Test 3: 50: cough

Question 1

luna 12 YO mixedbreed small dog

presents with worsening frequent harsh cough, normal respirations at rest, no crackles/wheezes, 3/6 systolic heart murmur

workup should include

Answer 1

xray
ECG or echo

chem/cbc/UA

heartworm test +/- baermann to rule out parasites

Question 2

how to stimulate a cough receptor

Answer 2

external compression
foreign material or airway secretion
inhalation of noxious gasses: smoke

Question 3

cough reflex is controlled by the —

Answer 3

brainstem

causes inhale, contraction of bronchial smooth muscle, then glottis opens and air is exhaled forcibly

Question 4

what happens after productive cough

Answer 4

often followed by swallowing

Question 5

history workup for coughing dogs

Answer 5

chronicity
exposure: traveling or boarding
exposure to noxious substances: smoke inhaltion
triggers: eating, drinking, excitment
voice change
other illness?

Question 6

dogs with cough from — will be normal at rest

Answer 6

airway disease

Question 7

dogs with cough from — will be abnormal at rest

Answer 7

pulmonary parenchymal disease

Question 8

coughing cat DDX

Answer 8

asthma
chronic bronchitis

Question 9

main causes of chronic cough in dogs

Answer 9

cardiac

• CHF with pulmonary edema
• compression of left mainstem bronchus by enlarged left atrium

airway

• tracheal collapse
• chronic bronchitis

pulmonary

• pneumonia
• cancer
• fibrosis

Question 10

how does left sided CHF cause cough

Answer 10

• Pulmonary venous congestion
• Increased hydrostatic pressure leads to fluid leak
• Alveolar edema occurs when lymphatic system is overwhelmed

Question 11

physical exam of left sided CHF

Answer 11

Murmur
Arrhythmia
Pulse deficits
Pulmonary crackles
Dyspnea, cyanosis

cardiomegaly, perihilar pulmonary edema and pulmonary venous congestion on xray

Question 12

Enlargement of the — may compress the left mainstem bronchus which can lead to frequent cough without —

Answer 12

left atrium

pulmonary edema

Question 13

how to treat cough from CHF and cough from big L atrium

Answer 13

CHF: will have pulmonary edema- lasix/furosemide, O2, vasodilator, pimobenden

L atrium enlargment: No pulmonary edema, + compression of mainstem bronchus: antitussive (anticough), No lasix

Question 14

tracheal collapse is caused by

Answer 14

chronic cough

Progressive degenerative of cartilage of the tracheal rings
Deficient glycosaminoglycans
Decreased chondrocytes

dorsal membrane becomes floppy and causes inflammation that leads to edema and mucous accumulation

Question 15

chronic bronchitis can lead to

Answer 15

Airway edema and hyperemia
Increased mucous secretion
Inflammatory cell infiltrates
Bronchial smooth muscle spasm
Impaired mucociliary clearance

May result in airway obstruction, predisposition to secondary infection, bronchiectasis(widening but damaged)

Question 16

diagnosis of chronic bronchitis

Answer 16

xray- bronchiolar pattern or normal

parasite testing: heartworm or lungworm

+/- bronchoscopy
+/- airway sampling for cytology and culture

Question 17

luna 12 YO mixedbreed small dog

presents with worsening frequent harsh cough, normal respirations at rest, no crackles/wheezes, 3/6 systolic heart murmur

ddx

Answer 17

bronchial pattern- circle-donut

comfortable at rest

chronic bronchitis

Question 18

luna 12 YO mixedbreed small dog

presents with worsening frequent harsh cough, normal respirations at rest, no crackles/wheezes, 3/6 systolic heart murmur

DDX: chronic bronchitis
workup?
treatment?

Answer 18

Tests:
bronchoscopy
airway cytology and culture
echo

treatment: antitussives, steroids, bronchodilator

Question 19

how do antitussive work

Answer 19

centrally acting opioid- suppress reflex and allows pt to sleep

can cause mild sedation and help reduce inflammation in airway

do not use with productive cough

Question 20

three common antitussives

Answer 20

hydrocodone
butorphanol
dextromethorphan

Question 21

treatment of cough with steroids is by

Answer 21

dosage at anti-inflammatory dose

Chronic inflammation may lead to bronchial wall thickening, increased mucous secretion, edema, bronchospasm

low dose prednisone that is slowly tapered to lowest effective dose

Question 22

advantages and disadvantages of inhaled medications

Answer 22

Advantages

• Drug delivered directly to site
• Limited systemic absorption

Disadvantages

• Cost
• May not be tolerated
• May not reach most severely affected areas

inhalers- fluticasone and albuterol

Question 23

general management to reduce coughing

Answer 23

weight control
reduce exposure to inhaled irritants
avoid excitement
use harness