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Comprehensive Guide to Managing Heaves in Horses for Optimal Health

Updated: Dec 6, 2023

Horse with heaves labored breathing

As winter arrives, it's all about warm clothes, spending hours inside, and warm coffee or hot chocolate. We’re also gearing up to protect ourselves from viruses and other diseases that usually spread during this time. Flu, cough, and other respiratory diseases are very common in the winter months. Horses are also at risk for respiratory diseases.

In the winter, horse owners start stressing about the season changes and aim to protect their horses from the cold weather. So, they stable the horses inside the barn for the cold nights and cover them with blankets. But little do they know that all the closed stall windows and doors can cause problems for ventilation. The air quality deteriorates, and the horse becomes exposed to allergens and toxins, resulting in a respiratory condition known as heaves.

In this article, we will discuss heaves and how to manage it. We’ll also expose how it develops, its signs and symptoms, how vets diagnose it, and the treatment options.

Equine Heaves or Recurrent Airway Obstruction (RAO)

Heaves, scientifically known as Recurrent Airway Obstruction (RAO), is a prevalent respiratory ailment among horses, akin to how asthma manifests in humans. Positioned within the realm of chronic obstructive pulmonary diseases (COPD), heaves entails a range of symptoms such as coughing, nasal discharge, labored breathing, and diminished performance. This condition originates from a heightened sensitivity of the horse's lungs and, in severe cases, may result in lasting damage to the respiratory system.

Summer Pasture-Associated Heaves

This variant typically emerges during the warmer months, with a notable prevalence in summer. The primary triggers for this type of heaves are allergens emanating from trees and grasses. Horses that graze in pastures laden with these allergens may be more susceptible to developing symptoms. The exposure to environmental elements during summer exacerbates respiratory distress in affected horses.

Classic Heaves

In contrast, Classic Heaves tends to manifest during winter, particularly in cold weather. The principal allergens in this scenario are often found within the confines of the horse's shelter. Barn dust, spores, and mold are the main culprits, and horses stabled in environments with inadequate ventilation are at an increased risk of developing this form of heaves during the winter season.

Managing heaves involves a comprehensive approach, ranging from environmental modifications to medical interventions. Minimizing exposure to known allergens, providing proper ventilation in stables, and employing suitable dietary measures are integral components of preventative care. In severe cases, veterinary guidance and prescribed medications may be necessary to alleviate symptoms and prevent further respiratory compromise.

Horse owners and caretakers should remain vigilant to the signs of heaves, especially during the seasons when the respective triggers are prevalent. Timely intervention and proactive management strategies are pivotal in ensuring the well-being and respiratory health of horses affected by this chronic respiratory condition.

The Origins of Heaves in Horses

Heaves in horses stem from a complex interplay of factors, primarily driven by allergic reactions to various environmental elements. Pollen, dust, mold, and other inhaled particles act as triggers, with horses developing an increased hypersensitivity to these substances. Additionally, there may be a genetic predisposition to heaves, suggesting a hereditary component in the development of this respiratory condition.

Microorganisms play a significant role in the onset of heaves, with certain bacteria and fungi identified as culprits. Among these, Faenia rectivirgula, Aspergillus fumigatus, and Thermoactinomyces Vulgaris are known to contribute to the inflammatory response within the equine respiratory system.

The presence of foreign objects, whether in the hay or the surrounding environment, prompts a heightened reaction in the horse's lungs. This reaction initiates bronchoconstriction, leading to the narrowing of the airways. Consequently, the affected horse experiences difficulty breathing, often accompanied by persistent coughing as the respiratory system attempts to expel the inhaled particles.

The cumulative effect of constant irritation is the inflammation and thickening of lung tissue. Hypersensitivity exacerbates the condition, resulting in the accumulation of mucus and the generation of pus within the respiratory tract. This intricate process underscores the multifaceted nature of heaves, where both allergic reactions and microbial involvement contribute to the progression of the disease.

equine bronchial tube comparison of a healthy tube and heaves tube
Comparison of bronchial tubes. Right side shows bronchoconstriction and mucus/pus accumulation. Photo credit: Doctor Ramey

Understanding the nuanced factors that contribute to heaves is crucial for implementing effective prevention and management strategies. By addressing environmental triggers, minimizing exposure to allergens, and considering genetic factors, horse owners and caretakers can play a pivotal role in supporting the respiratory health of their equine companions.

