Unit 3 - Lower Airway Disease and Pneumonia

Question 1

Why is inflammatory disease in cats identified as ‘feline lower airway disease’?

Answer 1

Because it is difficult to distinguish between bronchitis and asthma in cats so it is all just lumped together

Question 2

What inflammatory airway disease happens in dogs?

Answer 2

chronic bronchitis

Question 3

What is airflow limitation?

Answer 3

Impedance to air movement in the airways caused by inflammation, secretions, and smooth muscle contraction

Question 4

Characterize spontaneous bronchoconstriction in chronic bronchitis.

Answer 4

little to no spontaneous bronchoconstriction

Question 5

Characterize spontaneous bronchoconstriction in feline asthma.

Answer 5

reversible spontaneous bronchoconstriction

Question 6

What is the signalment for canine chronic bronchitis?

Answer 6

middle-aged to older, small breeds over-represented

Question 7

What is the signalment for feline asthma and bronchitis?

Answer 7

young to middle-aged adult, siamese is common

Question 8

What clinical signs are associated with inflammatory airway disease?

Answer 8

chronic cough, expiratory wheezes, and tachypnea at rest

Question 9

If a patient with one of the inflammatory airway diseases were dyspneic, what kind of dyspnea pattern would you most likely see?

Answer 9

restrictive

Question 10

What contributes to airflow limitation on expiration?

Answer 10

Positive thoracic pressures and airway inflammation contribute to airflow limitation

Question 11

What diagnostics are important for inflammatory airway disease?

Answer 11

CBC, parasite testing, rads (bronchial lung pattern), and TTW, ETW, or BAL (

Question 12

What parasite can cause ‘feline lower airway disease’?

Answer 12

Aleurostrongylus abstrusus

Question 13

How do cats get Aleurostrongylus and where do they live?

Answer 13

They ingest L3 larva and adult worms live in terminal bronchioles/alveolar ducts

Question 14

How is Aleurostrongylus diagnosed?

Answer 14

L1 larvae is ID’d in the airway fluid or feces

Question 15

How is Aleurostrongylus treated?

Answer 15

mild cases are self-limiting; fenbendazole

Question 16

What are the classic signs of feline asthma radiographically?

Answer 16

broncho-intersitial lung pattern, pulmonary hyperinflation, and atelectasis of the right middle lung lobe due to mucus plugging

Question 17

What will you find on bronchoscopy in feline asthma patients?

Answer 17

hyperemia, irregularity, increased mucus, and lower airway collapse

Question 18

How will the respiratory wash cytology look in cats with bronchitis?

Answer 18

neutrophilic

Question 19

How will the respiratory wash cytology look in cats with asthma?

Answer 19

eosinophilic

Question 20

What is the treatment for lower airway disease?

Answer 20

corticosteroids (tx of choice), bronchodilators (don’t effect inflammation), and +/- cough suppressants (dogs)

Question 21

What drugs can be used for inhaled therapy of lower airway disease?

Answer 21

fluticasone, albuterol, and others

Question 22

What are some other treatments for lower airway disease?

Answer 22

weight loss, harness versus collar, and environmental trigger avoidance

Question 23

What are the treatment goals for lower airway disease?

Answer 23

minimize clinical signs and slow airway remodeling

Question 24

What type of lower airway disease is eosinophilic bronchopneumopathy?

Answer 24

Interstitial disease

Question 25

What is eosinophilic bronchopneumopathy?

Answer 25

interstitial lung disease characterized by infiltration with eosinophils

Question 26

Most cases of eosinophilic bronchopneumopathy are _______.

Answer 26

iodiopathic

Question 27

What is the signalment for eosinophilic bronchopneumopathy?

Answer 27

young dogs, arctic breeds and rottweilers predisposed

Question 28

Before diagnosing for eosinophilic bronchopneumopathy, what must you rule out first?

Answer 28

parasites and neoplasia

Question 29

What does eosinophilic bronchopneumopathy respond well to?

Answer 29

corticosteroids

Question 30

What type of lower airway disease is idiopathic pulmonary fibrosis?

Answer 30

interstitial disease

Question 31

What breed typically gets Idiopathic pulmonary fibrosis?

Answer 31

West Highland White Terriers

Question 32

What do you find on auscultation with patients that have idiopathic pulmonary fibrosis?

