Klinisk gradering av hästens luftvägsstatus
en jämförande studie av kliniska graderingsprotokoll samt deras relation till luftvägshälsa och neutrofilförekomst i BAL-vätska
Respiratory disease with airway inflammation as main characteristic is common in the horse. It is a syndrome that is not yet fully understood. The etiology, pathogenesis and classification into different disease states are subjects for discussion and under continuous revision. Despite a number of modern techniques, the diagnostic procedure is challenging. There is no test considered to be gold standard when diagnosing these diseases. The clinical examination remains an important approach to the horse with suspected respiratory disease. The need for a standardized clinical scoring system for the equine airways has been addressed by clinicians and researchers. The clinical scoring systems used today are of varying complexity and contain different parameters that are graded in various ways. The aim of this study was to compare different clinical scoring systems for inflammatory airway disease in the horse and their relation to measured indices of inflammation in bronchoalveolar lavage fluid (BALF) and to clinical field status. Four of the protocols used in the study were taken from publications in the field of interest and one has been developed by the author of this under graduate thesis.Data collected from 70 clinical examinations (44 horses) have been used to compare the clinical scoring systems. The registered parameters were graded according to the different protocols and a total clinical score was achieved for each examination. Pearson correlation was used to study the covariance between the clinical scores from the different protocols and their relation to neutrophil elevation in BALF and clinical status.The results show that clinical scoring systems of varying complexity were of approximately equal value in predicting overall respiratory health or disease in horses with RAO/IAD versus clinically normal horses. It appears however that none of the scoring systems examined were predictive of neutrophil elevation in BALF as an objective measure of airway inflammation. The pair-wise correlation between individual scoring systems also varied when used on the same group of horses. Future refinement of scoring systems, possibly using individual factor analysis, may aid in identifying key clinical findings of value in a scoring system that could be standardized for interlaboratory use.