Signs and Symptoms of Heaves

Recognizing the signs and symptoms of heaves in horses is crucial for early detection and intervention. In the beginning stages, mild indications may be observed during exercise or while eating, including:

  • Frequent Coughing: Horses suffering from heaves often exhibit a persistent cough, initially triggered during exercise or eating.

  • Wheezing: Wheezing sounds may accompany the horse's breathing, indicating constriction or obstruction in the airways.

  • Increased Respiratory Rate: An elevated respiratory rate becomes noticeable, reflecting the horse's efforts to cope with respiratory distress.

  • Difficulty in Breathing: Labored breathing becomes apparent, with the horse exhibiting signs of respiratory discomfort.

  • Flared Nostrils: Flared nostrils are a visual cue of increased respiratory effort as the horse attempts to draw in more air.

  • Functional Limitation: Heaves can lead to a decline in the horse's overall performance, with reduced stamina and endurance.

  • Abnormal Lung Sounds: Unusual sounds, such as crackles or rattles, may be audible upon auscultation of the horse's lungs.

  • Nasal Discharge: The presence of nasal discharge is another indicator of respiratory distress in affected horses.

As the disease progresses, these mild symptoms can escalate to more severe manifestations:

horse with heaves has a heave line on the abdomen
Heave line seen on the lower portion of ribs. Photo credit: Horse Journals
  • Increased Cough Frequency: Initially limited to specific activities, the cough becomes more persistent and may occur even during periods of rest.

  • Heave Line Development: In severe cases, the horse may develop a visible heave line. This is a notable feature resulting from the increased effort exerted by the respiratory muscles during breathing. The stress on these muscles can lead to hypertrophy, leaving a distinct line on the abdominal muscles.

Recognizing these signs early on allows for timely veterinary intervention and the implementation of management strategies. Monitoring the progression of symptoms is essential for adjusting care protocols and ensuring the well-being of horses affected by heaves.

Detecting and Assessing Respiratory Distress in Horses

You should always call your veterinarian if you suspect any changes in your horse. They will be able to preform diagnostics or exams that can determine what is going on with your horse. If you suspect heaves, you should list the symptoms you notice to your vet. The vet will make a diagnosis based on physical examination and history.

Before the veterinary visit, make a detailed list of the symptoms you've noticed. Include information on the horse's cough frequency, breathing difficulties, and any other behavioral changes. This will assist the vet in understanding the scope of the issue.

Physical Exam

The veterinarian will conduct a thorough physical examination, focusing on key indicators of heaves. This includes checking for flared nostrils, episodes of coughing, fever, changes in performance intensity, and potential weight loss. In chronic cases, a notable sign is the development of a heave line, a visible indicator of respiratory distress.


The vet will employ auscultation to assess the lung field and listen to breathing sounds. This involves using a stethoscope to detect any abnormalities. Areas with restricted airflow may lack typical breathing sounds, and the vet may be able to identify crackles and wheezes. Increased airflow turbulence, a result of the constriction of alveolar walls, may contribute to these audible signs.

Diagnostics Used to Diagnose Heaves

Ensuring an accurate diagnosis of heaves in horses involves a multifaceted approach, employing various diagnostic tools to provide comprehensive insights into the respiratory condition. Here's an in-depth exploration of the diagnostics commonly used by veterinarians to diagnose heaves:

  • Complete Blood Count (CBC): A CBC is often advised to assess the blood cell count for signs of inflammation. Elevated levels of white blood cells, particularly neutrophils, may indicate an immune response and ongoing inflammation within the respiratory system.

  • Chest X-ray: Chest X-rays play a pivotal role in ruling out complications and other respiratory diseases. They offer a detailed view of the lungs, enabling the veterinarian to identify potential issues such as pneumonia, pleurisy, and overall lung damage.

  • Ultrasound: Utilizing ultrasound can help rule out inflammation of the pleura, the thin membrane covering the lungs. This non-invasive imaging technique provides valuable insights into the condition of the pleura and aids in the diagnostic process.

Horse trachea shows inflammation from heaves
Inflammation can be seen in the trachea with the endoscope. Photo credit: Anoka Equine
  • Endoscopy: Endoscopy involves the use of a small, flexible tube equipped with a camera to visually inspect the trachea and bronchioles. This allows the veterinarian to identify mucus buildup and inflammation, providing crucial clues about potential infections, heaves, or other respiratory diseases.

