Coughing in dogs + cats

Question 1

Most frequent cause in dogs is…

Answer 1

infectious tracheobronchitis (ITB) - aka kennel cough

Question 2

Acute coughing DDx

Answer 2

Infectious tracheobronchitis Airway irritation Foreign body Pulmonary haemorrhage Acute pneumonia Acute oedema Airway trauma

Question 3

chronic coughing DDx

Answer 3

Chronic bronchitis (tracheo-bronchial syndrome) Left sided HF Parasites Tracheal collapse Foreign body Bronchopneumonia Pulmonary neoplasia Extra-lumenal airway compression Eosinophilic diseases - PIE, FAAD Pulmonary fibrosis Pleural disease Ciliary dyskinesia

Question 4

chronic bronchitis - clinical signs

Answer 4

Chronic irritation to bronchial mucosa Mucosal hyperplasia Increased mucous production Decreased efficacy of respiratory defence mechanisms Inflammation/secondary infection Bronchospasm Reduced airflow Chronic cough

Question 5

chronic bronchitis - signalment + history

Answer 5

old, small breed, overweight dogs Insidious onset, dry hacking cough Rarely a history of known precipitating cause Cough paroxysmal and usually unproductive Exacerbated by excitement/exercise

Question 6

chronic bronchitis - clinical exam

Answer 6

Dog usually otherwise well Often slightly overweight Increbronchial noise/wheezes on auscultation Cough easily elicited on tracheal pinch Sinus arrhythmia + absence of murmur rule out cardiac cause

Question 7

chronic bronchitis - diagnosis

Answer 7

“Diagnosis of exclusion” Blood tests usually normal Radiography - Incr bronchial markings, False +ves + -ves Endoscopy - irregular airways and mucous hypersecretion Tracheobronchial wash - Chronic infl +/- +ve culture

Question 8

chronic bronchitis - treatment

Answer 8

Client education Management alterations Drug therapy

Question 9

chronic bronchitis - management

Answer 9

Clean atmosphere Humidification Diet Regular short walks Avoid pressure on neck

Question 10

chronic bronchitis - drug therapy

Answer 10

Bronchodilators Antibacterial agents - Short courses for control of clinical signs, Chronic therapy may select for resistant infection Expectorants/mucolytics Cough suppressants Anti-infl

Question 11

chronic bronchitis - bronchodilators

Answer 11

Indicated in most bronchial diseases Xanthine agents - Theophylline (Corvental-D) Beta-2 agonists - Terbutaline (Bricanyl), Adrenaline Anti-muscarinics - Atropine (multiple other effects preclude use)

Question 12

chronic bronchitis - Antitussives and Mucolytics

Answer 12

Opiate derivatives - Butorphanol (Torbutrol), Codeine Advantageous when used to suppress non-productive cough Don’t suppress a productive cough not patients with alveolar pattern on radiographs Tracheal collapse, Bronchial compression Bromohexine (Bisolvon) - management of productive bronchial disease + bronchopneumonia to assist the expectoration of respiratory secretions

Question 13

chronic bronchitis - Anti-inflammatory medication

Answer 13

corticosteroids

Question 14

chronic bronchitis - prognosis

Answer 14

therapy - reduce/minimise the frequency of cough Cure unrealistic and usually unobtainable Many dogs with chronic bronchitis live happily for years

Question 15

feline asthma

Answer 15

“Feline Allergic Airway Disease” (FAAD) Most common cause of persistent coughing in cats Antigenic stimulus results in inflammation, mucous, oedema and bronchoconstriction Airway hyper-reactivity, smooth muscle hyperplasia and airway narrowing result

Question 16

Feline Allergic Airway Disease (FAAD) - history + PE

Answer 16

Intermittent dyspnoea and coughing acute and life-threatening bouts Rarely identifiable stimulus PE - May be normal between bouts, incr resp effort, audible wheezes esp on expiration, Hyperinflation of lung

Question 17

Feline Allergic Airway Disease (FAAD) - diagnosis

Answer 17

Blood tests - eosinophilia Radiography - Bronchial pattern, Hyperinflated lung Tracheal wash - Infl cells - mostly eosinophils R/o parasites and secondary bacterial infection

Question 18

Feline Allergic Airway Disease (FAAD) - emergency therapy

Answer 18

Oxygen Rapid acting corticosteroid e.g. methylprednisolone succinate Bronchodilator, Atropine, Adrenaline

Question 19

Feline Allergic Airway Disease (FAAD) - prognosis

Answer 19

Variable Some cats stable on therapy long term therapy will be necessary to find the right regime in each individual Some cases cannot be controlled Some cases will die acutely

