SDL: Feline Asthma

Question 1

CASE SCENARIO: Jim, 5yrs old, MN DSH

• 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

Answer 1

Coughing - paroxysmal

Change in behaviour

Mild expiratory wheeze in dorsal caudal lung fields on both sides

Question 2

Differentials for Jim’s problem list?

Answer 2

Feline asthma

Parasites - lungworm

FB

Hypereosinophilic syndrome

Chronic bronchitis

Neoplasia

• Mediastinal lymphoma
• Laryngeal lymphoma
• Primary lung neoplasia
• Metastatic neoplasia

Heart disease

Mycoplasma pneumonia

Question 3

Investigations you would like to do?

Answer 3

• Radiography
• Blind Broncho Alveolar Lavage (BAL)
  
  • Through ET tube
  • Not through endoscopy due to narrow airways and hypersensitivity reaction can become worse
• Haematology
  
  • Rule out other differentials

Question 4

Explain the image

Answer 4

Bronchial pattern in all lung fields

• Thick tram lines

Diffuse interstitial pattern

Hyperinflation/inspiratory radiograph - increased space between diaphragm and cardiac silhouette

Gas in stomach? Due to starving overnight?

All other structures appear

Question 5

What radiological features are helpful in terms of differentials for jim’s cough?

Answer 5

Patterns are helpful in increasing suspicion of respiratory cause of disease

• Feline asthma
• Chronic bronchitis

Puts neoplasia and FB lower down the differential list

Question 6

Reasons for and against doing a bronchoscopy with Jim?

Answer 6

Reasons for:

• Bronchial pattern
• Good for ruling in diseases
• Most diseases will affect the majority of the airways so should pick up disease
• Good for cytology samples
• Directly visualise pathology
• Already anaesthetised for radiographs

Reasons against:

• Difficult
• Risk of damage
• Already struggling to breath - could make the problem worse
• Need small enough endoscope
• Risky if suspicious of feline asthma

Question 7

Results for blind endotracheal was are:

Cytology:

• mucus ++
• mixed inflammatory cells
  
  • non degenerate neutrophils ++
  • eosinophils++
• small numbers of rbcs
• small numbers of bacteria (extracellular)
• no parasitic larvae or toxoplasma seen

Additional analysis:

• bacterial culture –ve
• Mycoplasma felis PCR -ve

What treatment would you recommend?

Answer 7

Prednisolone to manage the inflammation (PO)

Consider fluticasone (via aerokat)

Give fenbendazole at the same time

Allergen investigation

If no response to these then review case as this is not inflammatory disease