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Recurrent airway obstruction (RAO) and Inflammatory airway disease (IAD) are common respiratory diseases in stabled horses. In recent years, inhalation of glucocorhicoids has become a popular therapeutic approach. We hypothesized that the success of therapy might be augmented, if aerosol therapy is performed under exercise by using mobile inhalation devices. Using a scoring system, 12 horses with a history of RAO or IAD were examined (clinical examination, arterial blood gas analysis, bronchoscopy and bronchoalveolar lavage cytology) to confirm the diagnosis and classify respiratory disease as mild to moderate (IAD or RAO in remission) or severe (RAO in exacerbation). Horses received aerosol therapy with budesonide (3 mu g/kg BDW twice daily). 6 animals were inhaled at rest and the remaining 6 during lunging exercise (10min walk, 10min trot, 5min canter, 10min walk). In the later, the inhalation device was started with the beginning of trotting. Afterwards, the clinical examination was repeated and differences in clinical scores and single parameters before and after therapy compared between the two groups. Aerosol therapy led to clinical improvement in all 12 horses. The clinical score was significantly reduced in the overall population (p =0.002) and in the subgroups, while no significant differences were found in single parameters evaluated. There were no significant differences in treatment success between the two inhalation groups. In conclusion, aerosol therapy can be recommended even in severe cases of RAO. Aerosol therapy under exercise does not augment the clinical effect of budesonide, but may ease handling of affected horses during inhalation.