Coughing

Question 1

T or F: Although the cough receptors are located primarily in the upper resp tract and large airways, they can be triggered even when the primary disease is distant from these sites

Answer 1

True; due to the movement of respiratory secretions or external secretion

Question 2

What are some differentials for acute coughing?

Answer 2

Viral/bacterial infection, airway FB, CHF, aspiration pneumonia

Question 3

What are some differentials for chronic coughing?

Answer 3

Chronic bronchitis - allergic bronchitis, collapsing airways, L atrial enlargement, fungal pneumonia

Question 4

What are some medications ghat can cause coughing?

Answer 4

ACE inhibitors and KBr

Question 5

What is a primary goal of your physical exam for a coughing patient?

Answer 5

To differentiate between cardiac and respiratory causes

Question 6

What are the two ways cardiac disease can cause coughing?

Answer 6

Chamber enlargement putting pressure (expect murmur) on an airway or congestion or pulmonary edema building up in the airways

Question 7

What are the most prominent parasites affecting the respiratory system of dogs and cats?

Answer 7

Filaroides osleri (D), Eucoleus aerophilus (D + C), Paragonimus kellicotti (D + C), Dirofilaria immitis (D + C)

Question 8

What ancillary blood tests should be performed on dogs and cats presenting with chronic coughing?

Answer 8

Heartworm antigen +/- antibody (cats), FeLV and FIV

Question 9

What specific radiographic views are needed to help in diagnosing heartworm disease? How about collapsing airways?

Answer 9

DV (accentuates pulm vessels); inspiratory and expiratory right laterals

Question 10

Transthoracic aspirates are useful in patients with what?

Answer 10

Solitary lung masses, diffuse pulmonary disease, and pneumonia

Question 11

How do you determine where you will be taking your transthoracic aspirate?

Answer 11

For solitary masses - use location based off 2 orthogonal rads; for diffuse disease, caudal lung lobes (b/t 7-9th ribs) 2/3 distance from costochondral junction to spine

Question 12

T or F: TTW and ET washes both require general anesthesia

Answer 12

False, only ET washes do

Question 13

What is one of the most important benefits of bronchoscopy?

Answer 13

It can be used to facilitate the collection of samples from the lower resp tract

Question 14

What are the indications for bronchoalveolar lavage?

Answer 14

Evaluation of diseases affecting the small airways and alveoli (+/- interstitium)

Question 15

What is a common adverse effect following any technique used for tracheal washes or BALs?

Answer 15

Transient hypoxemia - readily responsive to O2 therapy

Question 16

Endotracheal washes and BALs are useful in what animals?

Answer 16

Cats and small dogs

Question 17

What type of cells should predominate in a cytology of wash or BAL fluid?

Answer 17

Large mononuclear cells (I.e. macrophages)

Question 18

When should anaerobes be considered for wash/BAL fluid cultures?

Answer 18

In cases of aspiration pneumonia or pulmonary abscesses

Question 19

What the heck is whole body plethysmography?

Answer 19

A chamber where awake patients are placed that detects volumes of air displaced as they breathe

Question 20

What are the clinical signs of CIRD (aka Kennel Cough)?

Answer 20

Severe sudden onset of cough (productive or non productive), gagging, retching, nasal d/c, recent history of exposure to high dog volume, often NO signs of systemic illness

Question 21

Which drugs should be restrictively used in CIRD treatment?

Answer 21

Cough suppressants (only in non-productive coughs) and antibiotics (only if secondary bacteria pneumonia/infection - doxy, TMS or Clavamox)

Question 22

What is the clinical presentation of bacterial pneumonia?

Answer 22

more common in dogs, route of infection either inhalation or hematogenous, typically nonspecific signs including coughing, dyspnea, or nasal d/c +/- fever, cyanosis, or crackles

Question 23

How do you diagnose bacterial pneumonia?

