Not new here. Have been a member for several years but lost my login information after being off for a while so made a new one. 

I have a 22yr old retired barrel gelding that is used just occasionally as a mounted posse horse. that has had semi controlled COPD for 6 years with occasional heaves flare ups. Last night he got really bad and started bleeding from his nose. Of course all the vets are closed today but have an appointment for Wednesday. Over the last month he's probably lost 300-400lbs. But mostly in muscle. He still has a fat grass belly just zero muscles. After talking with the vet this afternoon she said we could up his steroid(dex) to 20ml/day but that will cause it's own issue especially with his age. She said at this point it sounds like he is in the very advanced stage of COPD. She said we need to have the discussion before we come and decide if we want to keep fighting or if we want to go ahead and let him have a peaceful ending. She said if that's what we wanted to do she would change some of his meds. But she also said at this point we are fighting a loosing battle. 

I think I am confident in my decision to go ahead and let him go but also wonder if later on I would wish we would have tried the different meds first. Has anyone had a horse in this advanced of a stage and was able to bring them back?

I haven't had a horse with serious copd. I just wanted to say I am so sorry. I know this is a hard decision to make. May God help you with your decisions regarding your horse & give you comfort if you choose to let him go. 

Tough one. My vet is a big fan of nebulizers and makes me specific solutions for each horse based on needs. Right now my horse with a little COPD gets a mix of dex, gentimycin, DMSO, and Albuterol few days a week. 10cc nebulized . It works locally and not systemic. SO far, lots of success. 

Having lost two to this issue I can tell you that I am 100% ok with my decision to let them go once they begin the weight loss during the summer months portion. My neighbor allowed his old pony to suffer until she passed on her own and I just couldn't do it. I can also say that neither bled so I would say you have a different case than mine. One old mare was sold to me without disclosing her issue and we lost her fast due to her weight at the time of purchase. We poured a lot into her but being so thin to begin with her body couldn't catch up to the extra strain on her.  The other probably had another year in him before he was bones but it was literally torture for him to stand in the pasture pouring sweat and heaving his breath out so I made the decision to pick a good day and let him go. I live in south Alabama so heat and humidity are a huge factor on how well I can maintain one with this issue. I supplemented the junk out of them, allergy meds, dex, bought a nebulizer, PHT blanket, etc and refrained from any exercise during "hot months". If you can find the trigger you can prolong the onset but it is always there. We don't have to hay, we feed on the ground, have plenty of rain and breezes to knock down dusts we just have thick hot air with a whole lot of pollen. No one can really tell you what to do or what you will regret. I regret I waited as long as I did with that mare and that I couldn't give them the air-conditioned, allergy reduced barn they needed to live "forever" but I don't regret the money on extras, the hard work and time spent or the final decision I made. Good luck and a whole heck of a lot of prayers and good vibes heading your way. 

I'm also in south Alabama. I know this plays a HUGE role. He went to the vet last week. She thinks if we can get the weight on him, in a healthy way or course, plus tweaking a few of his meds we can buy more time. I debated on trying for more time because I think we will be right back in the same spot in the spring. But I am willing to try the new med changes. She said there's a lot of if's. And she won't say he's going to make it but if we can get him by a few more weeks til it cools down he has a chance, granted it's not a huge chance, but it's enough I'm willing to try. 

 If you can get him to winter and fatten him up then the heaving trauma and weight loss won't hit as hard next summer but with adding weight and certain meds comes other issues like she mentioned. Ask your vet about benadryl type allergy meds. You can buy bulk off amazon and help negate some of the effects of the pollen next spring. Keeping them cool during episodes is another huge help so if you have a way to set up a mister or fans somewhere, that will make the heaving a little less traumatic on his body.

Are you absolutely positive that COPD is correct? Asking because I had a mare with all the physical visible symptoms. After 2 summers she was even getting a heave line. She always passed the bag test. Turns out she was allergic to Bahia grass. I gave her to a wonderful lady in Kentucky. She walked off the trailer in KY breathing fine. Has never had another problem. She would have died if she stayed in Louisiana.

yes. He got acute pneumonia several years ago. Vet didn't think he would make it but he did. However it severely damaged his lungs. It's been pretty well controlled until lately. 

Nebulizer! Does wonders for MOST of them. 

UPDATE. Vet is coming out first thing in the morning but we believe he has foundered now. I know there is options to help with founder but I've made the choice to help him over the rainbow bridge. I hope it isn't founder but with the new feed, supplement and his already poor health I'm really afraid it is founder.

I am sorry that this is happening, but it sounds like you are putting your horse's quality of life first. Hugs to you for possibly having to make a hard decision, it's never easy what ever you decide.