title: Exercise induced pulmonary hemorrhage in horses: American College of Veterinary Internal Medicine consensus statement.
abstract: BACKGROUND
  Published studies of exercise-induced pulmonary hemorrhage (EIPH), when assessed individually, often provide equivocal or conflicting results. Systematic reviews aggregate evidence from individual studies to provide a global assessment of the quality of evidence and to inform recommendations.
  
  
  OBJECTIVE
  Evaluate evidence to determine: if EIPH adversely affects the health, welfare or both of horses; if EIPH affects the athletic capacity of horses; the efficacy of prophylactic interventions for EIPH; and if furosemide affects the athletic capacity of horses.
  
  
  METHODS
  None.
  
  
  METHODS
  Systematic review. A panel of 7 experts was formed to assess evidence in the peer reviewed literature addressing each of the 4 objectives. Methodology followed that of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Publications were assessed for quality of evidence by working groups of the panel, and a summary of findings was presented in tables. Recommendations were based on quality of evidence and were determined by a vote of the panel.
  
  
  RESULTS
  Much of the evidence was of low to very low quality. Experimental studies frequently lacked adequate statistical power. There was moderate to high quality evidence that EIPH is progressive, is associated with lung lesions, that it adversely affects racing performance, that severe EIPH (Grade 4) is associated with a shorter career duration, that furosemide is efficacious in decreasing the incidence and severity of EIPH, and that administration of furosemide is associated with superior race performance.
  
  
  CONCLUSIONS
  Strong recommendation that EIPH be considered a disease and a weak recommendation for use of furosemide in management of racehorses with EIPH.
authors.affiliation: University of Melbourne, Werribee, Vic., Australia.
authors.forename: K W
authors.initials: KW
authors.lastname: Hinchcliff
authors.affiliation: Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN.
authors.forename: L L
authors.initials: LL
authors.lastname: Couetil
authors.affiliation: University of Sydney, Sydney, NSW, Australia.
authors.forename: P K
authors.initials: PK
authors.lastname: Knight
authors.affiliation: Clinical Sciences, Colorado State University, Fort Collins, CO.
authors.forename: P S
authors.initials: PS
authors.lastname: Morley
authors.affiliation: Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI.
authors.forename: N E
authors.initials: NE
authors.lastname: Robinson
authors.affiliation: University of Pennsylvania, New Bolton Center, Kennett Square, PA.
authors.forename: C R
authors.initials: CR
authors.lastname: Sweeney
authors.affiliation: Equine Sports Medicine Practice, Waterloo, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: van Erck
mesh_terms: D000818:Animals; D032921:Consensus; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000662:veterinary*; D006734:Horse Diseases / Q000209:etiology* / Q000517:prevention & control; D006736:Horses; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control / Q000662:veterinary*; D008297:Male; D010805:Physical Conditioning, Animal / Q000009:adverse effects*; D064796:Veterinary Sports Medicine
chemical_list: D005665:Furosemide
keywords: Bleeding; Lungs; Physiology; Respiratory