Francisco Tirado

Recurrent Airway Obstruction (RAO)

Recurrent airway obstruction (RAO) is a common condition in many different types of horses. It is a performance limiting problem commonly caused by an allergic respiratory response. Signs include:
– chronic cough
– nasal discharge
– increased respiratory rate (tachypnoea) and effort (dyspnoea)

Episodes of RAO are usually caused by exposure of susceptible animals to common allergens. The most common culprits are organic dusts mwhen horses are stabled, bedded on straw, and fed hay (in particular round bales). Removal of these causal agents will usually result in remission of any signs. It most commonly starts at around 9 years of age, although 12% of mature horses have some degree of allergen induced lower airway inflammation. There is no breed or gender predilection, but there does seem to be a heritable component to susceptibility.

Clinical Signs

Signs of RAO include flared nostrils, increased respiratory rate (tachypnoea), cough and if the problem has been going on for long enough then the horse can have a heave line. Breathing usually includes a prolonged, laboured expiratory phase. Usually a cough is heard when the horse is exercised or being fed. Mildly affected horses may present with minimal signs at rest but coughing and exercise intolerance are noted during increased performance.

Some horses can demonstrate signs during summer, which, usually indicates sensitivity to pollens and certain moulds and this is called summer pasture-associated obstructive pulmonary disease. Management of this is similar to RAO except with the addition of pasture avoidance.


Most commonly diagnosis is made on clinical exam and history alone, routine blood samples are commonly unhelpful in this scenario, x-rays of the chest are also not commonly not beneficial. Bronchoalveolar lavage (BAL) is usually not required in horses with obvious clinical signs and can be contra-indicated in horses with breathing difficulties at rest.


The most important aspect of treating RAO is to limit exposure to the causal agents. Medical treatment will stop the signs and symptoms but these will return as soon as it is stopped if management chenges haven’t been put in place. Medical treatment consists of a combination of drugs to open up the airways (bronchodilators) and steroids to reduce inflammation.

Acupuncture Case Study


This 6 year-old polo pony was presented to us with a very severe left hind lameness. She was found not weight bearing and quite distressed in the stable. After our examination and supportive treatment it was decided to refer her to the Equine Referral Hospital at the RVC for further diagnosis as we suspected a possible fracture.

After a few days in the hospital and a complete diagnostic assessment including “Bone scan??? and ultrasound examination, a rupture of the vastus medialis muscle was identified. A period of rest and anti-inflammatories was advised for some weeks.

The prognosis was fairly good but after a few weeks the owner reported a significant muscle waste above the left stifle. This atrophy was getting worse and worse and the pony was still quite lame.

The client had already been using the services of a physiotherapist but the pony was still quite sore at walk. At that stage, I recommended acupuncture and I was very pleased when the client called me back to update me after the first session. She was already moving more comfortably but still not pain free.

We noticed that the pain was reducing but the muscle waste was not. The lack of muscle above the stifle was getting so severe that the joint was losing stability and becoming also a mechanical lameness. By this time, it was obvious there was a neurological involvement during the muscle rupture. This means that the nerve was also affected and without a healthy and functioning nerve, the muscle was going to keep wasting.

I decided that this polo pony really needed some extra help in the form of electro-acupuncture as horses with nerve damage and muscle waste are the best candidate for this technique.

As a member of the Shotter&Byers team I was very proud that the partners were supportive once again considering integrative therapies as an option for restoring and preventing injuries. They purchased an Electroacupuncture machine and therefore this polo pony became my first electroacupuncture patient.

After a couple of sessions, the owner started noticing that the muscle was recovering its volume and the biomechanics of the stifle joint was improving significantly.

Currently, we are just waiting for this young polo pony to start training gradually and she will hopefully be playing this 2017 season.

In conclusion, this is one of the examples of how Acupuncture can help restore your horse´s health.

Please feel free to contact the office on 01 306 627 706 if you would like to discuss or arrange an acupuncture treatment for your horse.

Fran Tirado BVSc MRCVS CertVetACU (IVAS)





Shotter & Byers believes in the use of combined modern Western medicine and Acupunture as a traditional Chinese medicine therapy in the purpose of restoring or mantaining your horse wellbeing and health.

Francisco `Fran´ Tirado has trained in Veterinary Acupuncture since 2013 when he completed the ABVA (Association of British Veterinary Acupuncuture) foundation course and he has also completed the IVAS (International Veterinary Acupuncture Society) Certification course. He is currently a member of the ABVA.

What is Acupuncture?

Acupuncture may be defined as the insertion of needles into specific points on the body to produce a healing response. Each acupuncture point has specific actions when stimulated. This technique has been used in veterinary practice in China for three thousands years to treat many conditions. The Chinese also use acupuncture as preventative medicine.

Traditional Chinese Medicine (TCM) supports the body’s ability to heal and rebalance itself.

In western terms, scientific research has proven the merits of acupuncture for pain relief, anti-inflammatory effects, reproductive and hormonal regulation and gastrointestinal disturbances among many other effects.

What conditions can acupuncture be used for?

Most commonly acupuncture is used for enhancing performance in competition horses.

  • It is an excellent drug-free modality for relieving musculoskeletal pain:
  • Neck and Back pain
  • Sacroiliac pain
  • Myofascial pain syndrome
  • Arthritis
  • Laminitis
  • Navicular disease

Acupuncture can also be very effective for:

  •  Gastrointestinal problems (chronic diarrhoea, frequent spasmodic colics, weight     loss, inappetance).
  •  Hormone/metabolic disease
  •  Behavioral issues
  •  Respiratory problems like heaves (COPD/RAO)
  •  Head-shaking

What does the treatment look like?

The first examination and treatment can take from 45 to 90 minutes and sometimes will include an assesment at walk, trot and canter. Initially a full history will be taken, then a complete inspection of the horse including a careful palpation of diagnostic acupuncture points, examination of the tongue and pulse will take place.

After this, a diagnosis is stablished and an according strategic treatment planned.

Then, very small fine needles are placed in specific points.

Sometimes the needle can be heated with a herb called moxa (Moxibustion) or a small volume of vitamin B12 and blood or homeopathic remedies can be injected on the acupuncture points.

Most horses will accept acupunture treatment very well. Some animals will become sleepy or lethargic for a few hours post treatment. That is why we recommend to exercise the horse before the treatment and resume work on the next day.

The length and frequency of acupuncture treatments depends on the condition of the patient and the method of stimulation that is used by the veterinary acupuncturist. Usually an acute condition may require only one or two treatments, while a chronic condition may require a series of treatments over a period of 4-6 weeks.

It is not uncommon for owners to notice an immediate improvement in their animal. However, more often than not, acupuncture needs to be performed several times over the course of a few weeks in order attain the maximal benefit. At that point, your horse may need monthly or quarterly treatments or he may never need an acupuncture treatment again.

Can I combine Acupuncture with a regular visit?

Acupuncture can be combined with a regular visit, but preferably not with one that will require sedation or the use os steroids as this will decrease its efficacy.

What does it cost?

The initial session costs  £84   (incl. VAT).

Follow up sessions costs £54   (incl. VAT).

Acupuncture stimulates the body’s own healing processes.

Fran Tirado BVSc MRCVS


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