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DOI: 10.1055/a-1581-6231
Remodeling beim equinen Asthma – Einfluss von Haltungsoptimierung und pharmakologischer Therapie
Remodeling in equine asthma – Effects of antigen avoidance and pharmacological therapy![](https://www.thieme-connect.de/media/10.1055-s-00034912/202105/lookinside/thumbnails/10-1055-a-1581-6231-1.jpg)
Zusammenfassung
Der Begriff Remodeling beschreibt den Prozess, der zu Veränderungen in Struktur und Aufbau im Vergleich zu gesundem Gewebe führt. Zumindest beim schweren equinen Asthma kommt es hauptsächlich, aber nicht ausschließlich, infolge der neutrophilen Entzündung zu einer Hypertrophie der glatten Bronchial- und arteriellen Gefäßmuskulatur sowie zu einer Fibrosierung der luftführenden Wege, aber auch des pulmonalen Interstitiums. Zur milden bis moderaten Form des equinen Asthmas ist bislang deutlich weniger bekannt. Lange wurde davon ausgegangen, dass das Remodeling irreversibel ist. Während dies für die glatte Bronchialmuskulatur weitgehend bis >heute gilt, gibt es beim Remodeling der extrazellulären Matrix der Lamina propria der Atemwege neue Erkenntnisse. Sowohl eine langfristige Remission durch konsequente Haltungsoptimierung als auch Glukokortikoide können den Kollagengehalt hier annähernd normalisieren. Das Remodeling der arteriellen Gefäßmuskulatur ist durch langfristige Haltungsoptimierung über mindestens 12 Monate und Bronchodilatatoren, nicht aber alleinig durch inhalative Glukokortikoide ebenfalls reversibel. Obwohl noch nicht abschließend geklärt, könnte die mit guter Prognose oft ausheilende milde bis moderate Form des equinen Asthmas eine Vorläuferform der schweren Form sein, bei der auch in der Phase der Remission Einschränkungen der Lungenfunktion nachweisbar sind, selbst wenn keine offensichtlichen klinischen Symptome vorliegen. Somit sind die frühzeitige Diagnosestellung des equinen Asthmas und ein früher Therapiebeginn entscheidend, damit zu Beginn der Behandlung möglichst wenige irreversible Veränderungen vorliegen. Der konsequenten Haltungsoptimierung kommt therapeutisch die größte Bedeutung zu, daneben sollten Glukokortikoide und Bronchodilatatoren eingesetzt werden.
Abstract
The term remodeling describes the process resulting in a tissue that is structurally and architecturally altered compared to its healthy counterpart. At least in severe equine asthma, this occurs mainly, but not exclusively, as a consequence of neutrophilic airway inflammation and is characterized by hypertrophy of the smooth muscle layers in airway and arterial walls as well as fibrosis of the bronchial walls and pulmonary interstitial tissue. To date, much less is known for mild to moderate equine asthma. For a long time it was assumed that these processes are irreversible, and at least for the remodeling of airway smooth muscle this is valid until today. In contrast, remodeling of the extracellular matrix disappears almost completely following long-term remission in consequence to strict antigen avoidance and environmental improvement as well as after glucocorticoid therapy. The remodeling of the arterial vasculature is also reversible following at least 12 months of antigen avoidance and bronchodilatory therapy, but not by inhaled glucocorticoids alone. Although not proven to date, the mild to moderate forms with a good prognosis for complete recovery may be a progenitor for severe equine asthma, in which lung function is restricted even during disease remission despite the absence of obvious clinical signs. Early diagnosis and therapy are, therefore, essential for the management of equine asthma prior to the development of irreversible remodeling, in particular of the bronchial smooth muscle. Antigen avoidance is of highest importance, and should be supported by glucocorticoids and bronchodilators.
Schlüsselwörter
Pferd - Lunge - Fibrosierung - Glukokortikoide - Bronchodilatatoren - HaltungsoptimierungPublication History
Received: 20 January 2021
Accepted: 26 July 2021
Article published online:
01 September 2021
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