to make it through the intestine into the blood.

OP, the risk of steroids in laminitis is now only thought to be in the cases of horses with metabolic disease (PPID, IR, EMS). If your horse doesn't have any of those, the occurrence of steroid induced laminitis is rare. This is quite an old review, but still relevant:

https://onlinelibrary.wiley.com/doi/full/10.1111/j.2042-3292.2011.00320.x

I would discuss antihistamine options with the vet, as allergy-induced asthma is the most common type in humans and horses.

I’m only going by what my vet told me. That was the argument used with (and accepted by) the insurance company too as opposed to using oral steroids so I’m sure, in the case of the steroids prescribed for my horse, there must have been some truth it the theory.

 

[SEL]

We tested my mare for cushings and her insulin levels before a course of steroids, just to make sure she wasn't already on the laminitis risk scale.

 

[Shilasdair]

My horse has been on oral steroids constantly for about 9 years now - the vet (a very good one) assured me that there was no credible link between laminitis and oral steroid use (although there was a strong link to injections).
The down side is that oral steroids stimulate appetite so it's quite hard keeping the weight off...