Coughing in Small Animals: Diagnostic Approach COPY Flashcards
what is the cough reflex
forced expiratory effort against a closed glottis
what is the cough reflex mediated by
irritant receptors in airways and lungs
what occurs to the expectorate coughed up
swallowed or terminal retch with white forth (productive)
what are respiratory causes of a cough (6)
- bacterial & viral
- inflammatory/allergic/chronic airway disease
- neoplastic
- parasitic
- protozoal/fungal
- traumatic/structural abnormality
what are cardiovascular causes of persistent cough
- cardiomegaly
- pulmonary edema (esp if acute)
do cats cough with pulmonary edema
controversy
cats are said to not cough with pulmonary edema
how are coughs investigated (9)
- history
- clinical features (signalment)
- physical exam
- blood/fecal tests
- thoracic radiographs
- thoracic and cardiac ultrasonography
- bronchoscopy, bronchoalveolar lavage
- FNA of lungs
- CT
what are the history considerations of a persistent cough (11)
- acute vs. chronic (=daily for at least 2 months)
- concurrent signs (sneezing, dyspnea)
- character: soft/harsh/honking
- productive/non-productive
- duration/frequency/timing
- relationship to activities
- vaccination/travel/worming
- respiratory noises: stridor/stertor
- respiratory pattern: dyspnea
- exercise intolerance/lethary
- appetite
what are toy breeds predisposed to
tracheal collapse
what are terriers predisposed to
lung fibrosis
what are cats predisposed to
asthma
what are large breed dogs predisposed to
laryngeal paralysis
what are older dogs prone to
neoplasia
what are small dog breeds predisposed to
DMVD
what are the specific physical exam (8)
- palpate cervical area
- tracheal pinch reflex: if cough is elicited
- pulse quality
- resp pattern
- resp noises
- facial edema (cranial mediastinal masses(
- abdominal palpation
- lymph nodes
what sounds when auscultating indicate cardiac causes to a cough (5)
- sinus tachycardia
- arrhythmias
- murmurs
- gallop sounds
- pulmonary crackles
what sounds would indicate respiratory causes when auscultating (5)
- sinus arrhythmia
- bradycardia
- crackles
- wheezes
- stridor/stertor
what lab tests can be used to investigate a cough (7)
- hematology
- biochemistry
- cats: FELV/FIP/FIV
- Baermann’s fecal larval migration
- serology/microfilaria for heart worm
- biomarkers: NTproBNP
- AngioDetect: angiostrongylus vasorum
what findings on radiograph can indicate a cough (5)
- soft tissues of neck: upper resp tract lesions (foreign bodies, trauma, cervical tracheal collapse)
- mediastinum: masses, compression/deviation of normal structures
- cardiomegaly, pulmonary edema & vascular congestion
- alveolar, lobar, interstitial, bronchial lung patterns
- tumours, cysts
what is cor pulmonale
right cardiomegaly –> indicative of pulmonary hypertension (chronic pulmonary disease for ex. IPF)
what can be heard on auscultation with cor pulmonale
velcro crackles
what radiographic changes are seen with cor pulmonale
interstitial or broncho-interstitial lung pattern
rounding of right side of heart
what changes are seen here and what is ddx

rounding of right side of heart
cor pulmonale
what changes are seen here and what is ddx

some rounding of right heart
cor pulmonale
when is thoracic ultrasonography useful for coughing
masses
pleural effusion
when is echocardiography useful
when trying to rule out cardiac causes for cough
can confirm mitral valve disease, cardiac chamber enlargement, etc
when is endoscopy useful
direct observation of airway
look at larynx, trachea, etc
foeign bodies, laryngeal collapse, tracheal collapse
what is bronchoscopy used for
evidence of pneumonia
parasites (lungworm)
chronic bronchitis (roughening and thickening of mucosa)
foreign body
what is bronchoalveolar lavage
using endoscope and flusing saline
definitive diagnosis of lower airway disease (pneumonia, eosinophilic bronchitis, Bordetella)
what is FNA lung mass
if there is a mass in the lungs that’s adjacent to the chest wall
what is CT useful for
interstitial lung disease (ex. pulmonary fibrosis which doesn’t show up on radiographs)