  • Bronchoalveolar Lavage (BAL): Considered the most reliable method for confirming the diagnosis of heaves, bronchoalveolar lavage involves taking a fluid sample from the lungs. This sample is then examined under a microscope to assess the presence of inflammatory cells. The predominant cells observed are typically macrophages and neutrophils, offering insights into the nature and extent of the inflammation within the respiratory tract. This method is particularly effective in severe cases, providing a definitive diagnosis of heaves.

By integrating these diagnostic tools, veterinarians can establish a comprehensive understanding of the horse's respiratory health. The combination of imaging, blood analysis, and direct sampling techniques ensures a precise diagnosis, allowing for targeted and effective treatment strategies tailored to the specific needs of horses affected by heaves.

Can heaves be cured?

No, heaves cannot be cured but it can be managed. You can reduce the signs of inflammation and other symptoms. This can be done by improving the horse's environment, medication and taking preventive measures to make him less exposed to allergens. The air quality must be monitored and improved with proper ventilation to provide the best environment for your horse.

6 Ways to Manage Heaves in Horses

Although Heaves is not curable, some precautions can reduce or even eliminate the signs and symptoms. Below are a couple ways to manage heaves.

Avoid Exposure to Dust and Allergens

For effective management of heaves in horses, minimizing exposure to dust and allergens is paramount. Implementing strategic measures to optimize the horse's living conditions and daily routine can significantly alleviate respiratory distress. Here's a detailed exploration of practical steps to avoid exposure:

  • Outdoor Living and Pasture Access: Maximizing outdoor living is ideal for horses with heaves. Allowing your horse daily access to fresh pasture land rather than confining them in a barn can reduce exposure to airborne irritants. If hay is part of the diet, ensure it is of high quality, and round hay bales should only be considered if pasture availability is insufficient. Round bales, despite being a convenient feeding method, may pose a risk for horses prone to heaves. Round bales can accumulate dust and mold, contributing to respiratory challenges.

  • Ventilation in Indoor Spaces: In situations where stalling is necessary, prioritizing proper ventilation is crucial. Choose a stall location with good airflow to reduce the concentration of airborne particles. This can be achieved by strategically placing the stall in areas with optimal air circulation.

  • Bedding Considerations: Opt for bedding materials that minimize dust exposure. Avoiding fine shavings and opting for alternatives that generate less dust can contribute to a healthier indoor environment for the horse. Providing a solid stall floor, such as floor mats or concrete, helps prevent dirt particles from becoming airborne when the horse moves.

Horse eating a round bale of hay develops heaves
Is this your horse? She could be at risk for developing heaves. Photo credit: Horse Canada
  • Hay Feeding Practices: Hay huts, while convenient, can contribute to dust exposure. Consider alternative feeding methods that minimize respiratory risk. Ensure that the hay provided is of good quality, free from mold and contaminants. Hay nets or racks can be used to elevate hay off the ground, reducing the likelihood of ingesting dust and debris.

  • Regular Monitoring and Adjustments: Consistent monitoring of the horse's condition is essential. Assess the effectiveness of the implemented measures and make adjustments as needed. Regular veterinary check-ups can provide insights into the horse's respiratory health and guide further modifications to the management plan.

By incorporating these practical strategies into the daily care routine, horse owners can create an environment that mitigates exposure to dust and allergens, thereby promoting the respiratory well-being of horses affected by heaves. The emphasis on outdoor living, proper ventilation, bedding choices, and hay feeding practices collectively contributes to a holistic approach to heaves management.

Nutritional Management for Heaves

When it comes to addressing heaves in horses, a tailored nutritional approach can play a pivotal role in managing symptoms and supporting overall respiratory health. Here's a comprehensive exploration of effective nutritional strategies:

  • Alternatives to Traditional Hay: Traditional hay can contribute to dust exposure, exacerbating respiratory issues in horses with heaves. Consider switching to hay alternatives such as alfalfa, hay pellets, or other forage options. These alternatives are often lower in dust and can provide essential nutrients without compromising respiratory health.

alfalfa pellets for horses with heaves
  • Vitamin and Mineral Supplementation: Ensure that the horse's vitamin and mineral needs are met through appropriate supplementation. Adding a balanced supplement to the diet can help maintain overall health. Vitamins, in particular, play a crucial role in boosting immunity and acting as natural anti-inflammatories. Consult with your veterinarian to determine the specific requirements for your horse's nutritional needs.

  • Omega-3 Fatty Acids: Incorporate omega-3 fatty acids into the horse's diet to harness their anti-inflammatory properties. Sources like flaxseed or fish oil can be beneficial in mitigating inflammation associated with heaves. These fatty acids contribute to respiratory well-being and support overall health.