Answer 32

diffuse inspiratory crackles

Question 33

What does idiopathic pulmonary fibrosis look like on rads?

Answer 33

diffuse broncho-interstitial lung pattern

Question 34

How is idiopathic pulmonary fibrosis diagnosed?

Answer 34

biopsy, rule out cases of secondary fibrosis

Question 35

What is the prognosis of idiopathic pulmonary fibrosis?

Answer 35

poor long-term

Question 36

What type of lower airway disease is bacterial pneumonia?

Answer 36

alveolar disease

Question 37

What can cause bacterial pneumonia?

Answer 37

Immunocompromise, recumbency, and impaired host defenses

Question 38

What is the route of infection of bacterial pneumonia?

Answer 38

aspiration (inhaled), hematogenous, and traumatic/penetrating

Question 39

What is the most common bacterial isolate of bacterial pnuemonia?

Answer 39

E. coli

Question 40

What other bacterial isolates are found in bacterial pneumonia?

Answer 40

(from most to least common) Pasteurella, Bordatella, Anaerobes, Streptococcus, and Staphylococcus Mycoplasma species are also common

Question 41

Are aerobes are anaerobes more commonly isolated in bacterial pneumonia cases?

Answer 41

aerobes

Question 42

What is the number 1 cause of community-acquired infectious pneumonia in dogs less than a year of age?

Answer 42

Bordatella bronchiseptica

Question 43

What are the clinical signs of bacterial pneumonia?

Answer 43

lethargy, reduced appetite, exercise intolerance, increased respiratory rate/effort, fever, nasal discharge, +/-cough

Question 44

How is bacterial pneumonia diagnosed?

Answer 44

CBC, radiographs, pulse ox/arterial blood gase, and airway wash with culture

Question 45

What is the distribution of an interstitial to alveolar pattern of aspiration pneumonia?

Answer 45

cranial-ventral

Question 46

What is the distribution of an intersitital to alveolar pattern due to humatogenous pneumonia rads?

Answer 46

dorsal-diffuse

Question 47

Aspiration pneumonia is the most common cause of bacterial pneumonia in _____ dogs.

Answer 47

adult

Question 48

What is the initial problem to cause aspiration pneumonia in dogs?

Answer 48

airway irritation/injury

Question 49

What is aspiration pneumonia commonly associated with?

Answer 49

regurgitation, megaesophagus, laryngeal paralysis, myasthenia gravis

Question 50

Do you want a cidal or static antibiotic to treat bacterial pneumonia?

Answer 50

cidal

Question 51

When selecting an appropriate antibiotic, what factors should you keep in mind?

Answer 51

spectrum, good lung penetration, low risk of side effects, cost, and mode/frequency of administration

Question 52

What is the empiric treatment for uncomplicated bacterial pneumonia?

Answer 52

Narrow spectrum, single therapy - amoxicillin/amoxicillin clavulanate, cephalexin, doxycycline (Bordatella), TMS, and Azithromycin

Question 53

What is the duration for treatment in uncomplicated bacterial pneumonia?

Answer 53

1-2 weeks post-radiographic resolution

Question 54

What is the empiric treatment for complicated/severe bacterial pneumonia?

Answer 54

Broad spectrum, combination therapy (aerobic and anaerobic coverage, gram negative and positive coverage), parenteral administration initially, adjust based on C/S results

Question 55

How long is treatment for complicated/severe bacterial pneumonia?

Answer 55

1-2 weeks post-radiographic resolution

Question 56

What is the empiric treatment for hospitilized patients with complicated/severe bacterial pneumonia?

Answer 56

IV administration of antibiotics initially, and hospitilization with supportive care (IV fluids, nebilization, nutritional support, O2 if needed)

Question 57

What is the benefit of nebulization?

Answer 57

loosens/moistens airway secretions and improves expectoration

Question 58

What can cause fungal pneumonia?

Answer 58

Blastomyces dermatidis, Histoplasma capsulatum, Coccidiodes immitis, and Cryptococcus neoformans in cats

Question 59

How is fungal pneumonia diagnosed?

Answer 59

cytology (most important) and urine antigen (for histo/blasto)

Question 60

What is the treatment for fungal pneumonia?

Answer 60

long-term antifungals (itraconazole/fluconazole) +/- anti-inflammatory steroids