Tracheobronchial diseases--cats Flashcards
DDx for felines presenting with a cough, wheeze, or respiratory distress?
- Pulmonary parasites
- Heartworm
- Bac. or viral bronchitis
- Toxoplasmosis
- Idiopathic pulmonary fibrosis
- Neoplasia–carcinoma
- Aspiration pneumonia
- Idiopathic feline bronchitis/asthma
- Chronic bronchitis
Idiopathic feline bronchitis
What is it?
Signalment?
Clinical signs?
- Asthma = bronchial constriction
- Signalment
- Any age–commonly in young to middle aged cats (3-5yrs)
- Siamese appear predisposed
- Clinical signs
- Variable
- Chronic or intermittent cough
- Acute resp distress (more likely)
- Open-mouth breathing
- Audible wheezing
- Auscultation–wheezes, crackles, inc. resp effort
- Systemic signs are not found
Idiopathic feline bronchitis
Diagnosis
- 1st tier
- Radiographs–IF CAT IS STABLE ENOUGH
- CBC–17-46% have eosinophilia
- Fecal–Aelurostrongylus spp (lungworm)
- 2nd tier
- Transtracheal wash/bronchoscopy/BAL
- Cytology/culture
Idiopathic feline bronchitis
Radiographs
- Normal lungs in 23% of cases
- Bronchial pattern predominates
- Reticular interstitial and patchy alveolar opacities can sometimes be found
- Hyperinflation of lungs is found
- Air-trapping–constriction of small airways does not allow inspired air to be exhaled–>lungs overinflate
- 10% have collapsed right middle lung
- Flattening of diaphragm
- Clinical signs precede radiographic changes
![](https://s3.amazonaws.com/brainscape-prod/system/cm/183/420/635/a_image_thumb.png?1458065228)
What’s wrong with these radiographs? What disease is most likely associated with them?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/183/421/417/q_image_thumb.png?1458065076)
- Left: collapsed right middle lung lobe
- Right: patchy alveolar/interstitial alveolar pattern
- Idiopathic feline bronchitis
Idiopathic feline bronchitis
Bronchoscopy
- Mucosal hyperaemia
- Increased mucous
- Perform broncho-alveolar lavage
![](https://s3.amazonaws.com/brainscape-prod/system/cm/183/421/632/a_image_thumb.png?1458065383)
Idiopathic feline bronchitis
Point of transtracheal wash/BAL?
Cytology?
Culture/sensitivity?
- TTW/BAL may help differentiate asthma from other differentials
- Cytology
- Asthma–inc. eos and neut and mixed inflammation
- Infectious–degenerative neut and/or intracellular bac.
- Parasitic–larvae or ova
- Culture/sensitive–if +, less likely to be feline asthma, but still think of poss secondary infection
Idiopathic feline bronchitis
Treatment?
- Treat in acute life-threatening cases
- NO STRESS
- O2-rich environment
- Rapid-acting corticosteroid
- Dexamethasone SC, IM (IV often too stressful)
- Bronchodilation choices
- Albuterol via metered-dose inhaler (MDI) or orally
- Terbutaline (0.01mg/kg SC)
- Bronchodilation w/in 15-30min
- Cats can become dazed/disoriented
- Also comes as MDI
Idiopathic feline bronchitis
Long-term management
- Environmental management
- Improve indoor air quality
- Eliminate potential allergens/irritants
- Anti-inflammatories–glucocorticoids
- Prednisolone/prednisone–0.5-1mg/kg BID
- Taper once clinical signs controlled
- 7 day recheck
- Depo-medrol for patients that cannot be medicated orally due to aggression (last resort)
- 10-20mg/cat IM q4-8wk
- Warn owners of potential side effects
- Metered dose inhaler (MDI)
- Fluticasone proprionate (flixotide or flovent)
- Beclomethasone (Quar or becotide)
- Prednisolone/prednisone–0.5-1mg/kg BID
Idiopathic feline bronchitis
Metered dose inhaler (MDI)
- “Aerocat” or “pediatric spacer”
- Advantages
- Minimizes systemic corticosteroid side effects
- Easier to treat–no pill-popping
- Perhaps higher drug conc. delivered to lungs
- Disadvantages
- Inc. risk of dental disease
- Re-emergence of latent herpesvirus infection
- Local dermatitis
- Recommended not to start on MDI until there is good control w/ systemic glucocorticoids
Idiopathic feline bronchitis
Chronic clinical signs?
Intermittent coughing and wheezing
Idiopathic feline bronchitis
Other possible long-term treatments?
- Oral bronchodilator indications
- Chronic management when large quantities of glucocorticoids required
- When there is adverse reaction to glucocorticosteroids
- When owner cannot use the MD I
- Which bronchodilator
- Oral theophylline–at night
- Terbutaline–at night in crisis
- Albuterol oral
- Antibiotics
- Therapeutic trial for mycoplasma
- Doxycycline, chloramphenicol, azithromycin
- Give bolus of water after doxycycline
- Therapeutic trial for mycoplasma
Idiopathic feline bronchitis
Prognosis
- Chronic disorder–some form of long-term glucocorticoids needed in most cases
- Long-term medically treated–good prognosis for control of clinical signs
- If untreated–develop permanent changes of chronic bronchitis w/ irreversible damage (fibrosis) and emphysema
Feline chronic bronchitis
What is it?
Characterized by?
- Chronic airway inflammation, typically in older cats
- Char. by
- Neutrophilic inflammation
- Mucosal edema
- Mucus gland hypertrophy
- Excessive mucus production
Feline chronic bronchitis
Clinical signs?
Management?
- Clinical signs indistinguishable from asthma
- Rarely have life-threatening broncho-constriction
- Coughing on daily or almost daily basis
- Usually in older animals
- Management focuses on control of inflammation using glucocorticoids