The prescience to measure airway reactivity in horses without heaves

The prescience to measure airway reactivity in horses without heaves Pferdeheilkunde 18 622 A landmark research paper was published by Klein and Deegen in 1986 entitled "Histamine inhalation provocation test: Method to identify nonspecific airway reactivity in equids. The paper made little 'splash' in the lay press, nor was there an abundance of scholarly commentary in response. It seemed that, like many German papers, it went disturbingly unnoticed in the USA. At the time, I began working as a Large Animal Medicine Resident and Graduate Student at the University of Guelph in Ontario, Canada, fresh out of private practice. There, Dr. Laurent Viel was meticulously cataloguing the bronchoalveolar lavage (BAL) cytology of horses with poor performance, and I was fortunate to join his group. We principally saw racehorses, and the common complaint was 'fading at the fl mile mark.' Viel seemed to me to be one of the only persons, that was really enthusiastic about low-grade airways inflammation in horses without heaves (Fogarty and Buckley 1991). Indeed, there was no name for this condition in English, so we and others (Moore et al 1997) made them up: small airway disease, small airway inflammatory disease, and inflammatory airway disease. Viel (1997) hypothesized that the cytologic inflammation portended airway obstruction, and the latter was the cause of poor performance. Klein and Deegen's paper was crucial evidence, but the proof of concept would not come for years. Klein and Deegen appeared to have sensed the need to address problems in their clinical caseload by using more objective tests. Conventional testing using esophageal pressure -flow data does not detect abnormalities in non-heaves horses (Sasse 1973, Hoffman 2002) so a different approach was needed. Klein and Deegen were persistent, and followed their hunch that something was functionally deranged in these milder cases. Many of the horses had remarkable mucus accumulations visible by endoscopy, the latter technique being rather new. They proposed a challenge test analogous to methacholine challenge in humans suspected with asthma. Anyone that has performed lung function test in equine outpatients knows that it poses several challenges. Equine patients are unaccustomed to the lung function testing equip-

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