Feline Asthma (SDL) Flashcards
Jim
5 yo MN DLH cat
- BIOP from a kitten
- indoor/outdoor cat
- 2 other cats are normal
- 6 mth history:
- coughing
- occ paroxysmal
- becoming worse
- stays indoors more
Physical exam:
- HR 168
- RR 32
- MM colour pink
- Auscultation:
- mild expiratory wheeze bilateral dorso caudal lung fields
- no heart murmur
- no pulse deficits
- Construct a problem list for Jim
- What are the differentials for Jim’s problem list?
- •Coughing
- Paroxysmal
- Getting worse
- Doesn’t want to go out
- RR – 32? (Stressed at vet)
- Mild expiratory wheeze
- •Asthma
- Chronic bronchitis
- Infectious – bacterial, viral parasitic
- Mycoplasma pneumonia
- Mycobacteria Felis
- Parasite - Aeleurostrongylus Abstrusus
- Foreign body
- Neoplasia
What investigations would you like to do for Jim?
- Radiographs – lateral and DV
- Bloods – hematology and biochemistry
- Jim is booked in for thoracic radiographs
1. what views would you like to take? - He has been starved overnight and physical examination is essentially unchanged
- body weight 4.5kg
- BCS 3/5
- What anaesthetic protocol would you like to use?
- Lateral and DV
- •Pre-oxygenate
- Premed: ACP and Opioid (buprenorphine)
- Induce: Propofol and oxygenate at induction
- T piece circuit
- Isoflurane to maintain
- Recovery – in sternal
- Safe anaesthesia is always about thinking about the drugs to use (premed and induction agent), the route of administration, the doses that might be needed, intubation (what equipment might be needed), anaesthetic circuit, monitoring during anaesthesia and during the recovery period.
Are you happy with the radiographic quality?
What radiological features are helpful in terms of your list of differentials for Jim’s cough?
- Are you happy with the radiographic quality?
- Yes
- What radiological features are helpful in terms of your list of differentials for Jim’s cough?
- Asthma – bronchial thickening seen as tram lines and doughnuts
- Could still be chronic bronchitis or an infectious cause
What are some reasons for and reasons against doing bronchoscopy in Jim?
Reasons for:
- Confirm diagnosis
- Rule out infectious
- Biopsy
- Could do a wash
Reasons against:
Cost
Unlikely to get scope far
May not see a lot as not having an attack
Laryngeal paralysis risk
You decide against bronchoscopy but would like to do an airway lavage procedure
- what techniques are available?
- what samples do you need?
- You decide against bronchoscopy but would like to do an airway lavage procedure
- what techniques are available?
- (You could have done it alongside scope)
- Trans tracheal wash
- BAL
- what samples do you need?
- Use saline and draw back. Send for bacteriology and cytology.
Jims blind endotracheal wash results are as followed.
What have you ruled out so far with these investigations?
What is your presumed diagnosis?
- What have you ruled in or ruled out so far with these investigations?
- Parasites
- Bacteria
- Viral
- What is your presumed diagnosis?
- Asthma
With a presumed diagnosis of asthma, what treatment would you like to start for Jim and why?
- Glucocorticoids, although nonspecific in their actions, are the mainstays of treatment for feline asthma. Glucocorticoids have potent antiinflammatory effects and are used to suppress airway inflammation and thus slow down or minimize irreversible airway-remodeling damage.
- Manage inflammation
- dexamethasone iv
- Manage bronchospasm
- Terbutaline – do not use if unsure in heart failure! Causes TACHYCARDIA and worsens!
- selective β2 receptor agonist
- smooth muscle relaxant
- bronchodilation
- ideally rule out heart disease 1st
- inhaled salbutamol
- selective β2 receptor agonist
- can give every 30 mins for 2-4 hrs
- stop if stresses the patient
Other than his medication for asthma, is there any other advice you would like to give?
- Steroids – diabetogneic in cats so if PUPD will need to stop
- Reduce allergen if suspect one (may be seasonal or in a room)
- Reduce cleaning product
- Reduce sprays perfumes, smells etc
- Reduced dust
- Reduce weight
Jim goes onto the following treatment and his follow ups go as follows:
- Treatment: prednisolone 1mg/kg po twice a day for 10 days
- At a 10 day check up appointment Jim has been coughing less and seems brighter and more lively at home.
- The good response to treatment is reassuring that you have treated him correctly for inflammatory airway disease
- You decide to reduce his dose to 0.5mg/kg po twice a day and see what happens over the next 4-6 weeks
Things to consider and answers:
- Will you need to see Jim?
- Will further investigations be necessary, if so, what?
- Can you just alter his treatment
- Has his prognosis changed?
- Will you need to see Jim? Yes he will need regular medication checks – especially checking for PUPD
- Will further investigations be needed- if so, what? Will depend on clinical signs, if well controlled probably not
- Can you just alter his treatment? Needs small alterations in steroid dosing.
- Has his prognosis changed? The prognosis for these conditions depends mainly on the severity of the disease. In most cases, appropriate therapy will dramatically improve clinical signs and quality of life for the cat, but life-long therapy may be required and acute severe attacks can prove fatal if treatment is not initiated promptly. In some cases there will be ongoing damage to the lungs and this may result in irreversible fibrotic changes within the lungs in some cases, that can eventually prove fatal.
You get a phone call from Jims owner:
“Jim has been doing so well but we came in from work this evening and he is breathing really fast with his mouth open- he just doesn’t look right at all”
- What might be going on?
- What is your advice?
- What change to Jim’s treatment migt be required and why?
- What might be going on? Acute attack
- What is your advice? Give him Terbutaline or inhaled salbutamol
- What changes to Jim’s treatment might be required and why? May need to increase the preds
You get a phone call from Jims owner:
“Jim has been doing so well but he is getting very clever at spitting out his tablets. We think he missed a couple of days and now he seems to be coughing again”
- What is your advice?
- What changes to Jims treatment might be required anf why?
- What is your advice? Discuss ways of getting in. Maybe crushing tablet in food. Pill popper?
- What changes to Jim’s treatment might be required and why? May need to change from an oral form if this is still not able to be given. Maybe long acting injection if possible?
You get a phone call from Jims owner:
“Jim has been doing so well but he has put on quite a lot of weight and in the last few days he has urinated in our bedroom and he seems very thirsty”
- What might be going on?
- What is your advice?
- What changes to Jims treatment might be required and why?
- What might be going on? Diabetes
- What is your advice? Withdraw steroids but slowly
- What changes to Jim’s treatment might be required and why? Diabetogenic. May need to move to an aerosol. Inhaled steroid.
You get a phone call from Jims owner:
“Jim started coughing again when we reduced his tablet dose. We increased the dose back to his starting dose. He’s still coughing badly but seems bright and happy”
- What might be going on?
- What is your advice?
- What changes to Jims treatment might be required and why?
- What might be going on? Fibrotic change
- What is your advice? Wont get better - lifelong
- What changes to Jim’s treatment might be required and why? None as it wont help
You get a phone call from Jims owner:
“Jim has been doing so well but in the last few days he has gone off his food, his coughing is worse and seems quite fruity. He spends all day on our bed.”
- What might be going on?
- What is your advice?
- What changes to Jims treatment might be required and why?
- What might be going on? Possible infection
- What is your advice? Bring him in, clinical exam, xray and maybe a BAL
- What changes to Jim’s treatment might be required and why? Depends on findings