Answer 23

Interstitial to alveolar pattern on rads, Hematology - inflamm leukogram, TTW, bronchoscopy, BAL, pulm aspirate

Question 24

What is the treatment protocol for bacterial pneumonia and what’s the prognosis?

Answer 24

Antibiotics (based on C+S, ampicillin, cefazolin, TMS, aminoglycoside), hydration, nebulation and coupage, ANTITUSSIVES CONTRAINDICATED; treat for at least 1 week past resolution of CS; Px is generally good

Question 25

What disease is viral pneumonia typically associated with?

Answer 25

Canine distemper virus

Question 26

How do you diagnose fungal pneumonia?

Answer 26

Diffuse miliary interstitial pattern and hilar lymphadenopathy on rads, TTW, bronchoscopy, BAL, pulm aspirate - pyogranulomatous/eosinophilic inflamm, organisms within macrophages

Question 27

How do you treat fungal pneumonia?

Answer 27

Itra/Fluc/Ketoconazole (Ampoteracin B in life threatening cases), O2 therapy, corticosteroids?; treat for at least 3 MONTHS beyond resolution of CS; Px is fair to guarded

Question 28

How do you diagnose aspiration pneumonia?

Answer 28

Alveolar pattern in right middle lung lobe (or dependent lung lobe) +/- megaesophagus on rads, TTA - sterile inflammation initially w/ eventual 2ndary bacterial infection

Question 29

How do you treat aspiration pneumonia and what’s the prognosis?

Answer 29

Symptomatic care (O2, nebulization and coupage) +/- abx if no improvement after 2-3d, inflamm leukogram gets worse, fever or if on H2 blockers/PPI; can be fatal

Question 30

Where anatomically does collapsing trachea most commonly occur?

Answer 30

At the thoracic inlet

Question 31

What does the term canine chronic bronchitis refer to?

Answer 31

Long-term airway inflammation with some irreversible damage

Question 32

How do you diagnose canine chronic bronchitis?

Answer 32

Prominent bronchial/peri-bronchial infiltrates and some interstitial infiltrates, bronchiectasis and right sided cardiomegaly (advanced cases) all on rads; TTW - nonspecific inflammation w/ goblet cell hyperplasia and squamous metaplasia; bronchoscopy - excess mucus secretion, mucus membrane unusually friable

Question 33

What is important to stress to owners of patients with chronic canine bronchitis?

Answer 33

That because the damage to most of the airways is irreversible, treatment is aimed at relieving clinical signs, NOT a cure

Question 34

What diseases that cause coughing are the only ones where corticosteroids are the mainstay of therapy?

Answer 34

Canine chronic bronchitis and eosinophilic bronchopneumopathy

Question 35

What are the multiple drugs used in treating canine chronic bronchitis?

Answer 35

corticosteroids, bronchodilators (b agonists or methylxanthines), cough suppressants (only in non-productive coughs), +/- antibiotics (based on C+S), anticholinergics and inhaled steroids/b-agonists

Question 36

What is bronchiectasis?

Answer 36

The permanent dilation of bronchi - typically complication of chronic resp disease such as chronic bronchitis

Question 37

Describe the clinical presentation of eosinophilic bronchopneumopathy

Answer 37

Dogs typically young adults (4-6yrs) with interval b/t disease onset and diagnosis varying between 3 wks to 6 yrs; harsh, sonorous cough, persistent, followed by gagging/retching +/- crackles, wheezes and increased lung sounds

Question 38

How do you diagnose EBP?

Answer 38

Mild to marked eosinophilia on CBC, chest rads may show mod to severe bronchinterstitial pattern and thickening of bronchial walls, yellow/green airway secretions, thickening of mucosa, airway hyperemia, exaggerated concentric airway closure upon expiration, incr eos/neut % on BAL

Question 39

What disease should be considered in any young patient with recurrent respiratory secretions?

Answer 39

Primary ciliary dyskinesia