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Respiratory > Coughing Dogs and Cats > Flashcards

Coughing Dogs and Cats Flashcards

0
Q

Best diagnostic test for coughing patient?

A

Thoracic radiographs

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1
Q

Most common cause of acute coughing in dogs?

A

Infectious Tracheobronchitis (ITB)

  • if hx and PE consistent with this then tx as if it is
  • if clinical signs not consistnet then further investigation indicated
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2
Q

Causes of acute coughing

A
  • infectious tracheobronchitis
  • airway irritation
  • FB
  • pulmonary haemorrhage
  • acute pneumonia
  • acute oedema
  • airway trauma
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3
Q

Define acute and chronic coughing

A
  • artificial distinction

> acute = sudden onset, does not persist for more than 2-3 weeks

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4
Q

Causes of chronic coughing ?

A
  • chonric chronchitis (tracheobronchial syndrome)
  • cardiac disease
  • parasites
  • tracheral collapse
  • FB
  • bronchopneumonia
    > rarer:
  • pulmonary neoplasia
  • extra-lumenal airway comression
  • eosinophilic disease (PIE, FAAD)
  • pulmonary fibrosis
  • pleural diseasse
  • ciliary dyskinesia
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5
Q

What is chronic bronchitis?

A 
> clinical syndrome
- chronic irritation to bronchial mucosa
- mucosal hyperplasia
- ^ mucous production 
- v efficacy of resp defence mechanisms 
- inflammation/2* infection 
- bronchospasm 
- v airflow
- chronic cough 
> underlying cuase usually unknown (smoking, pollutants etc.)
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6
Q

Signalment and Hx of chornic bronchitis?

A
  • typically old, small breed, overweight
  • insidious onset, dry hacking cough
  • rarely hx of known precipitating cause
  • cough paroxysmal and usually unproductive
  • exacerbated by excitement/excercise, pulling on lead, change in environmental temperature or humidity, times of day
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7
Q

PE findings of chronic bronchitis

A
  • otherwise NAD
  • often slightly overweight
  • ^ bronchial noise/wheezes on auscultation
  • cough easily elicited on tracheal pinch
  • sinus arrhythmia may be exaggerated
  • absence of murmur help to rule out cardiac cause of cough
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8
Q

How can chronic bronchitis be diagnosed?

A
  • diagnosis of exclusion
  • bloods normal
  • radiography (^ bronchial markings, but maybe false +/-)
  • endoscopy (irregular airways and mucous hypersecretion)
  • tracheobronchial wash (chronic inflammation +- positive culture, probably 2*)
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9
Q

Can you completely eradicate chronic bronchial disease?

A

No! Try to minimise coughing so it isnt debilitating to patient

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10
Q

what can be seen on rads with chonric bronchial inflamamtion?

A

tramlines and donuts

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11
Q

Aims of tx of chronic bronchitis?

A 
- management alterations 
> avoid smoke, dust
> humidify air
> maintain weight 
> avoid pressure on neck
- drug therapy possibly (not chroniccally) 
> bronchodilators
> Antibiotics
> Expectorants and mucolytics
> cough suppressants
> Anti-inflammatory
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12
Q

Types of bronchodilators

A 
> Xanthines
- theophylline
> beta-2 agonists
- terbutaline (bricanyl)
- adreanaline
> anti-muscarinics
- atropine (multiple other effects ay preclude use)
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13
Q

Types of anti-tussives. WHen are antitussives good?

A

> opiate derivatives (NB. side effects eg. sedation, constipation)
- butorphanol (torbutrol)
- codeine
- Good for NON-productive coughs (tracheal collapse, bronchial compression)
- Not indicated if alveolar pattern seen on rads
Bromohexine (Bisolvon)
- mucolytics

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14
Q

Advantages and disadvantages of anti-inflammatorys?

A

> Corticosteroids (low dose)
+ imprived clinical signs and QOL
- too effective
- animal and owner become depednnt on tx
- iatrogenic hyperadrenocorticism develops
-> overweight -> worsening resp disease
give inhaled to v side effects

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15
Q

Side effects of bronchodilators?

A
  • tachycardia
  • excitability
    (eg. xanthines = caffeine)
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16
Q

SIde effects of expectorants?

