Relationship between prevalence and severity of exercise-induced pulmonary hemorrhage and environmental factors.

Environmental factors including temperature, air quality, and track surface significantly influence EIPH prevalence and severity in racing Thoroughbreds.

This prospective blinded observational study examined 937 Thoroughbred racehorses across 12 U.S. racetracks to identify environmental risk factors associated with exercise-induced pulmonary hemorrhage (EIPH). Videoendoscopy was performed 30-60 minutes post-race with blinded severity grading by three independent observers. Key findings demonstrated that ambient temperature was negatively associated with both EIPH prevalence and severity, with cooler conditions correlating with increased disease occurrence. Furosemide administration showed protective effects (OR=0.04), while poor air quality (AQI>100) significantly increased EIPH severity in 2-year-old horses. Track surface type influenced EIPH prevalence, with turf and all-weather surfaces showing protective effects compared to dirt. Lifetime race number was positively associated with EIPH occurrence, suggesting cumulative exposure effects. These findings establish environmental factors—particularly temperature and air quality—as significant contributors to EIPH development and severity in racing Thoroughbreds, with implications for race scheduling and track management decisions.

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