The evidence base for equine asthma management continues to develop, with inhaled therapy and environmental management now established as the welfare-optimal approach.
The evidence base for equine asthma management has matured substantially over the past decade, with inhaled therapy via equine spacer devices now the standard of care for horses with ongoing access to appropriate equipment and veterinary guidance. The welfare benefit of inhaled versus systemic corticosteroids is substantial: systemic dexamethasone or prednisolone rapidly controls inflammation but produces immunosuppression, laminitis risk, and metabolic effects with repeated use. Inhaled therapy at therapeutic doses avoids these systemic effects while maintaining local airway anti-inflammatory efficacy. The practical barrier is cost and owner compliance with twice-daily inhalation protocols. Environmental management remains essential regardless of treatment approach — even perfectly managed inhaled therapy does not compensate for continued high-antigen exposure that perpetuates the inflammatory stimulus.