A

^ productiveness of cough

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17
Q

Side effects of corticosteroids?

A

-Iatrogenic HAC signs

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18
Q

Side effects of cough suppressants?

A
  • trapping airway secretions

- sedation

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19
Q

What is the main problem with chronic bronchitis?

A

More annoying for owner - not that bad for dog! Can live long happy life

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20
Q

What is FAAD?

A

Feline ALlergic Airway Disease (= Feline Asthma)

  • most common cause of persistent coughing in cats
  • Antigenic stimulation -> inflam, mucous, oedema, bronchoconstriction
  • Airway hyperreactivity, smooth mm hyperplasia and airway narrowing result
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21
Q

Hx and PE of FAAD?

A
  • intermittent dyspnoea and coughing
  • acute life threatening bouts
  • rarely identifiable stimulus
    > PE
  • may be normalbetween bouts
  • ^ resp effort
  • expiratory wheezes
  • hyperinflation of lung
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22
Q

Diagnostics of FAAD?

A
  • Bloods: Eosinophilia
  • Rads: bronchial pattern and hyperinflated lung
  • trach wash: inflammatory cells, predominantly eosinophils - R/O parasites and 2* bacterial infection
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23
Q

Emergency Tx of FAAD?

A
  • oxygen
  • rapid acting corticosteroid eg. methylprednisolone succinate
  • bronchodilator (atropine/adrenaline)
24
Q

Chronic maintainence of FAAD?

A
  • corticosteroids tapered to lowest effective dose (nebulise)
  • bronchodilators (terbutaline, theophylline etc.)
  • other ways of controlling inflammatory process (cyproheptadine, LT inhibitor? unlicensed but may have some success)
25
Q

Prognosis of FAAD?

A
  • variable
  • some cats stabilise: find best tx for individual
  • some cases cannot be controlled and may die acutely
  • chronic, long term commitment!
26
Q

What is THE feline lungworm?

A

Aeluostrongylus

27
Q

What disease does aelurostrongylus cuase? Tx?

A
  • alveolar/interstitial disease (LRT with eosinophilia)

- fenbendazole tx

28
Q

Which parasites can affect the respiratory tract of dogs? Which is most common?

A
  • Angiostrongylus vasorum*
  • Filaroides (Oslerus) Osleri
  • Dirofilaria
    > Young animals affected
29
Q

What is angiostrongylus? Intermediate host?

A

Lungworm, slug

30
Q

History signs of lungworm?

A
  • Chronic cough unresponsive to convential tx
  • coagulopathy (angiostrongylus)
  • dyspnoea/wheezing
  • coughing up blood
31
Q

PE findings of lungworm? Diagnostics?

A
  • no specific findings on physical
    > Dx
  • Haem = Eosinophilia
  • Feacal exam or TTW = Larvae
  • Rads = broncho/alveolar infiltration, nodular interstitial pattern, pulmonary hypertension, nodules at tracheal bifurction with filaroides)
  • bronchoscopy = tracheal nodules (filaroides)
32
Q

Is filaroides more or less common than angiostrongylus?

A

filaroides much less common than angiostrongylus

33
Q

What pattern is typically seen with Angiostrongylus Vasorum?

A
  • Air bronchograms

- Peripheral cloudy interstitial pattern with clear central area of lungs

34
Q

What new test is available for detection of angiostrongylus vasorum?

A

Snap test by IDEXX
- intravascular parasite
> BUT may be subclinical angiostrongylus not related to clinical signs if this test is too sensitive!

35
Q

Tx of lungworm?

A

> fenbendazole 7d tx all types of respiratory parasite

> recent licensing of milbemycin and moxidectin for angiostrongylus

36
Q

Prognosis of lungworm?

A
  • prognosis generally good
  • some present so severely that they die before you can treat
  • pulmonary vascular remodelling: Pulmonary hypertension and R heart disease (similar to dirofilaria immitus)
37
Q

Pathophysiology of tracheal collapse

A
  • loss of normal structure of tracheal rings
  • dorsal ligament stretches and trachea loses normal cylindrical structure
  • dynamic variation in tracheal diameter occurs
  • cervical trachea collapses on INSPIRATION
  • thoracic trachea collapses on EXPIRATION
  • > cough and dyspnoea (insp/exp/both)
38
Q

History and PE findings of tracheal collapse?