what are the main causes of coughing in kitties (4)
- infectious
- inflammatory/allergic
- neoplastic
- parasitic/fungal/protozoal
what are the infectious & inflammatory causes of cough in cats (4)
- cat flu: URT infection
- pneumonia
- chronic bronchopulmonary disease
- pulmonary fibrosis
what are the infectious causes of feline upper resp tract infections (6)
- feline rhinotracheitis virus (FHV)
- feline calici virus (FCV)
- feline corona virus
- Bordetella bronchiseptica
- mycoplasma spp
- chlamydophila felis
what medications are used to treat feline URT infections
amoxycillin clavulanate
doxycycline
antivirals? famciclovir (FHV)
interferon (give in early infection)
what are supportive treatments of feline URT infections (5)
- good nursing
- appetite stimulants
- mucolytics
- decongestants
- nebulized air
are bacterial/viral pneumonia common in cats
uncommon
look for underlying cause (aspiration, immunosuppression)
when can pneumonia occur in association with in cats
chronic bronchitis/asthma
what will BAL fluid cytology show if there is a bacterial/viral pneumonia
increased neutrophils
what antibiotics are used to treat bacterial/viral pneumonia in cats
based on culture and sensitivity
but empirical: amoxicillin clavulanate/doxycycline
what are the supportive therapies for bacteria/viral pneumonias in cats (5)
- IV fluids
- oxygen
- coupage
- airway humidification
- bronchodilators
what are the clinical features of chronic bronchitis (5)
- coughing for at least 2 months
- dyspneic episodes may occur if concurrent asthma
- pyrexia
- lethargy
- inappetence if concurrent bronchopneumonia
how is chronic bronchitis/chronic airway disease treated (6)
- glucocorticosteroids: oral or inhaled
- bronchodilators: oral or inhaled
- antibacterial therapy
- mucolytics
- control of environmental pollutants
- physiotherapy
what is the long term management of chronic bronchitis/chronic airway disease (3)
- bronchodilators
- antibiotics
- corticosteroids
what bronchodilators used to treat chronic bronchitis/chronic airway disease (4)
- salbutamol (albuterol) inhaled
- salmeterol (serevent) inhaled
- terbutaline
- theophylline
what antibiotics used to longterm treat chronic bronchitis/chronic airway disease (3)
- doxycycline
- enrofloxacin
- clindamycin
what corticosteroids are used to longterm treat chronic bronchitis/chronic airway disease (4)
- prednisolone: 0.25-2 mg/kg PO q 12 hours for 7-14 days then taper dose
- fluticasone (inhaled)
- budesonide (inhaled)
- beclomethasone (inhaled)
what are the radiographic signs of chronic bronchitis
collapsed middle lung lobe
what changes are seen here and ddx

chronic bronchitis or feline asthma
collapsed middle lung lobe
what changes are seen and ddx (3)

- generalized bronchial pattern with more markings than usual
- soft tissue density
- rounding of lung lobes
what neoplasia is more common in the lung primary or secondary
secondary more common
what tumours can cause coughing
tumours of pharynx, trachea and mediastinum
what are the parasitic causes of coughing in cats (3)
- Aeluronstrongylus abstrusus
- Capillaria aerophilia
- Dirofilaria immitis
what are fungal causes of coughing in cats
- cryptococcus neoformans (mainly nasal)
- aspergillus
- histoplasma
- blastomyces
what are the protozoal causes of cough in cats
toxoplasmosis
what are the causes of coughing in dogs (6)
- infectious
- inflammatory/allergic
- neoplastic
- paraisitc/fungal/protozoal
- structural
- cardiac
what are infectious causes of kennel cough (infectious laryngotracheitis) in dogs (6)
- bordetella bronchiseptica
- parainfluenza III
- canine distemper virus
- canine adenovirus II
- canine herpes virus
- mycoplasma spp
what are the clinical signs of kennel cough (4)
- harsh easily elicited non-productive cough
- +/- pyrexia
- inappetence
- nasal discharge
how is kennel cough managed in dogs (5)
- restrict exercise (& isolate)
- harness instead of collar
- avoid dusty/smoky environment
- +/- tetracyclines/potentiated sulphonamides
- +/- antitussives
what are the clinical features of chronic bronchitis/CAD in dogs (12)
