This is not best practice as different medication mixes are more corrosive to the medication cup. It is best to deliver the bronchodilator first to open up the lungs, then any subsequent corticosteroid (flixotide) or antibiotic treatment afterwards.
On average the delivery time is 1ml per minute. However, the more viscous or thick the solution this may be slowed down slightly. For example, a difficult to nebulise antibiotic.
All of the items listed on our drug chart can be used with Flexineb, but in critical cases (pneumonia for example) it is often
best to use the ‘top shelf’ solutions such as Flixotide & Ventolin as these are specifically designed for nebulisation. These are commonly used in COPD & RAO horses also to
stabile the horse & then the owner can move down to more generic formats such as dexamethasone etc.
For detailed information refer to the Medication Chart. (Click here to view it.)
Mast cell inhibitors are anti-allergy medications commonly known as Intal in Australia. They are very often available in nebule
form also. The active ingredient is Sodium Cromoglycate. Some vets prefer to use these for horses due to the commonly known fact that steroids are not good for horses due
to its ability to cause laminitis. Many compounding pharmacies can develop sodium cromoglycate nebule solution.
The foal system is ideal for clinic use in the case of pneumonias in young foals or indeed in the case of meconium aspiration –
it can get medication to the target site the lungs quickly.
The primary cups for use are Grey & Green coded. The Standard grey cup will deliver most medications at our standard flow rate,
but if the solution is more difficult to nebulise, for example an anti biotic, it can take some time. In this case we would recommend a green cup for a shorter delivery time
of this viscous solution. However, green cups are not suitable for steroids or brocodilators because in general they are quite thin watery liquids and if delivered
through a green cup they will deliver too quickly, compromising the particle size. Green cups are only for use with antibiotics & some other natural solutions.
For detailed information refer to the Medication Chart. (Click here to view it.)
The particle size of the aerosol, is critical to successful nebulisation, deposition & absorption to the lung tissue. The ideal
particle size for deposition to the lung is 3-5 microns (as per the Flexineb Scintigraphy study). 71% of the particles produced by Flexineb are from 3-5 microns
which is the ideal size for absorbtion and deposition to the lung tissue.
Nebulisation is the gold standard of respiratory care. MDI inhalers, are disadvantaged in that they are designed for human use
and as such they can struggle to reach the lower respiratory tract of the horse. It’s a long way for powdered medication to travel and it has been found in studies that
MDI’s struggle to get further than the head and upper respiratory tract.
As per the scintigraphy, 71% gets to the lower respiratory tract & the remaining 29% gets to the upper respiratory tract & trachea.
