Bronchial Disease And Tracheal Collapse Flashcards
What are the bronchial diseases?
Chronic bronchitis
Esopinophilic bronchopneumopathy
Primary ciliary dyskinesia
Neoplasia
What is chronic bronchitis?
Chronic inflammation of the bronchial mucosa with no identifiable underlying cause
What are the proposed etioliges of chronic bronchitis?
Allergens
Airway pollution
Previous airway infection
Gastroesophageal reflux disease
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..
What is the signalment of chronic bronchitis?
Middle age to older
Often small breed and overweight
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
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
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
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
What do you see in radiographs with chronic bronchitis?
Diffuse bronchial, interstitial, or bronchointerstitial markings, or rads may be normal
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
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
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
What drug therapy is helpful in chronic bronchitis with concurrent bronchoconstriction
Theophylline
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
What is eosinophilic bronchopneumopathy (EBP)
?
Eosinophilic infiltration of bronchial mucosa and pulmonary parenchyma suspected to be the result of immunologic hypersensitive
What breeds are predisposed to eosinophilic bronchopneumopathy ?
Siberian husky
Malamute
Young adult
Female>male
What pattern do you see on radiographs for esopinophilic bronchopneumopathy ?
Moderate to severe diffuse bronchointerstitial pattern
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
