Upper airway disorders stay front and center in equine practice: full analysis

EquiManagement has published a new Disease Du Jour episode on upper airway disorders in horses, featuring Dr. Kaycie Hatcher on the disorders equine clinicians see most often, how to structure a differential list, and how treatment and management decisions are made in practice. The topic lands in an area of equine medicine that’s both clinically familiar and persistently challenging: upper airway disease is a common source of abnormal respiratory noise, exercise intolerance, and poor performance, but the lesion responsible is not always apparent on a routine exam. (equimanagement.com)

That challenge is part of why the subject keeps resurfacing in continuing education. EquiManagement’s Disease Du Jour series, launched in 2019 for equine veterinarians and related professionals, regularly covers practical disease management topics. Upper airway disease, in particular, sits at the intersection of sports medicine, internal medicine, imaging, endoscopy, and client communication. EquiManagement has previously covered airway concerns in performance horses and, more recently, the ethics of airway surgery in equine athletes, underscoring how the field has moved beyond simple “noise correction” toward more nuanced questions about physiology, performance, and welfare. (equimanagement.com)

The clinical backdrop is broad. Upper airway disorders in horses can be static, causing obstruction at rest, or dynamic, becoming clinically important mainly during exercise. Common differentials include recurrent laryngeal neuropathy, dorsal displacement of the soft palate, axial deviation of the aryepiglottic folds, epiglottic entrapment, guttural pouch disease, progressive ethmoid hematoma, and sinus disease. History remains central: clinicians are advised to ask whether the horse makes noise at rest or only during work, whether the sound is inspiratory or expiratory, whether it appears only under certain conditions such as poll flexion or high speed, and whether nasal discharge is present. (vettimes.com)

Research and reference sources also reinforce a key diagnostic point likely to resonate with practitioners listening to Hatcher’s episode: many important upper airway problems are dynamic. Vet Times describes dynamic endoscopy as crucial for accurately diagnosing several exercise-related upper airway disorders, including recurrent laryngeal neuropathy and dorsal displacement of the soft palate, when history, physical exam, and resting endoscopy do not fully explain the complaint. Merck Veterinary Manual similarly notes that horses with laryngeal hemiplegia often present with poor performance or inspiratory noise during intense exercise, and that endoscopic evaluation is necessary for diagnosis. In recurrent laryngeal neuropathy specifically, prevalence is reported to be higher in tall Thoroughbreds and draft breeds, making signalment part of the diagnostic picture as well. (vettimes.com)

Industry discussion around upper airway disease has also become more selective about intervention. In EquiManagement’s recent reporting on the ethics of airway surgery, David Tremaine, BVSc, PhD, FRCVS, said static lesions that obstruct breathing at rest present a clearer welfare case for treatment, while dynamic lesions are more difficult to define and diagnose. That same article notes British Horseracing Authority data reviewed by Tremaine showing that 13.7% of roughly 57,000 horses in training from 2000 to 2025 underwent some form of airway intervention, with numbers trending slightly downward since 2020. The implication is that the profession is not moving away from airway workups, but it may be getting more cautious about which horses truly benefit from procedural treatment. (equimanagement.com)

Why it matters: For equine veterinarians, this is less about a single new finding than a timely refresher on case approach. Upper airway complaints can look deceptively straightforward to pet parents and trainers, especially when the presenting issue is “making a noise,” but the downstream decisions are not simple. The wrong assumption can lead to unnecessary surgery, missed lower-airway disease, or failure to identify a lesion that only appears at speed. The strongest thread across the available sources is that a disciplined workup still wins: careful history, targeted resting exam, endoscopy, and dynamic assessment when indicated, followed by treatment tailored to lesion type, severity, athletic demands, and welfare considerations. (vettimes.com)

That’s especially relevant as practitioners continue to field questions about performance expectations and management tradeoffs. Some cases call for surgery, such as tie-back procedures or ventriculocordectomy in selected laryngeal neuropathy cases, while others may be better managed with conditioning changes, anti-inflammatory treatment, tack adjustments, or monitoring. And because upper and lower airway disease can overlap, clinicians may need to widen the lens rather than narrow it too quickly. EquiManagement’s earlier respiratory coverage has stressed environmental management and the “one airway” concept, which remains useful when a horse’s signs don’t fit neatly into a single anatomic box. (vettimes.com)

What to watch: The next phase in this conversation is likely to center on better lesion-specific decision-making, wider use of dynamic and overground endoscopy in performance cases, and continued scrutiny of which airway procedures improve welfare and function, versus those performed mainly to address noise or competitive expectations. (equimanagement.com)