Bronchial Disease

Question 1

Give differentials for coughing

Answer 1

Compression of the mainstem lobar bronchi

• left atrial enlargement
• tracheobronchial / bronchial lymphadenopathy
• neoplasia

Stimulation of cough receptors

• laryngeal disorders
• tracheal disorders
• bronchial disorders

Excessive mucous / fluid / inflammation

• pneumonia
• bronchopneumonia
• pulmonary oedema

Question 2

What is the pathology of chronic bronchitis?

Answer 2

Excessive mucous cell production
Increased goblet cell numbers
Hyperplasia of the submucosal glands
Damage to the cilia
Loss of ciliated epithelium
Squamous metaplasia of the mucosa
Secondary infection

Question 3

What is the clinical presentation of chronic bronchitis?

Answer 3

Small toy breed dog
Chronic cough - more than 2 out of 12 months
Worse on excitement
Attempting a productive cough

Question 4

How should you diagnose bronchitis?

Answer 4

Thoracic radiographs - bronchial pattern - donuts and tramlines
Haematology and biochemistry - rule hout other disease
Bronchoscopy = main diagnostic tool
- irritation and chronic changes on bronchial mucosa
- bronchomalacia - bronchioles collapse on expiration
- oedematous mucosa
Bronchoalveolar lavage - cytology, bacteriology, parasitology

Question 5

How much saline should you flush the bronchi with during a BAL to obtain a sample?

Answer 5

0.2-0.5 ml kg
10ml dog , 2 ml cat

Courage will increase the amount of fluid you get back
Sample with have froth on the top if you have sampled the lungs - surfactant

Question 6

What respiratory parasites are there?

Answer 6

Angiostrongylus vulgaris
Oslerus osleri = nodules at the tracheal bifurcation
Crenosoma vulpis = worms seen in bronchi
Aelurostrongylus abstrusus - cats

Question 7

What is the predominant cell type in a BAL?

Answer 7

Alveolar macrophages 70%
Neutrophils 20%
Lymphocytes 10%

(Normal to see ciliated epithelial cells and goblet cells)

Question 8

What will you find in a chronic bronchitis BAL sample?

Answer 8

Cytology

• increased mucous
• increased neutrophils and macrophages
• squamous metaplasia of epithelium
• presence of bacteria

Bacteriology - normally negative in chronic bronchitis

Question 9

How can chronic bronchitis be managed?

Answer 9

Wait control
Exercise on a harness
Avoid irritants - smoking
Decrease mucous viscosity - saline nebulisation
Bronchodilators
- PDE inhibitors - theophylline, etamiphyline
- beta 2 agonists - terbutaline - v good but not licensed
Nebulised corticosteroids - fluticasone
Systemic steroids - prednisolone
Antibiotics - only if positive culture or intracellular bacteria
Mucolytics - Bromhexine

Question 10

What is bronchiectasis?

Answer 10

Bronchi are wide all the way down into the lower airways

- prone to secondary infection

Question 11

What antibiotics can be used in respiratory tract infections?

Answer 11

Selection based on C&S from BAL sample
Broad spectrum
Potentiated amoxicillin
Fluoroquinolones - enrofloxacin, marbofloxacin
Clindamycin

Gram negatives
Cephalexin
Metronidazole

TMPS - pneumocystis carinii
Doxycycline - mycoplasma or bordetella

Question 12

What antibiotics should you use for life-threatening pneumonia?

Answer 12

Potentiated amoxicillin + Fluoroquinolones + metronidazole

Question 13

How does eosinophillic bronchopneumopathy present?

Answer 13

Scent hounds
Young large breed dogs
Chronic bronchitis –> pulmonary granulomas
Presumed hypersensitivity reaction

Non-productive cough

Question 14

How can eosinophillic bronchopneumopathy be diagnosed?

Answer 14

Bronchoscopy - copious yellow / green mucous

More than 25% eosinophills in BAL

Question 15

How can you treat eosinophillic bronchopneumopathy?

Answer 15

Prednisolone - immunosuppressive dose, then taper
Worm
Antibiotics if indicated after c&s
Bronchodilators - theophylline, terbutaline
Mucolytics - Bromhexine

Question 16

How does feline asthma present?

Answer 16

Very common allergic airway disease
Particularly in indoor cats

Coughing and serve dysponea
Expiratory phase more affected that inspiratory

Auscultated expiratory wheezes
May be concurrent HCM

Question 17

How can you diagnose feline asthma?

Answer 17

History
Expiratory wheeze
Bronchial pattern on radiography +/- evidence of HCM
Air trapping on radiography - lungs hyper inflated, barrel chest, flattened diaphragm

Question 18

How can you treat the dysponeic cat with feline asthma?

Answer 18

Minimise stress
Humidified oxygen 
IV dexamethasone 
IV or IM terbutaline 
Salbutamol MDI - spacer 
If life threatening - adrenaline IV or IT

Question 19

How can you manage feline asthma in the long term?

Answer 19

Salbutamol (Ventolin)
1 puff BID or as required
Onset 5min, duration 4h

Fluticasone
2 puffs BID
Long term control of inflammation

Keep away from environmental allergens
Allow outdoor access
Terbutaline BID PO
prednisolone - taper dose to e.o.d

Question 20

What is the presentation of a bronchial foreign body and how should it be treated?

Answer 20

Sudden onset coughing
Gun dog breeds that exercise through fields
Long standing halitosis and failure to respond to antibiotics

Tx bronchoscopy to remove