  • Herbal Supplements and Essential Oils: Explore the potential benefits of Herbal supplements and essential oils in managing heaves. Certain herbs and oils possess anti-inflammatory and immune-supporting properties. Essential oils, in particular, can aid in reducing inflammation and acting as antispasmodics. However, it's crucial to consult with your veterinarian before introducing any new supplements or oils to ensure they align with your horse's specific needs and health status.

Engage in an open dialogue with your veterinarian regarding the best nutritional options for your horse's stage of the disease. Veterinarians can offer valuable insights into the specific dietary requirements and supplements that would be most beneficial for managing heaves. Regular communication ensures that the nutritional plan is tailored to the horse's individual needs and the progression of the condition.

In summary, adopting a holistic nutritional management plan can significantly contribute to the well-being of horses with heaves. By making informed choices about hay alternatives, incorporating essential vitamins and minerals, and exploring the potential benefits of omega-3 fatty acids, herbal supplements, and essential oils, horse owners can actively support respiratory health and enhance the quality of life for their equine companions.

Check the Quality of Hay and Ensure Some Moisture

Feeding your horse with high-quality hay is fundamental to its overall well-being, especially when managing respiratory conditions like heaves. Here's an in-depth exploration of why hay quality matters and how ensuring some moisture can mitigate risks associated with dust and contaminants:

  • Quality Assurance in Hay: Optimal hay quality involves careful consideration of its source, farming practices, and cleanliness. Ensure that the hay is sourced from reputable suppliers who follow proper harvesting and storage procedures. Well-maintained and clean hay reduces the risk of respiratory irritants such as dust, mold, and spores.

  • Addressing Mold and Spores: Even in high-quality hay, the presence of mold and spores is a possibility. These contaminants can have adverse effects on equine respiratory health. Regularly inspect hay batches for signs of mold, discoloration, or unusual odors. Proper storage in a dry and well-ventilated space can also help minimize the risk of mold growth.

  • Moistening or Steaming Hay: To further mitigate the risk of flying particles and respiratory irritants, consider moistening or steaming the hay before feeding it to your horse. Moistening hay with water can help settle dust and reduce the inhalation of airborne particles. Steaming hay is an excellent option for horses with respiratory diseases, including heaves.

hay steamer for horses with heaves
Photo credit: Farm Vet
  • Benefits of Hay Steaming: Hay steaming offers a multifaceted solution to respiratory challenges. By subjecting hay to steam, the process effectively eliminates a significant portion of dust and foreign particles. Moreover, hay steamers can reach temperatures sufficient to kill fungal spores and eradicate living organisms like mites. This makes steaming an attractive option for maintaining the nutritional benefits of hay while minimizing the respiratory risks associated with dust and contaminants.

  • Considerations for Hay Steamers: While hay steamers offer substantial benefits, it's essential to acknowledge that they can be a significant investment. The upfront cost of purchasing a hay steamer might be a consideration for some horse owners. However, the long-term benefits in terms of improved respiratory health and overall well-being for horses with conditions like heaves may outweigh the initial expense.

In conclusion, the meticulous assessment of hay quality, coupled with moisture management techniques such as steaming or wetting, can profoundly impact the respiratory health of horses. By prioritizing these considerations, horse owners can create an environment conducive to optimal equine health, particularly for those managing respiratory conditions.

Feed at Chest Height During Heaves Flare-ups

While feeding at ground level is generally considered optimal for horse digestion, horses with heaves present a unique challenge where respiratory health takes precedence. During heaves flare-ups, strategic adjustments to feeding practices become crucial to minimize exposure to dust and allergens. Here's an in-depth exploration of the considerations and practices for feeding at chest height during heaves flare-ups:

Hay Soaking and Elevated Feeding

Soaking hay is a valuable step in reducing dust and airborne irritants. Once hay is soaked, feeding it at chest height becomes a practical solution. Using hay mangers or hay nets that elevate the hay can help keep it off the ground, minimizing the risk of dust inhalation. Elevating the hay to chest height serves as a protective measure during heaves flare-ups. Horses with respiratory conditions, including heaves, are particularly sensitive to dust and allergens. Feeding at chest height helps keep the hay away from ground-level contaminants, reducing the likelihood of triggering respiratory distress.

