Virulent Rhodococcus equi causes pyogranulomatous bronchopneumonia in foals. The route of infection of foals has been considered to be inhalation of aerosolized bacteria from soil that is contaminated with equine feces. Thus, disease caused by R. equi has been regarded as an opportunistic infection of environmental origin and not a contagious disease. In this study, we report the exhalation of virulent R. equi from the respiratory tract of naturally infected foals. A handheld air-monitoring system was used to recover virulent R. equi from the exhaled breath of foals, and the concentration of virulent R. equi organisms in exhaled air was compared to the concentration in environmental air samples taken from the holding pens and lane areas on farms. R. equi strains carrying the vapA gene of the virulence plasmid were detected by using colony blotting and DNA hybridization techniques in cultures of exhaled air from 67% (37/55) of foals tested. The concentration of virulent R. equi organisms in exhaled air from foals was significantly higher than that in environmental air (P<0.001). There were no significant differences in the median concentrations of virulent R. equi bacteria exhaled by clinically healthy or diseased foals. The high concentrations of virulent R. equi bacteria in exhaled air suggested that aerosol transmission between foals is possible and may have a significant impact on the prevalence of R. equi pneumonia on farms. The air sampling technique described is potentially useful as a noninvasive method for the detection and quantification of virulent R. equi in the respiratory tract of foals.