Letters: 10/00

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Response From Flair Nasal Strips
I was delighted to see the June article on Flair equine nasal strips, but I was disappointed by the omission of certain facts and the implication that CNS Inc. purports Flair nasal strips enhance performance.

As you stated, initial research by Dr. Howard Erickson at Kansas State University showed horses wearing Flair nasal strips had a 5-6% reduction in the amount of oxygen consumed during the highest phase of exercise and during recovery. This reduction was also seen when measuring carbon dioxide produced during these phases of exercise. This is indeed a measure of work, and reductions were significant in all horses studied.

It is true that the greatest reduction in pulmonary hemorrhage was seen in two horses, those with the greatest aerobic capacities. What was not mentioned in the article was that there was a 32.5% mean reduction in the number of red blood cells recovered from the lungs of all but one of the horses studied. While we as an industry struggle for ways to effectively treat exercise-induced pulmonary hemorrhage (EIPH), I would think that a drug-free mechanical means of addressing the airway side of the bleeding equation would be embraced by the industry as a whole.

As you are aware, EIPH has long-term implications on the health of horses. As we continue to learn more through research, it appears that sub-clinical pulmonary hemorrhage has the potential to adversely affect pulmonary function and the health of these athletes. Flair nasals strips are not curative in their approach to pulmonary hemorrhage; nothing to date can come close to making this claim. What we can say is that we have the ability to reduce the severity of EIPH by a percentage, whatever that may be, and you must agree that any reduction is a step in the right direction. All the ongoing research strongly supports the results of the initial clinical study. I must say CNS is committed to research. A second study is nearing completion at Dr. Erickson’s facility, and a third is underway at Kentucky Equine Research. We can claim that Flair strips are effective in addressing and reducing EIPH.

Regarding performance, we never claimed that using Flair strips will improve a horse’s performance. This is an argument that has been propagated by the industry and by media. Intuitively, it makes sense that if you are removing stresses placed on the lungs of exercising horses that they would be in a better position to give their best effort, and I am in total agreement. However, when people talk about competitive advantages gained by horses wearing Flair, the argument falls apart. Horses wearing the strips acquire the same amount of oxygen as any other horse. They are acquiring it at a reduced energy cost. This reduction in energy cost translates to faster recovery times in clinical studies. Rather than looking at this product as something that may affect performance and outcome, the industry should be viewing it as a preventative health device that will in the short and long term positively impact the health of their horses.

Craig F. Shoemaker, DVM, MS
Director Equine Medical Sales, CNS
Minneapolis, MN

We agree these devices should be viewed as breathing aids with the potential to reduce the work of breathing and reduce level of exercise induced pulmonary hemorrhage in some horses, not as a performance enhancer across the board.

While we never stated CNS made performance claims, as you say, the implication is clearly there and will remain unless a strong statement to the contrary is issued. In fact, CNS president Cohen stated, in an interview with the Minneapolis Sports Ticker, “We believe that Flair equine nasal strips can help performance horses achieve their full potential,” which, when talking about racehorses, means only speed. He further modified that statement by saying: “But it may not necessarily make horses run faster.” Use of only prominent racehorses, which have won high-profile races, in product promotions further leads the consumer and press to reach a performance conclusion.

We reviewed the original research and had several exchanges with Dr. Erickson. As you know, the sample size was relatively small and the only results that reached statistical significance related to the two horses we discussed. The “mean” (i.e. numerical average) reduction in red cells recovered on lung wash was heavily skewed because of the large reduction in those two animals.

We believe it would be misleading to tell people to expect a 35.2% reduction in red cells recovered (which may or may not accurately reflect the degree of pulmonary hemorrhage in any given animal), or a 5% reduction in energy expenditure across the board. If ongoing research has confirmed or further elaborated upon the initial studies we would be glad to review that but at the time this article was prepared the only information we were given was the original study.