Lower Airway Disease in Cats Flashcards
What is the signalment of lower respiratory disease in cats?
What is it liekly to be in young versus older cats?
Signalment
Lower airway disease tends to affect young adult to middle aged cats but can affect cats of any age
Older cats-increases suspicion for other disease such as
- hyperthyroidism
- neoplasia
- cardiac disease
Younger cats and kittens-increases suspicion for
- infectious disease
- viral
- parasitic
- Mycoplasma
- bacterial
- toxoplasma
**Bacterial pneumonia is relatively uncommon in cats compared with dogs**
What is the clinical history for lower respiratory track disease in cats?
Clinical History
Usually a low grade chronic disease
- coughing
What does a coughing cat look/sound like?
- audible wheezing
- “exercise intolerance”
Sometimes a very acute presentation
- brought in as an emergency
- respiratory distress
- mouth breathing
- tachypnoea
Episodic respiratory distress
- self limiting?
- respiratory effort?
What questions should we ask?
What questions should we ask?
- Are there any trigger factors?
- Change in environment?
- New cat litter?
- Passive smoking?
- Seasonal?
- Is the cough productive?
- Is anything “brought up”?
- Often confusion with hair balls
- Any significant weight loss, anorexia?
*
Is it an acute or chronic disease in cats?
Cats are excellent at masking their clinical signs
- quieter?
- staying in bed all day?
- less playful?
- grooming less?
- staying at floor level/reluctant to jump up on furniture?
- An emergency presentation doesn’t always mean an acute disease
Look at this schematic for lower airway disease in cats?
How to assess your patient/is it critical?
Assessing the cat: how critical is your patient?
Respiratory reserve often minimal
Sympathetic stimulation –> counterproductive (HR goes up and Oxygen requirement increases) caused by:
- transport
- waiting room
- is it “cat friendly”?
- physical exam
Initial assessment should be hands off
Triage emergency patients
- Are there trained staff empowered to make decisions?
What does the START anacronym stand for?
Simple Triage and Rapid Treatment
Treatment is often selected on a risk/benefit basis-if the risk is low and the benefit is high (eg supplementing oxygen) then the decision to treat is straightforward ” Prioritise oxygenation… START: simple triage and rapid treatment
How to assess respiratory pattern?
Respiratory pattern:
- watch and listen
- try to localise disease
Discuss the upper airway disease in terms of laryngeal disease?
Laryngeal disease
Laboured inspiration
stridor
↑ effort
slow inspiratory phase
+/-change in
- purr
- Vocalisation
Upper airway disease check for signs of?
Check the clinical history for signs of
- Dysphagia +/-salivation
- Coughing /gagging
- might be triggered by eating/drinking
- “Head shaking” behaviour
Signs of lower airway disease?
Lower airway disease: often more subtle
Laboured expiration
- prolonged expiratory phase
- additional expiratory push
- audible expiratory wheeze
↑ airway resistance due to
- bronchospasm
- mucous
- bronchial wall thickening
+/-occasional –> paroxysmal cough
- owners may think “fur ball”
Discuss physical exam with regards to lower respiratory track disease?
Physical Examination
Can be deceptively normal
- rule out other diseases?
Auscultation:
quiet room
listen for an expiratory wheeze
is the heart normal?
- no murmur
- no gallop rhythm
- no tachycardia
What is the most common cause of LRT disease?
Inflammatory
What is feline asthma?
- Reversible situation
- Immune mediated process
- Inhaled allergen
- Airway hyper reactivity
- Bronchoconstriction
- Eosinophillic airway inflammation?
Signs: episodic respiratory distress and dyspnoea
What is chronic bronchitis?
- Response to infection or inhaled irritants
- Airway damage
- Excess mucus
- Neutrophilic airway inflammation?
Signs: Chronic coughing is a key feature
Discuss feline asthma and chronic bronchitis?
Currently…. without a better understanding of the aetiology of these two conditions, there is a lot of overlap in terms of presentationand treatment is essentially the same
What do you see on this radiograph?
evidence of hyperinflation, quite a gap between diaphragm and caudal border of the heart. Normally would be closer together – this separation is often a hallmark of hyperinflation which is what we are looking for supportive evidence with inflammatory airway disease
This is a BAL from a cat with CHF.
What can you see?
- Perl’s stain showing positive for iron (haemosiderin) in the macrophages
- Known as “heart failure cells” – don’t want to do a BAL on a cat with suspected heart failure!
- Feature of chronic congestion
- Reviewing the history for this 14 year old MN DSH cat who was referred for further investigations: he had lost some weight, was quiet and less keen to eat but not coughing. Physical examination revealed a heart rate of 250 (at rest) and tachypnoea (RR 38). Auscultation revealed a gallop rhythm and a systolic murmur (grade III/VI). We should not have airway disease at the top of the list of differentials for a cat like this