Regularly observe your horse's behavior and respiratory patterns. Monitoring for signs of improvement or exacerbation during elevated feeding can inform adjustments to the management plan. This observational approach ensures that the feeding strategy aligns with the horse's well-being.

Before implementing changes to feeding practices, consult with your veterinarian to discuss the specific needs of your horse. Veterinarians can provide guidance on the frequency and duration of elevated feeding based on the severity of heaves and the individual horse's condition.

Medical Management for Heaves

Effectively managing heaves in horses often involves a strategic combination of medications to alleviate symptoms and improve respiratory function. Here's a detailed exploration of medical management options for heaves:

  • Corticosteroids: Corticosteroids are often the primary medication prescribed for heaves. These anti-inflammatory agents help mitigate the inflammatory response in the airways, reducing bronchoconstriction and alleviating respiratory distress. Corticosteroids are effective in controlling symptoms during heaves flare-ups, but their prolonged use may require careful monitoring due to potential side effects.

  • Bronchodilators: Bronchodilators play a crucial role in widening the airways, making it easier for the horse to breathe. By relaxing the smooth muscles in the respiratory tract, bronchodilators help reduce bronchoconstriction and improve airflow. Combining bronchodilators with other medications can enhance their effectiveness in managing heaves symptoms.

  • Antihistamines: Antihistamines are another class of medications that can be used to reduce allergic responses and minimize coughing in horses with heaves. They work by blocking histamine receptors, thereby modulating the inflammatory response and mitigating symptoms triggered by allergens.

horse inhaler used for horses with heaves
Photo credit: University of Saskatchewan
  • Equine Inhalers: Equine inhalers, FDA-approved devices, offer a targeted approach to delivering medication directly to the respiratory tract. These inhalers provide a more localized and efficient means of administering bronchodilators or other prescribed medications. While effective, equine inhalers can be a relatively expensive option.

The administration of medications for heaves should always be done under the guidance and supervision of a veterinarian. Veterinarians have the expertise to assess the severity of the condition, prescribe appropriate medications, and tailor the treatment plan to the individual needs of the horse. Never administer any medication to your horse without consulting the vet, as incorrect dosage or medication choice can have adverse effects. The vet will consider factors such as the severity of symptoms, the horse's overall health, and any potential side effects associated with long-term medication use. Collaboratively determining the most suitable treatment plan ensures optimal outcomes for the horse's respiratory well-being.

In conclusion, medical management for heaves involves a nuanced approach, combining medications such as corticosteroids, bronchodilators, and antihistamines. Equine inhalers, while effective, may be a more costly option. The key to successful management lies in close collaboration with a veterinarian, ensuring that the chosen treatment plan aligns with the specific needs and condition of the horse.

Acupressure Therapy for Heaves

Acupressure emerges as a valuable complementary care option for horses with heaves, offering a holistic approach to addressing imbalances and promoting overall respiratory health. While not a quick fix, acupressure sessions contribute to long-term well-being by bringing balance to the animal.

Acupressure is a holistic modality that works gradually to restore balance in the body. Given that heaves presents as an imbalanced respiratory disorder, acupressure sessions are most effective when integrated as part of a preventative care plan. Regular sessions can contribute to maintaining balance and preventing recurrent episodes of heaves. Gentle pressure to specific points help to reduce the allergic response associated with heaves. By targeting these points, acupressure aims to improve breathing function by relaxing hypertrophied muscles, stimulate the release of anti-inflammatory cytokines, and clear obstructions from the nose and nasal cavity.

acupressure work on a horse can prevent heaves
  • Improves Breathing Function: Acupressure aids in relaxing hypertrophied muscles, promoting better breathing function.

  • Stimulates Anti-Inflammatory Response: By activating the immune system, acupressure encourages the release of anti-inflammatory cytokines.

  • Prevents Recurrent Episodes: Regular acupressure sessions can contribute to preventing the recurrence of heaves episodes.

  • Clears Nasal Obstructions: Acupressure helps clear the nose and nasal cavity from obstructions, facilitating smoother respiratory function.

  • Encourages Relaxation and Calmness: Beyond the physical benefits, acupressure promotes relaxation, calming the body and mind.

  • Effective for Respiratory Imbalances: Acupressure is versatile and beneficial for various respiratory imbalances, including colds, coughing, and sneezing.

Seeking professional acupressure sessions from practitioners like Poll to Pastern can enhance the effectiveness of this modality. Routine acupressure sessions, guided by experienced practitioners, can be scheduled to integrate seamlessly into your horse's care plan.

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