Lit Respiratory Flashcards
Describe:
a) The genetic disorder of the larynx that Norwich Terriers are predisposed to, and the
b) Causal gene mutation
c) Clinical manifestations
d) Management strategies
Johnson JVIM 2021
a) Normal nares and palate, but excessive supraglottic tissue & a narrow key hole or V-shaped lumen in the immediate infraglottic region –> narrowed laryngeal opening increases resistance to airflow, which could augment soft tissue swelling in the oropharynx.
b) ADAMTS3 metallopeptidase enzyme - responsible for promotion of lymphangiogenesis (–> lymphedema & soft tissue swelling).
c) Mimics clinical features of classic BOAS. Stertor or stridor. Range of clinical severity - relatively asymptomatic (despite marked morphological changes) to marked resp distress.
d) Sx - ventriculectomy
What scoring system was established for Norwich terriers predisposed to a genetic laryngeal disorder? What correlations did this scoring system have with quality of life?
Johnson JVIM 2021
Norwich terriers affected by an upper airway syndrome (NTUAS) scoring system. Based on # & severity of obstructive lesions detected endoscopically (range 0-25).
No correlation - 81% dogs had excellent QOL </= 3 (range 0-40, higher worse), with worse scores in dogs that underwent sx.
What gene mutation was identified in a juvenile schnauzer with chronic respiratory tract infections, and what are the pathophysiologic effects?
Hedgespeth JVIM 2021
Deleterious missense A/C mutation within the NAT10 gene, gene essential for microtubule acetylation, appropriate ciliary development, and cytokinesis (reported in humans with ciliary aplasia).
When comparing cytology & culture results of ET and TT washes in dogs with respiratory disease, what was the proportion of discordant results (i.e. cytology positive/culture negative and cytology negative/culture positive)?
Graham JVIM 2021
Cytology +/culture - discordancy was uncommon (8%). Cytology -/culture + discordancy was frequent (55.4%) but occurred less often (14.2%) when only growth >/=1+ was considered positive (i.e. light growth common even when cytology -)
–> Presence of bacteria on cytology was a good predictor of any growth, while their absence was a good predictor of the absence of growth of 1+ or more.
What were the 2 outcomes of using undiluted 5% gentamicin nebulisation in dogs with B. bronchiseptica infection compared to use of diluted gentamicin?
Dogs treated with undiluted gentamicin nebulisation & ……… in lavage were more likely to be cured at 3-4 weeks & have a shorter duration of treatment.
Cannone JVIM 2020
Higher rate of clinical cure at 3-4 weeks (defined as absence of cough for min 1 week).
Shorter median duration of treatment (4 vs 6 weeks).
<1000 cells/uL
When evaluating the utility of blood and BALF matrix metalloproteinase activities in WHWTs with chronic idiopathic pulmonary fibrosis (CIPF) vs healthy WHWTs/other breeds & dogs with other respiratory diseases,
Serum & BALF MMPs may be useful as ….. markers but not …. markers for CIPF.
CIPF WHWTs had significantly higher activities of ……….. in serum; higher BALF ……… activities compared to dogs with chronic bronchitis (CB), and higher BALF ……..activities compared to dogs with CB & eosinophilic bronchopneumopathy.
Määttä JVIM 2020
Diagnostic, prognostic
Pro-MMP-7; pro-MMP-9; pro-MMP-2
Matrix metalloproteinases (MMPs) participate in ECM remodelling.
Amongst shelter dogs, dogs with signs of canine infectious respiratory disease complex (CIRDC) had serum [25(OH)D] that was ….ng/mL higher/lower than healthy shelter dogs.
Dogs positive for …… had lower serum [25(OH)D] compared to dogs that tested negative.
Serum [25(OH)D] differed/did not differ between shelter and non-shelter dogs.
Serum [25(OH)D] was significantly associated/not associated with duration of time in the shelter.
