💊 Vet Guide: Prednisolone Use in Horses with Laminitis or Cushing’s Disease | 2025 Steroid Safety & Risk Management 🐴

By Dr Duncan Houston, BVSc

Steroids like **prednisolone** are essential tools in managing equine allergies, asthma, and inflammatory disease. However, in horses prone to **laminitis** or those diagnosed with **equine metabolic syndrome (EMS)** or **Cushing’s disease**, steroid use comes with serious caution. 🧠🐎

In this 2025 guide, I’ll walk you through what recent research tells us about prednisolone risk in laminitis-prone horses, and when its use may still be justified under close veterinary supervision. ⚠️📋

🧪 Why Steroids Are Used in Horses

Prednisolone is a corticosteroid commonly prescribed to manage:

• 🦟 Insect bite hypersensitivity (sweet itch)
• 🌬️ Equine asthma (inflammatory airway disease)
• 🌾 Environmental and food allergies
• 🧼 Immune-mediated skin conditions

In many horses, these medications are highly effective at reducing **inflammation, itching, and airway constriction**. However, they also interfere with glucose metabolism and can increase **insulin resistance**—a key factor in triggering laminitis. ⚠️

🧠 Laminitis, EMS & Cushing’s Disease

Laminitis is a painful and often debilitating hoof condition caused by **inflammation and failure of the laminae**, the structures that connect the hoof wall to the bone. It is strongly linked to metabolic disorders like: 🧬

• 📈 Equine metabolic syndrome (EMS)
• 🧠 Pituitary pars intermedia dysfunction (PPID, also called Cushing’s disease)

These horses are **already at higher risk** for founder (chronic laminitis). Steroid use has traditionally been considered contraindicated in these cases. ❗

📊 The British Study: Is Prednisolone Really That Risky?

To explore this concern, researchers in the UK conducted a 13-year retrospective study comparing 416 horses treated with oral prednisolone to 814 untreated controls. 🧪

Key Findings:

• 🐴 Average horse age: 13 years
• 🧬 No significant difference in breed, sex, or use
• 📉 Laminitis incidence:
• 3.5% in non-treated horses
• 2.5% in horses treated with prednisolone

Interestingly, **there was no significant increase in laminitis risk** overall. But here's the nuance: of the horses that did develop laminitis while on prednisolone, **50% had EMS or Cushing’s**. 🔬

⚖️ What This Means for Horse Owners

This data suggests that **prednisolone may be safe in the general equine population**, but **special caution is warranted** in horses with metabolic disease. It doesn’t rule out use—but it does demand careful risk assessment. ✅⚠️

Best Practices for Prednisolone Use:

• 🩺 Only use prednisolone when absolutely necessary
• 📋 Always test for EMS or PPID before long-term steroid therapy
• 🧪 Use the **lowest effective dose** for the **shortest duration**
• 📈 Monitor insulin and glucose levels during treatment

🧠 Alternative Therapies to Consider

For allergic or respiratory conditions in laminitis-prone horses, consider alternatives like:

• 🌿 Omega-3 fatty acids for anti-inflammatory support
• 💨 Nebulized medications (bronchodilators, inhaled steroids)
• 🧂 Environmental allergen control—dust-free bedding, soaked hay
• 💊 Antihistamines or mast cell stabilizers (where appropriate)

In some cases, **local therapy** (e.g., skin creams or nebulizers) avoids systemic risk altogether. 🧠

📲 Use Ask A Vet for Medication Safety Guidance

The Ask A Vet app can help you manage steroid decisions and laminitis risk in real time:

• 📋 Track steroid dose, duration, and symptoms
• 🧪 Ask about insulin testing or safer alternatives
• 📱 Submit photos of hoof condition for evaluation
• 🧠 Get second opinions on whether steroid use is appropriate

Make informed decisions before the risk becomes real. 🐴📲

✅ Prednisolone Use in Laminitis-Prone Horses (2025)

• 💊 Prednisolone does not significantly increase laminitis risk overall
• 🧬 But 50% of steroid-induced laminitis cases had EMS or PPID
• 📉 Always use the **lowest effective dose**, and monitor carefully
• ⚠️ Avoid use in metabolic horses unless strictly necessary
• 📱 Use Ask A Vet to help balance benefits vs risks

📲 Final Thoughts from Dr Duncan Houston

Prednisolone can be life-changing for horses with respiratory or allergic issues—but for those with EMS, Cushing’s, or previous laminitis, it must be used with extreme caution. Talk to your veterinarian about safer options, and if steroids are necessary, use the data, track the risks, and monitor closely. 🧠💙

Download the Ask A Vet app to get real-time medication advice, monitor metabolic conditions, and make safe treatment choices in 2025. 🐎📱