Coughing Flashcards
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
True; due to the movement of respiratory secretions or external secretion
What are some differentials for acute coughing?
Viral/bacterial infection, airway FB, CHF, aspiration pneumonia
What are some differentials for chronic coughing?
Chronic bronchitis - allergic bronchitis, collapsing airways, L atrial enlargement, fungal pneumonia
What are some medications ghat can cause coughing?
ACE inhibitors and KBr
What is a primary goal of your physical exam for a coughing patient?
To differentiate between cardiac and respiratory causes
What are the two ways cardiac disease can cause coughing?
Chamber enlargement putting pressure (expect murmur) on an airway or congestion or pulmonary edema building up in the airways
What are the most prominent parasites affecting the respiratory system of dogs and cats?
Filaroides osleri (D), Eucoleus aerophilus (D + C), Paragonimus kellicotti (D + C), Dirofilaria immitis (D + C)
What ancillary blood tests should be performed on dogs and cats presenting with chronic coughing?
Heartworm antigen +/- antibody (cats), FeLV and FIV
What specific radiographic views are needed to help in diagnosing heartworm disease? How about collapsing airways?
DV (accentuates pulm vessels); inspiratory and expiratory right laterals
Transthoracic aspirates are useful in patients with what?
Solitary lung masses, diffuse pulmonary disease, and pneumonia
How do you determine where you will be taking your transthoracic aspirate?
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
T or F: TTW and ET washes both require general anesthesia
False, only ET washes do
What is one of the most important benefits of bronchoscopy?
It can be used to facilitate the collection of samples from the lower resp tract
What are the indications for bronchoalveolar lavage?
Evaluation of diseases affecting the small airways and alveoli (+/- interstitium)
What is a common adverse effect following any technique used for tracheal washes or BALs?
Transient hypoxemia - readily responsive to O2 therapy
Endotracheal washes and BALs are useful in what animals?
Cats and small dogs
What type of cells should predominate in a cytology of wash or BAL fluid?
Large mononuclear cells (I.e. macrophages)
When should anaerobes be considered for wash/BAL fluid cultures?
In cases of aspiration pneumonia or pulmonary abscesses
What the heck is whole body plethysmography?
A chamber where awake patients are placed that detects volumes of air displaced as they breathe
What are the clinical signs of CIRD (aka Kennel Cough)?
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
Which drugs should be restrictively used in CIRD treatment?
Cough suppressants (only in non-productive coughs) and antibiotics (only if secondary bacteria pneumonia/infection - doxy, TMS or Clavamox)
What is the clinical presentation of bacterial pneumonia?
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
How do you diagnose bacterial pneumonia?
Interstitial to alveolar pattern on rads, Hematology - inflamm leukogram, TTW, bronchoscopy, BAL, pulm aspirate
What is the treatment protocol for bacterial pneumonia and what’s the prognosis?
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
What disease is viral pneumonia typically associated with?
Canine distemper virus
How do you diagnose fungal pneumonia?
Diffuse miliary interstitial pattern and hilar lymphadenopathy on rads, TTW, bronchoscopy, BAL, pulm aspirate - pyogranulomatous/eosinophilic inflamm, organisms within macrophages
How do you treat fungal pneumonia?
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
How do you diagnose aspiration pneumonia?
Alveolar pattern in right middle lung lobe (or dependent lung lobe) +/- megaesophagus on rads, TTA - sterile inflammation initially w/ eventual 2ndary bacterial infection
How do you treat aspiration pneumonia and what’s the prognosis?
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
Where anatomically does collapsing trachea most commonly occur?
At the thoracic inlet
What does the term canine chronic bronchitis refer to?
Long-term airway inflammation with some irreversible damage
How do you diagnose canine chronic bronchitis?
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
What is important to stress to owners of patients with chronic canine bronchitis?
That because the damage to most of the airways is irreversible, treatment is aimed at relieving clinical signs, NOT a cure
What diseases that cause coughing are the only ones where corticosteroids are the mainstay of therapy?
Canine chronic bronchitis and eosinophilic bronchopneumopathy
What are the multiple drugs used in treating canine chronic bronchitis?
corticosteroids, bronchodilators (b agonists or methylxanthines), cough suppressants (only in non-productive coughs), +/- antibiotics (based on C+S), anticholinergics and inhaled steroids/b-agonists
What is bronchiectasis?
The permanent dilation of bronchi - typically complication of chronic resp disease such as chronic bronchitis
Describe the clinical presentation of eosinophilic bronchopneumopathy
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
How do you diagnose EBP?
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
What disease should be considered in any young patient with recurrent respiratory secretions?
Primary ciliary dyskinesia
