A 18 yo Dutch warmblood is presented for mild coughing, especially when eating, and nasal discharge with feed material. What are your top DDX? (3)

• A. Choke
• B. Strangles
• C. Rhinitis
• D. EIPH

Answer: (A)

This scenario points to choking (esophageal obstruction) as the most likely issue. When a horse coughs mainly during eating and you see nasal discharge that contains feed, it’s a classic sign that food material is stuck in the esophagus or regurgitating up into the pharynx and out through the nostrils. The coughing is the airway’s response to irritation, and the feed in the nasal discharge directly links this problem to the esophagus rather than the nasal or lower airway.

Strangles tends to present with fever, anorexia, and purulent nasal discharge plus swollen lymph nodes, not feed-contaminated discharge tied to meals. Rhinitis causes nasal discharge but not typically coughing specifically associated with eating or feed in the discharge. Exercise-induced pulmonary hemorrhage presents with coughing or epistaxis after exertion, not a pattern tied to eating.

So the combination of coughing during eating and nasal discharge containing feed makes choking the best fit.