Respiratory disease is one of the commonest medical reasons for referring a horse to the Royal Veterinary College, with coughing the main presenting sign. Investigation requires the taking of a detailed history, clinical examination, the use of appropriate diagnostic aids and noting response to medication and management changes. On arrival the horse is stabled in a minimal dust environment, remaining there until discharge. The use of a dust-free box frequently produces a favourable response without the use of medication which in itself is diagnostic. The problem of a horse which is asymptomatic on discharge from the Royal Veterinary College and becomes symptomatic following the failure of its owner to implement advice given on changes in management is discussed.