Jaffey JVIM 2020
7.3ng/mL, lower
CHV-1 DNA
Did not differ
Not associated
Name 3 most common presenting signs in dogs with pulmonary hypertension.
Johnson JVIM 2020
Syncope (64%), cough (56%), respiratory difficulty (32%)
Common disease conditions associated with PH in dogs?
Johnson JVIM 2020
Tracheobronchomalacia, pulmonary fibrosis, inflammatory airway disease, brachycephalic syndrome; multiple disorders in some dogs.
What was the a) clinical response and b) survival outcome for dogs with respiratory-associated PH treated with sildanefil?
Johnson JVIM 2020
a) Variable. Dogs surviving >1mth had significantly improved tricuspid regurgitation pressure gradient (83.0 > 55.4mmHg) & QOL.
b) 32% mortality (death or euthanasia) within 1 month. 50% mortality at 6 months. 16% long-term survival (>/= 5yrs post-diagnosis).
a) Inflammatory airway disease in cats – differences between asthma & chronic bronchitis?
b) Name a clinical feature that may be useful in differentiating cats with asthma & chronic bronchitis.
Lee JVIM 2020
a) Asthma – increased airway responsiveness & bronchoconstriction. Manifested by acute wheezing or respiratory difficulty, which is reversible by bronchodilator tx. Likely results from exposure to allergens. Classified by eosinophilic airway inflammation. Chronic bronchitis – presence of cough. Bronchoconstriction is not part of the clinical picture. Characterised by non-septic suppurative airway inflammation in response to an unknown insult.
b) Age – cats with eosinophilic inflammation were significantly younger (4.4yrs) than those with neutrophilic inflammation (8yrs).
a) Tracheal stenting decreases the rate of pathogenic infections in geriatric dogs & dogs with traditional-type collapse (TTC) by ……% and …..% respectively.
b) Prior to stent placement, which 2 groups of dogs had higher % of positive pathogenic airway infections?
1. Geriatric dogs
2. Malformation-type collapse (MTC) dogs
3. Traditional-type collapse (TTC) dogs
4. Younger dogs
c) What are the risk factors for development of pathogenic infections in dogs undergoing tracheal stent placement?
Lesnikowski JVIM 2020
a) 52% & 56%
b) Geriatric (61%) & traditional-type collapse (TTC) dogs (62%) – vs young (32%) & malformation-type collapse (MTC) dogs (33%).
c) History of pneumonia (OR 3.6) & cardiac dz (OR 1.25) in geriatric dogs; hepatomegaly in young dogs (OR 1.5).
What were the significant changes noted in tracheal diameter immediately & longer term post placement of an intraluminal stent in dogs with tracheal collapse?
Was stent migration a significant complication at any time point?
Raske JVIM 2018
Immediate - 21% in intra-thoracic tracheal diameter (~5% for remaining). Longer term - mean % change ranged from 2.5-15% along cervico-thoracic trachea.
Minimal stent shortening overall.
No clinically relevant stent migration in this study.
Describe the differences in cats with aspiration pneumonia when compared to cats with bronchopneumonia or IAD in terms of:
- Clinical features
- Duration of clinical signs
- Radiographic findings
- BAL microbiology results
Dear JVIM 2020
- AP cats less likely to present with cough & more likely hypothermic vs cats with BP or IAD. Usually present as acute onset tachypnea.
- AP cats had significantly shorter median duration of signs (12d) vs BP cats (270d) or IAD cats (180d).
- Radiographically, more likely to have an alveolar pattern & higher total severity score in AP cats vs BP/IAD cats.
- BAL culture results: none had Mycoplasma cultured in AP cats, but Mycoplasma spp. most common organisms cultured from BP cats.
How do storage conditions impact aerobic bacterial culture results of BALF in dogs?
Curran JVIM 2020
BALF samples may be stored at 4degC for 24hrs before culture w/o substantially altering culture results.
