Foxy Eosinophilic bronchpneumopathy Flashcards
Questions to ask about the coughing dog?
- What is the dog’s body condition? Has she lost weight?
- Is the dog up to date with vaccinations including kennel cough?
- Has she been in kennels recently or prior to the initiation of the cough?
- Has the dog travelled abroad or within the UK recently? – think parasitic lung disease
- What is the exact nature of the cough? Dry, honking, productive?
- Is it worse at different times of day?
- Is it worse at rest or exercise?
- Is appetite/thirst normal?
- Any other signs e.g. regurgitation (what is the relevance of this)?
- Is it progressive?
- Has the nature of the cough changed?
- Has she ever suffered collapsing or syncopal episodes?
- Have the owners any other dogs and are they affected?
What is foxy problem list?
–Chronic cough
–Mild exercise intolerance
What view is this?
Right lateral view taken under GA as ET tube can be clearly seen in the trachea.
Describe your findings?
There is a marked bronchial lung pattern throughout all the lung fields. There is flattening of the diaphragm. The cardiac silhouette is normal size and shape.
What view is this?
A Dorsoventral view
Describe your findings?
There is mild right sided enlargement with a slight reverse ‘D’ shape. There are thickened radiodense rings around the bronchi and ‘tram lines’ throughout the lung fields indicating a bronchial lung pattern. However the film has been taken during the expiratory phase.
Using both radiographs what is the predominant lung pattern?
Bronchial lung pattern
What are you main differentials?
PIE Pulmonary infiltrate of Eosinophils
CB Chronic bronchitis
bronchopneumonia
What would you do next?
Bronchoscopy and
Bronchoalveolar lavage
You next decide to perform Bronchoscopy under GA
- What anatomical structures can be seen in this picture?
- Describe your findings
- What would you do next?
•What anatomical structures can be seen in this picture?
–Carina (division into mainstem bronchii)
•Describe your findings
–Mucopurulent material in airway
•What would you do next?
–Lavage and sample collection
Discuss this bronchoalveolar lavage?
- BAL cytology: predominant cell type: eosinophils.
- No parasites / evidence of bacterial infection
- Faecal examination – negative for parasites
- Eosinophilic bronchpneumopathy (EBP).
Previously known as Pulmonary infiltrate of Eosinophils (PIE)
What is the treatment for EBP?
•Fenbendazole – Exclude parasitic causes of eosinophilia
–50mg/kg once daily for 10 days
- Antibiotic therapy if secondary infection
- Bronchodilators
- Mucolytics
- Prednisolone
–2 – 4mg/kg then taper
- Inhaled Fluticasone / salbutamol
- Some dogs require azothiaprine
What is the prognosis for EBP Eosinophilic bronchpneumopathy ?
- The long term prognosis is good, however relapse is likely and long term management is very likely to be required.
- Inhaled medication tends to work well in these cases
Discuss eosinophillic pneumonia?
- Diverse group of infiltrative pulmonary disorders
- Limited understanding of these disorders
- Shared link is the presence of large numbers of eosinophils
- Vary from life threatening respiratory distress to more chronic forms
- Usually respond well to corticosteroid therapy
Discuss eosinophillic pneumonia further?
- Idiopathic
- Secondary
- Previously known as pulmonary infiltrates with eosinophils
- There is no clear classification of these disorders in human or veterinary medicine
- Idiopathic causes in dogs tend to present with a chronic form and can vary from a ‘chronic bronchitis’ type disease to a pulmonary granulomatous disease
- Systemic involvement with high circulating eosinophil count or just pulmonary involvement
- Usually see a mixture of bronchial / interstitial involvement on radiographs
