Abstract: Among athletic/sports animals, the horse has a unique ability to increase its oxygen uptake by a factor of 60 during heavy exercise. This is achieved by physiological adaptations of all the links in the oxygen chain. Ventilation is increased by a factor of 30. Since the horse is a compulsory nasal breather, this hyperpnea necessitates high transmural pressure changes, which may be responsible for the dynamic collapse of the airways. Blood flow is increased by a factor of 10. Since the left ventricle is not very compliant, this increase necessitates a high filling pressure in the pulmonary circulation, which may induce capillary stress failure and exercise-induced pulmonary haemorrhage. Lastly, oxygen transport is improved by splenic contraction which increases haemoglobinemia by 50%. Sports horses frequently suffer from several problems, which are related either to endogenous or exogenous stresses experienced during their career. These stresses, caused by the use of the horse as a competition animal, may lead to several medical problems. At a systemic level, endogenous stresses include hyperkaliemia, lactacidemia, and hyperthermia; oxidative stress may induce problems at a general, and/or a pulmonary level. External factors, e.g. poor quality of inspired air, transport, hot and humid ambient conditions, and microbiological agents, may also induce abnormal body attacks, and lead to health problems.