But inappropriate storage (room temperature or exposure to heat) can result in overgrowth of E. coli or B. bronchiseptica - can alter clinical decisions.
In dogs undergoing thoracotomy for primary spontaneous pneumothorax, how often did pneumothorax recur post-operatively? In what timeframe was recurrence typically observed?
Risk factors for recurrence?
Dickson JAVMA 2021
13% recurrence.
Median 9d post-op; but most within 30d post-op (>30d rare ~3% recurrence).
No risk factors identified.
- Indications for tracheal endoluminal stent placement in dogs?
- What short-long term benefits did stent placement confer to dogs with tracheal collapse?
Congiusta JAVMA 2021
1. Severe tracheal collapse refractory to medical management. Malformation-type TC - stronger indication vs traditional-type TC (dynamic).
2.
What clinical features should prompt suspicion for pulmonary veno-occlusive disease and haemangiomatosis in dogs?
What thoracic imaging findings are expected with these dogs?
Prognosis/survival?
Reineiro JVIM 2019
Older dogs (median 11yo, no age/sex predisposition) presenting with acute respiratory distress. Absence of L-sided CHF & other causes of respiratory disease.
R-sided cardiomegaly with patchy-diffuse interstitial to alveolar pulmonary pattern. NB: 60% dogs had L cardiac silhouette. 33% had pulmonary arterial hypertension (may have underestimated %?)
CT - perivascular diffuse nodular ground-glass opacities & PA enlargement
Prognosis guarded, 66% dogs died within 1 day, MST 3days.
NB: histopathologic criteria of PVOD = occlusive remodeling of small-sized to medium-sized pulmonary veins, PCH = alveolar capillary proliferation and congestion).
What is Heliox? How may it affect breathing in brachycephalic dogs?
Benavides JVIM 2019
Heliox is an O2/Helium mixture. It has less density than normal air, so promotes laminar air flow.
Use in normal & brachycephalic dogs increased peak inspiratory flow (PIF), peak expiratory flow (PEF) rates & normalised tidal breathing flow-volume loop shapes.
—> Overall improves flow rate & patterns in brachycephalic dogs.
What POCUS findings were consistent with pulmonary oedema in dogs?
Sensitivity & specificity of findings?
JAVMA 2019
B line scores 10+ & presence of 2+ sites positive for B lines.
Sn 92%, Spec 94%
(NB: Ward JAVMA 2017 - similar paper evaluating lung POCUS for cardiogenic pulmonary oedema)
What 2 respiratory syndromes are described in Irish Wolfhounds? What are the proposed pathogenetic mechanisms & clinical manifestations?
Viitanen JVIM 2019
1) Recurrent bacterial pneumonia (RBP) - MIDDLE-AGE/OLDER IWHs (median 5yo).
Median 5 episodes of BP. Predisposing factors: focal bronchiectasis (10/11) common; less prevalent - uni/bilateral lar par & oesophageal hypomotility.
Local/systemic Ig deficiencies or primary ciliary defects not detected.
2) Unique rhinitis & bronchopneumonia syndrome (RBPS) described in YOUNG IWHs. Variable rhinorrhea present mostly from birth, accompanied by recurrent BP. Clinical picture resembles primary ciliary dyskinesia or primary immune deficiency (possibly IgA deficiency). Hereditary disease.
- List 3 major complications associated with endoluminal tracheal stent placement.
- What 2 factors increase the risk of caudodorsal tracheal stent fracture?
- What factor was associated with obstructed tissue ingrowth & thoracic inlet fractures in these dogs?
Violette JVIM 2019
1. Stent fracture (25%), obstructive tissue ingrowth (19%), progressive tracheal collapse (12%).
2. (Natural) tracheal taper, stent diameter oversizing in the intra-thoracic trachea.
3. Tracheal malformations (70% dogs with obstructive tissue ingrowth, 100% dogs with thoracic inlet fractures).
