Bronchial Disease And Tracheal Collapse Flashcards by Corinne Perra

What are the bronchial diseases?

Chronic bronchitis

Esopinophilic bronchopneumopathy

Primary ciliary dyskinesia

Neoplasia

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What is chronic bronchitis?

Chronic inflammation of the bronchial mucosa with no identifiable underlying cause

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What are the proposed etioliges of chronic bronchitis?

Allergens

Airway pollution

Previous airway infection

Gastroesophageal reflux disease

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What is the pathophysiology of chronic bronchitis?

Bronchial inflammation and mucus cause coughing —>thickening of bronchial walls —> narrowing and weakening of airways —> cause more cough and inflammation

It’s a cycle really..

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What is the signalment of chronic bronchitis?

Middle age to older

Often small breed and overweight

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What is the usually the presenting complaint and history in a patient with chronic bronchitis?

Chronic cough (>1 month)

non productive
“harsh”, “hacking”, or “deep”
terminal retch and paroxysms of cough

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What are potential abnormal exam findings in chronic bronchitis ??

Pulmonary crackles, wheezes, or snapping

Expiratory dyspnea

Tachypnea

Cyanosis

Murmur of tricuspid regurgitation (R apical systolic)
Murmur of mitral regurgitation (L apical systolic)

Obesity and periodontal disease

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What is the differential diagnosis for chronic cough??

Tracheal collapse 
Pulmonary fibrosis 
Eosinophilic bronchopneumopathy 
Parasitic lung disease 
Neoplasia 
Laryngeal disease 
Degenerative mitral valve disease 
Dilated cardiomyopathy

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What diagnostics do you do in chronic bronchitis?

Minimum database (MDB)- no specific abnormalities

Heartworm antigen test and fecal analysis
Thoracic radiographs with cervical region

Presumptive diagnosis of CB is often made based in history, exam, radiographs ad ruling out other cause with HW and fecal testing

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What do you see in radiographs with chronic bronchitis?

Diffuse bronchial, interstitial, or bronchointerstitial markings, or rads may be normal

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What are advanced respiratory diagnostics can help diagnose chronic bronchitis

Fluoroscopy/bronchoscope —> airway collapse

Bronchoscope evaluates for neoplasia, foreign body, parasites, bronchitis, brochiectasis, bronchomalacia

BAL for infectious neoplastic

Laryngeal exam for paralysis

Thoracic computed tomography

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What is the treatment for chronic bronchitis?

Avoid/reduce potential allergens

Corticosteroid therapy

Weight loss

Eliminate/reduce periodontal disease

Eliminate any secondary respiratory infection (eg mycoplasma and bordetella) —>doxycycline, azithromycin, enrofloxacin

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When can you use cough suppressants in chronic bronchitis cases?

Short term basis to break cycle

Long term if cough is refractory to other therapies

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What drug therapy is helpful in chronic bronchitis with concurrent bronchoconstriction

Theophylline

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What are common complications of chronic bronchitis?

Brochiectasis -permanent dilation of bronchi due to inflammation

Bronchomalacia -collapse due to weakened walls

Chronic obstructive pulmonary disease -obstruction of small airways due to thickening of walls and mucus accumulation

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What is eosinophilic bronchopneumopathy (EBP)

Eosinophilic infiltration of bronchial mucosa and pulmonary parenchyma suspected to be the result of immunologic hypersensitive

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What breeds are predisposed to eosinophilic bronchopneumopathy ?

Siberian husky
Malamute

Young adult
Female>male

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What pattern do you see on radiographs for esopinophilic bronchopneumopathy ?

Moderate to severe diffuse bronchointerstitial pattern

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What would you see on a MDB for eospinophilic bronchopneumopathy ?

Esopinophilia
Basophilia
Neutrophilia

What is your DDX for

Coughing, gagging/retching, and dyspneic dog
Nasal discharge
MDB: eosinophilia, basophilia, and neutrophilia

Eosinophilic bronchopneumopathy

Parasitic —> rule out with fecal sed or float

What is the treatment for eosinophilic bronchopneumopathy ?

Corticosteroid

What is primary ciliary dyskinesia?

Defective ciliary motility resulting in mucus accumulation, inflammation, and recurrent bacterial infections

What is the cause of primary ciliary dyskinesia ?

Generic mutation

-identified in old English sheepdogs

What other tissues can be affected in primary ciliary dyskinesia ?

