🩺 Vet’s 2025 Guide to Aspiration Pneumonia in Horses

By Dr Duncan Houston BVSc

1. What Is Aspiration Pneumonia?

Aspiration pneumonia occurs when food, liquids, saliva, or medication accidentally travel into the lungs instead of the stomach. The material carries bacteria into the airway, triggering inflammation and infection. Foals and older horses are most affected :contentReference[oaicite:3]{index=3}.

2. Common Causes

• Choke (esophageal obstruction): food builds up and may be inhaled when horses swallow :contentReference[oaicite:4]{index=4}.
• Poor swallowing/choking reflex: due to dental issues or neurological problems.
• Nasogastric intubation or oral medication: iatrogenic causes if material enters the lungs :contentReference[oaicite:5]{index=5}.
• General anaesthesia: airway protection is critical to prevent reflux aspiration :contentReference[oaicite:6]{index=6}.

3. Stages & What to Look For

The disease progresses across stages:

• Acute: immediate coughing, respiratory distress, rapid breathing, fever, possible collapse :contentReference[oaicite:7]{index=7}.
• Subacute: symptoms may emerge days later—lethargy, decreased appetite, persistent cough, mild fever :contentReference[oaicite:8]{index=8}.
• Chronic: abscesses, pleuropneumonia, weight loss, systemic illness, toxemia :contentReference[oaicite:9]{index=9}.

4. Diagnosis

• History & clinical exam: coughing after feeding, nasal discharge, fever, fast breathing :contentReference[oaicite:10]{index=10}.
• Imaging: thoracic ultrasound or radiographs detect consolidation, abscesses :contentReference[oaicite:11]{index=11}.
• Tracheal wash/BAL culture: identifies bacteria and guides antibiotic therapy :contentReference[oaicite:12]{index=12}.
• Bloodwork: infection markers like elevated WBC, fibrinogen.

5. Immediate First Aid

1. Stop feeding and keep the airway clear.
2. Keep the horse upright in a calm, well-ventilated area.
3. Seek veterinary help immediately—this is an emergency :contentReference[oaicite:13]{index=13}.
4. Administer antibiotics early if aspiration occurred recently even before signs appear :contentReference[oaicite:14]{index=14}.

6. Treatment Plan

• Antibiotics: broad-spectrum, then adjusted per culture. Combine penicillin, aminoglycosides, metronidazole for mixed infections; rhodococcus spp. may need macrolides :contentReference[oaicite:15]{index=15}.
• Supportive care: IV fluids, NSAIDs, oxygen, nebulization to ease breathing :contentReference[oaicite:16]{index=16}.
• Drainage: thoracocentesis in pleural effusion or abscesses :contentReference[oaicite:17]{index=17}.
• Nutritional support: tube feed if swallowing is impaired; ensure hydration.
• Rehabilitation: gradual return to activity, re-evaluation via imaging and repeat cultures.

7. Prognosis & Possible Complications

Prognosis varies widely:

• Guarded to poor: depending on volume inhaled, bacterial load, and treatment delay :contentReference[oaicite:18]{index=18}.
• Complications: lung abscesses, pleuritis, laminitis, sepsis—cause extended treatment and risk :contentReference[oaicite:19]{index=19}.

With aggressive treatment many horses survive, though complications require vigilant care :contentReference[oaicite:20]{index=20}.

8. Prevention Strategies

• Administer meds slowly, ensure swallowing, don’t force-feed.
• Supervise feeding—don’t let horses bolt feed; soak when needed :contentReference[oaicite:21]{index=21}.
• Intubation only by professionals with airway protection :contentReference[oaicite:22]{index=22}.
• Ensure fish-safe environments: prevent choke via dental care and slow feeders.

9. Ask A Vet Integration 🩺

Ask A Vet can support you by:

• Assessing early photos/videos of breathing difficulty or discharge.
• Providing antibiotic guidance and treatment adjustments.
• Helping interpret diagnostic results (imaging, culture).
• Reminding you of treatment duration and follow-ups.
• Advising on feeding techniques and choke prevention.

Download the Ask A Vet app to get expert telehealth support during diagnosis, treatment, and recovery from aspiration pneumonia—ensuring the best care in 2025 and beyond! ❤️

10. Summary Table

11. Final Thoughts

Aspiration pneumonia is a serious but manageable respiratory emergency when treated early and comprehensively. With prompt veterinary action, supportive care, and telehealth assistance from Ask A Vet, recovery is achievable. Prioritize prevention—slow feeding, safe tube use, and attentive care—to minimize risk and ensure your horse’s breathing stays strong in 2025 and beyond. 🩺❤️