A
  • Yorkshire terriers and poodles
  • chronic cough with gradual progression
  • quacking or honking cough
  • may progress to severe dyspnea sometimes
    > PE
  • Normal
  • clicking sound when they breath (dorsal ligament)
  • tracheal malformation may be palpated
  • elicit cough on palpation
39
Q

What diagnostics may be useful for tracheal collapse?

A
  • fluoroscopy and endoscopy (dynamic problem, may not be seen on rads)
40
Q

How is tracheal collapse graded?

A 
1-4
1 = slight dip 
2 = semilunar shape
3 = banana shape
4 = inverted trachea
41
Q

Tx of tracheal collapse

A
  • medical management
  • similar to chronic bronchitis esp. cough suppressant
  • surgery available, ^ risk, only for v severe cases
    > intralumenal stent
    > rings round outside
42
Q

Tx of pulmonary neoplasia?

A

1* without spread = can be resected, prognosis ok

2* or 1* with spread = poor prognosis

43
Q

What neoplasm commonly metastasises to the lungs?

A

Sarcoma

44
Q

Hx with 1* neoplasia

A
  • may be no clinical signs (found incidentally)
  • cough
  • haemoptysis
  • weight loss
  • rarely dyspnoea
45
Q

PE with 1* kung neoplasia

A
  • may be normal
  • may be assymmetric
  • movement of apex beat
  • unilateral v in resonance
  • unilateral ^ resp noise
46
Q

Methods of definitive diagnosis of pulmonary neoplasia?

A

> Radiography
- solitary soft tissue density
- Ddx: neoplasia, granuloma, abscess, cyst, haematoma
CT better resolution
Bronchoscopy and trach wash
- unlikely to be hepful unless affecting major airway or v exfoliative
Trucut / FNA biopsy if mass superficial

47
Q

Tx pulmonary neoplasia?

A
  • mass small and no mets = surgery, lobectomy (but ^ incidence recurrence)
  • adjunctive chemo possible (not much evidence)
48
Q

Is 1* or 2* neoplasia more common in the lungs? Ddx?

A

2*

  • similar clinicalsigns and diagnostic findings but likely to be multiple masses
  • Ddx: granulomatous disease, parasitic, deep fungal disease, TB
49
Q

Tx 2* neoplasia in lungs?

A

Not appropriate

- short term palliation of clinical signs

50
Q

How may FBs present with resp disease?

A
  • acute onset associated with recognised event eg. excercise in autumn with grass awns present
    (NB: kennel cough infectious tracheobronchitis highest incidence in autumn too)
  • do not respond to tx with ABx or antiinflams (though may respond sporadically)
  • halitosis as object rots
51
Q

PE FB findings

A
  • normal
  • intermittent pyrexia
  • localised ^ resp noise
  • focal area of dullness on percussion
52
Q

Diagnostics for FB?

A
  • radiography (focal involvement one lung lobe often caudal right lobe in dogs)
  • endoscopy for visualisation and retrieval
53
Q

Tx FB?

A

Removal!

  • but may have fragmented and be irretreivable
  • Surgical removal may be necessary +- partial/complete lobectomy at same time
54
Q

What is PIE?

A
  • pulmonary infiltrate with eosinophils
  • syndrome in dogs
  • may be immune mediated (allergic) cause
  • hx chronic cough unresponsive to ABx
  • may be seasonal
  • may be association with other allergic disease eg. atopy
55
Q

Dx PIE?

A
  • eosinophilia
  • rads: bronchial/alveolar pattern
  • bronchoscopy: ^ mucous in airways
  • airway washes: eosinophils
  • NB: May be 2* bacterial infection and neutrophilic inflammation
56
Q

Tx and prognosis of PIE?

A
  • control 2* infection
  • corticosteroids at immunosupressive doses (taper to lowest effective dose) potentially wean off altogether
  • prognosis excellent for control of clinical signs
    > May require prolonged/lifelong tx with risk of iatrogenic HAC (cushings)
57
Q

see notes for table of conditions causing coughing

A

Respiratory (18 decks)

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