- small toy and terrier breeds
- coughing for at least 2 months
- +/- crackles on auscultation
- +/- tachypnea
- +/- dyspnea
- +/- exercise intolerance
- +/- pyrexia
- +/- lethargy
- +/- inappetance
- bronchoscopic diagnosis
- bronchopneumonia complication
- eventual respiratory failure (fibrosis, pulmonary hypertension)
how is chronic bronchitis treated (11)
- avoid obesity
- harness
- corticosteroids: oral, inhaled
- bronchodilators: oral, inhaled
- antibacterial therapy (intermittent)
- mucolytics
- nebulization
- rest and exercise control
- control of environmental pollutants
- physiotherapy
- antitussives (esp if concurrent tracheal collapse)
what are the causes of allergic pulmonary disease in dogs (pulmonary infiltrate with eosinophils (PIE)/eosinophilic bronchopneumonopathy (EBP) (3)
- parasites
- hypersensitivity to parasites
- inhaled allergens
what are the findings of allergic pulmonary disease in dogs (pulmonary infiltrate with eosinophils (PIE)/eosinophilic bronchopneumonopathy (EBP) in dogs (5)
- cough
- tachypnea
- dyspnea
- younger dogs
- eosinophilia (blood & BAL)
how is eosinophilic bronchopneumonopathy (EBP) treated (2)
- oxygen, cage rest
- corticosteroids
how is eosinophilic bronchopneumonopathy (EBP) chronically managed (6)
- fenbendazole
- environmental management
- corticosteroids (oral, inhaled gradual taper)
- harness
- control obestiy
- other immunosuppressive therapies
what are airway/lung/heart parasites in dogs that cause a cough (5)
- oslerus osleri
- crenosoma vulpis
- angiostrongylus vasorum
- capillaria aerophilia
- dirofilaria immitis
how is Oslerus osleri transfered
dam to offspring
how is crenosoma vulpis transfered
intermediate host (mollusc), fox feces
how is angiostrongylus vasorum transfered
intermediate host mollusc
how is capillaria aerophillia transfered
disease of foxes, rare in dogs
how is a parasitic cough presented (5)
- dyspnea if infection is widespread
- peripheral eosinophilia
- pulmonary hypertension (may lead to right sided CHF in A. vasorum and D. immitis)
- clotting disorders with A. vasorum
how are parasitic coughs treated
fenbendazole for 12-21 days
concurrently with prednisolone to prevent reaction to dying worms
how is coughing treated in cardiac patients
- cardiac meds for CHF
- antitussives: codeine, butorphanol
- prednisolone if concurrent CAD present
what is the age of onset usually in tracheal collapse
young to middle age toy breeds
what is the cough heard in tracheal collapse
goose honk sound
aggravated by lead pulling
what secondary resp diseases can be seen with tracheal collapse
tracheitis
chronic bronchitis
pneumonia
how is tracheal collapse acutely managed (5)
- acetylpromazine
- oxygen
- cool environment
- short acting corticosteroids
- opioids (buprenorphine, butorphanol)
how is tracheal collapse chronically managed (6)
- control obesity
- use harness
- environmental hygiene
- avoid prolonged barking
- avoid excessive excitement
- avoid resp tract infections
what are the antitussives used in tracheal collapse
- butorphanol
- codeine phosphate
what are the bronchodilators used in treatment of tracheal collapse
- methylxanthines
- beta-adrenergic agonists
what are the functions of methylxanthines (3)
- bronchodilation
- increased mucociliary clearance
- decreased diaphragmatic fatigue
what other medications are used to treat chronic tracheal collapse
- antitussives
- bronchodilators
- anti-inflammatory: corticosteroids
- antibiotics: secondary infeciton
what are the radiological interventions in tracheal collapse
self-expanding nitinol stents
what are the types of discrete foreign bodies in the airway
grass seeds, twigs, stones, other small solid objects
what are the clinical signs of airway foreign bodies (3)
- acute cough/choke
- developing to persistent cough
- halitosis
what are the complications to airway foreign bodies (3)
- pleural contamination
- lung lobe consolidation
- pulmonary abscess
how are foreign bodies in the airway treated (3)
- bronchoscopic retrieval
- exploratory thoracotomy: retrieval of foreign body or lung lobectomy
- antibacterial therapy