Inflammatory airway disease (IAD) is a commonly diagnosed but variably defined syndrome of equine lower airway inflammation. The most recent American College of Veterinary Internal Medicine (ACVIM) consensus statement, informed by research evidence, recommends a case definition based on clinical signs (poor performance or occasional coughing of at least 3 weeks duration), increased endoscopically-visible tracheal mucus, and bronchoalveolar lavage cytology, and proposes that the condition should be termed 'mild-moderate equine asthma' (mEA). In British Thoroughbred racehorses, research to date has focused on airway inflammation defined by increased tracheal mucus and inflammatory tracheal wash sample cytology. It has been unclear whether or to what extent the ACVIM consensus statement has influenced the practice of British racing veterinarians. The aim of this qualitative study was to characterize and understand rationales for current practices relating to diagnosing and managing airway inflammation in British racehorses. Audio-recorded focus group discussions were conducted with 25 participants from four veterinary practices in England. Practices were purposively selected to represent those responsible for different types of racehorse, in different geographical regions. Thematic analysis of transcripts identified (i) an over-arching theme of serving the racing industry within which two further themes (ii) disregarding of the consensus and (iii) the pragmatic clinician were nested. The requirement to serve the racing industry was a key driver of clinical approaches, strongly influenced in particular by the trainer. Participants widely disregarded the consensus case definition of IAD/mEA for British racehorses because of perceived differences in etiology, perceived lack of practicability, particularly of BAL sampling, and perceived lack of understanding of the British racing context by consensus authors. Participants shared a strong professional identity as pragmatic clinicians providing an individualized clinical approach based on direct experience, which was often prioritized as the most valuable evidence with which to inform clinical decision-making. Lack of alignment with international consensus presents a barrier to practicing and furthering evidence-based medicine. Improved dialogue and partnership in research would be valuable and further research tailored for this population, including continuing development of contextually acceptable diagnostic methods, may be required.

中文翻译：

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直接经验与基于研究的证据之间的冲突是英国赛车场对基于证据的呼吸道医学的主要挑战。

炎性气道疾病（IAD）是马下气道炎症的一种常见诊断但变化多样的综合症。根据研究证据，最新的美国兽医内科学院（ACVIM）共识声明建议根据临床体征（表现不佳或偶尔咳嗽至少3周），内镜下可见气管粘液增多以及支气管肺泡灌洗细胞学，并建议将该病称为“轻度中度马哮喘”（mEA）。迄今为止，在英国纯种赛马中，研究集中在气管炎症，其由气管粘液增多和气管冲洗液样本细胞学检查确定。尚不清楚ACVIM共识声明是否或在多大程度上影响了英国赛车兽医的行为。这项定性研究的目的是表征和了解与英国赛马的气道炎症的诊断和管理有关的当前实践的基本原理。音频录制的焦点小组讨论与来自英格兰四个兽医机构的25名参与者进行了讨论。目的是选择代表不同地理区域内不同类型赛马负责人的做法。笔录的主题分析确定了（i）为赛车行业服务的总体主题，其中另外两个主题（ii）忽视共识和（iii）务实的临床医生被嵌套。服务赛车行业的需求是临床方法的关键驱动力，尤其是受到培训师的强烈影响。参与者广泛地忽略了英国赛马的IAD / mEA共识案例定义，因为他们认为病因学上存在差异，认为缺乏实​​用性（尤其是BAL采样），并且认为共识作者对英国赛车环境缺乏了解。与会的参与者具有很强的专业素养，因为务实的临床医生根据直接的经验提供了个性化的临床方法，而这些经验通常被认为是最有价值的证据，可为临床决策提供依据。缺乏与国际共识的一致性为实践和发展循证医学提供了障碍。