Tissues with ciliated epithelial

otitis media
infertility
renal fibrosis

How do you treat ciliary dyskinesia?

Antibiotics Hydration Courage Close monitoring for infections

What is the difference between chronic bronchitis and asthma

Both are inflammation, mucus, and wall thickening of the bronchi Asthma also includes bronchospasm (primary feature of the disease)

What is the etiology of asthma vs chronic bronchitis

Asthma: allergic CB: previous insult/injury to airways

What are the primary effector cells in allergic asthma?

Eosinophils —> release proteins that case smooth muscle to be hyper-reactive

What is the signalment of feline asthma?

Young to middle aged cats Increase prevalence in Siamese cats

What is the common presenting history in asthmatic cats?

Coughing, wheezing Dyspnea/tachypnea Cats with bronchitis cough every day Asthmatic cats have intermittent/episodic signs Episodes can be severe—> respiratory distress Precipitated by environmental allergen, stress, or exercise

What do you hear on pulmonary auscultation of an asthmatic cat?

Normal or wheezes, increased BV sounds, or crackles

What pattern do you see on radiographs of an feline asthma patient?

Bronchial or bronchointerstitial pattern Often diffuse Hyperinflation (air trapping) —> increased size and lucency of lung field, flattening of diaphragm Right middle lung lobe atelectasis

What diagnostics do you do in a suspected feline asthma patient? What are you ruling out?

Thoracic radiographs Heartworm and feacal testing Bronchoscope and BAL fluid (only done in cats that do NOT respond to medial therapy for bronchitis or asthma because of small and hyper-responsive airways in cats) - >eosinophils in asthma - > neutrophils in bronchitis

What is the acute (emergency) treatment for a cat presenting with respiratory distress

Minimize stress/handling Supplemental O2 Rapid-acting corticosteroid If CHF is high on list, do short furosemide trial

What is the chronic treatment for feline asthma?

Oral corticosteroid : pred

What is tracheal collapse?

Dorsoventral flattning of the tracheal rings

What are etiologies of tracheal collapse?

Primary- cartilage rings are deficient in glycosaminoglycan, chondrotoxicity, and calcium Secondary- increased pressure/mechanical forces on the trachea in association with other chronic respiratory disease (eg chronic bronchitis, idiopathic pulmonary fibrosis

What is the pathophysiology of tracheal collapse?

Dorsal tracheal membrane gets over stretched and becomes inflamed and pendulous —> exacerbates airway narrowing during expiration During inspiration, when intrathoracic pressure is negative, the membrane in the thoracic portion gets pulled outward

Collapse of the cervical trachea occurs during _________, collapse of the thoracic trachea occurs during ___________

Inspiration, expiration

What is the signalment for tracheal collapse?

Small breed | Middle age to older

What is the most common clinical sign in tracheal collapse?

Chronic “honking” Episodes often terminate with a retch or gag —>often precipitated by pressure on trachea, excitement/activity, or drinking water ``` Exercise intolerance Dyspnea Excessive panting Cyanosis Syncope ```

What do your hear on auscultation of trachea on a dog with tracheal collapse?

Stridorous sounds

T/F: a left apical systolic murmur may be present in dogs with tracheal collapse

Yes but it is because DMVD is a common disease in this demographic

How do you diagnose tracheal collapse?

Thoracic radiographs including cervical region - lateral views on inspiration, expiration, and coughing - diameter of trachea may be asymmetric and dilated areas may be due to and over stretched dorsal membrane Fluoroscopy to tracheostomy for definitive diagnosis

What is the treatment for tracheal collapse?

Lifestyle and environmental modifications —> weight loss, and avoid heat, humid, and stress Medical therapy —> cough suppressant, corticosteroid short term, antibiotic, sedation in stress conditions, bronchodilator Intraluminal stent or surgical prostheses for patients with life-threatening dyspnea or patients that fail medical therapy

How do you treat a patient that comes into your clinic in respiratory distress due to severe tracheal collapse?

``` Sedation Supplemental O2 Corticosteroid Minimize handling/stress Cooling if hyperthermia ``` If in severe distress, or no improvement —> intubation and mechanically ventilated, may need emergency stenting or surgery

What is the prognosis for patients with tracheal collapse?

Well controlled clinical signs —> can survive for years if they do not have a fatal respiratory crisis or develop post op complications Moderate to severe clinical signs are usually euthanized due to poor quality of life