Question 20

Feline Allergic Airway Disease (FAAD) - maintenance

Answer 20

Corticosteroids - tapered to lowest effective dose Bronchodilators - Terbutaline, Theophylline etc. control of infl process Zafirlukast (Accolate) Leukotriene inhibitor

Question 21

Aelurostrongylus

Answer 21

Feline lungworm Occasionally results in clinical signs Alveolar/Interstitial disease Prolonged course of Fenbendazole required

Question 22

canine lungworm - history

Answer 22

Chronic cough unresponsive to conventional therapy Coagulopathy (Angiostrongylus) Dyspnoea/wheezing Haemoptysis

Question 23

lungworm treatment

Answer 23

7 days of fenbendazole - all types of resp parasite Milbemycin and Moxidectin specifically - angiostrongylus Prognosis good for cure Some cases of Filaroides have residual nodules at the tracheal bifurcation which result in cough Clinical signs may take many weeks to improve due to granulomatous reaction to killed parasites in lung parenchyma

Question 24

tracheal collapse - pathopysiology

Answer 24

Loss of normal structure of tracheal rings. Dorsal ligament stretches + trachea loses normal cylindrical structure Dynamic variation in tracheal diameter occurs Cervical trachea collapses on inspiration Thoracic trachea collapses on expiration cough and dyspnoea

Question 25

tracheal collapse - history

Answer 25

Yorkshire Terriers and Poodles Chronic coughing - Gradual progression Quacking or Honking cough May progress in severely affected individuals to bouts of dyspnoea

Question 26

tracheal collapse - PE

Answer 26

Affected dogs appear fairly normal audible clicking noise as airway collapses during respiration Tracheal malformation may be palpable Feel edge of deformed cartilages Characteristic cough may be elicited on tracheal palpation

Question 27

tracheal collapse - diagnosis

Answer 27

Collapse dynamic and therefore stationary radiographic images may not capture collapse Fluoroscopy - demonstrates and classifies severity of collapse Endoscopy may also be used to demonstrate collapse Collapse graded I-IV

Question 28

tracheal collapse - treatment + prognosis

Answer 28

Medical management Similar chronic bronchitis esp. cough suppressants Surgery available but r high risk and only considered for most severely affected individuals Intralumenal stenting Prognosis dependant upon severity Mild cases inconvenient Severe cases life threatening

Question 29

pulmonary neoplasia - history

Answer 29

May be no clinical signs Some found incidentally on radiography • cough due to airway involvement/erosion/compression haemoptysis Weight loss Rarely cause dyspnoea unless very extensive

Question 30

pulmonary neoplasia - PE

Answer 30

May be no abnormalities May be asymmetric findings Movement of apex beat Unilateral decrease in resonance Unilateral increase in respiratory noise

Question 31

pulmonary neoplasia - diagnosis

Answer 31

Radiography - Solitary soft tissue density CT – better resolution where available Bronchoscopy - tracheal wash - Unlikely to be helpful Biopsy - percutaneous “Tru-cut” or FNAB possible if mass superficial

Question 32

pulmonary neoplasia - management

Answer 32

mass small + shows no evidence of metastasis - surgery Surgical lobectomy High incidence of recurrence of clinical signs Some cases may be cured Adjunctive chemotherapy described Average survival about one year

Question 33

foeign bodies - history

Answer 33

acute onset with recognised event halitosis as foreign body degraded Variable response to antibiotics/anti-inflammatories

Question 34

foerign bodies - PE

Answer 34

•Often fairly normal •May be intermittently pyrexic •May have localised increase in respiratory noise •May have focal area of dullness on percussion

Question 35

foreign bodies - diagnosis

Answer 35

Radiography - focal involvement of one lung lobe often right caudal lung lobe in dogs Endoscopy allows visualisation and retrieval

Question 36

foreign bodies - treatment

Answer 36

Endoscopic retrieval - may have fragmented and be irretrievable Surgical removal - Often need to carry out partial/complete lobectomy at the same time

Question 37

Pulmonary infiltrate with eosinophils (PIE)

Answer 37

in dogs May be immune-mediated (allergic) History of chronic cough unresponsive to antibiotic therapy May be seasonal May be association with other allergic diseases e.g. atopy

Question 38

Pulmonary infiltrate with eosinophils (PIE) - diagnosis

Answer 38

Eosinophilia Radiographic evidence of bronchial/alveolar pattern Bronchoscopy - increased quantity of mucous in airways Airway washes reveal population of predominantly eosinophils N.B. may be secondary bacterial infection and neutrophilic inflammation

Question 39

Pulmonary infiltrate with eosinophils (PIE) - treatment + prognosis

Answer 39

Control secondary infection Corticosteroids at immunosuppressive doses - gradually tapered to the lowest dose that controls the clinical signs Prognosis - Excellent for control of clinical signs but may require prolonged/lifelong therapy with risk of iatrogenic HAC