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Coughing Dogs and Cats Flashcards

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0
Q

Best diagnostic test for coughing patient?

A

Thoracic radiographs

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1
Q

Most common cause of acute coughing in dogs?

A

Infectious Tracheobronchitis (ITB)

  • if hx and PE consistent with this then tx as if it is
  • if clinical signs not consistnet then further investigation indicated
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2
Q

Causes of acute coughing

A
  • infectious tracheobronchitis
  • airway irritation
  • FB
  • pulmonary haemorrhage
  • acute pneumonia
  • acute oedema
  • airway trauma
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3
Q

Define acute and chronic coughing

A
  • artificial distinction

> acute = sudden onset, does not persist for more than 2-3 weeks

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4
Q

Causes of chronic coughing ?

A
  • chonric chronchitis (tracheobronchial syndrome)
  • cardiac disease
  • parasites
  • tracheral collapse
  • FB
  • bronchopneumonia
    > rarer:
  • pulmonary neoplasia
  • extra-lumenal airway comression
  • eosinophilic disease (PIE, FAAD)
  • pulmonary fibrosis
  • pleural diseasse
  • ciliary dyskinesia
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5
Q

What is chronic bronchitis?

A 
> clinical syndrome
- chronic irritation to bronchial mucosa
- mucosal hyperplasia
- ^ mucous production 
- v efficacy of resp defence mechanisms 
- inflammation/2* infection 
- bronchospasm 
- v airflow
- chronic cough 
> underlying cuase usually unknown (smoking, pollutants etc.)
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6
Q

Signalment and Hx of chornic bronchitis?

A
  • typically old, small breed, overweight
  • insidious onset, dry hacking cough
  • rarely hx of known precipitating cause
  • cough paroxysmal and usually unproductive
  • exacerbated by excitement/excercise, pulling on lead, change in environmental temperature or humidity, times of day
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7
Q

PE findings of chronic bronchitis

A
  • otherwise NAD
  • often slightly overweight
  • ^ bronchial noise/wheezes on auscultation
  • cough easily elicited on tracheal pinch
  • sinus arrhythmia may be exaggerated
  • absence of murmur help to rule out cardiac cause of cough
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8
Q

How can chronic bronchitis be diagnosed?

A
  • diagnosis of exclusion
  • bloods normal
  • radiography (^ bronchial markings, but maybe false +/-)
  • endoscopy (irregular airways and mucous hypersecretion)
  • tracheobronchial wash (chronic inflammation +- positive culture, probably 2*)
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9
Q

Can you completely eradicate chronic bronchial disease?

A

No! Try to minimise coughing so it isnt debilitating to patient

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10
Q

what can be seen on rads with chonric bronchial inflamamtion?

A

tramlines and donuts

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11
Q

Aims of tx of chronic bronchitis?

A 
- management alterations 
> avoid smoke, dust
> humidify air
> maintain weight 
> avoid pressure on neck
- drug therapy possibly (not chroniccally) 
> bronchodilators
> Antibiotics
> Expectorants and mucolytics
> cough suppressants
> Anti-inflammatory
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12
Q

Types of bronchodilators

A 
> Xanthines
- theophylline
> beta-2 agonists
- terbutaline (bricanyl)
- adreanaline
> anti-muscarinics
- atropine (multiple other effects ay preclude use)
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13
Q

Types of anti-tussives. WHen are antitussives good?

A

> opiate derivatives (NB. side effects eg. sedation, constipation)
- butorphanol (torbutrol)
- codeine
- Good for NON-productive coughs (tracheal collapse, bronchial compression)
- Not indicated if alveolar pattern seen on rads
Bromohexine (Bisolvon)
- mucolytics

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14
Q

Advantages and disadvantages of anti-inflammatorys?

A

> Corticosteroids (low dose)
+ imprived clinical signs and QOL
- too effective
- animal and owner become depednnt on tx
- iatrogenic hyperadrenocorticism develops
-> overweight -> worsening resp disease
give inhaled to v side effects

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15
Q

Side effects of bronchodilators?

A
  • tachycardia
  • excitability
    (eg. xanthines = caffeine)
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16
Q

SIde effects of expectorants?

A

^ productiveness of cough

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17
Q

Side effects of corticosteroids?

A

-Iatrogenic HAC signs

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18
Q

Side effects of cough suppressants?

A
  • trapping airway secretions

- sedation

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19
Q

What is the main problem with chronic bronchitis?

A

More annoying for owner - not that bad for dog! Can live long happy life

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20
Q

What is FAAD?

A

Feline ALlergic Airway Disease (= Feline Asthma)

  • most common cause of persistent coughing in cats
  • Antigenic stimulation -> inflam, mucous, oedema, bronchoconstriction
  • Airway hyperreactivity, smooth mm hyperplasia and airway narrowing result
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21
Q

Hx and PE of FAAD?

A
  • intermittent dyspnoea and coughing
  • acute life threatening bouts
  • rarely identifiable stimulus
    > PE
  • may be normalbetween bouts
  • ^ resp effort
  • expiratory wheezes
  • hyperinflation of lung
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22
Q

Diagnostics of FAAD?

A
  • Bloods: Eosinophilia
  • Rads: bronchial pattern and hyperinflated lung
  • trach wash: inflammatory cells, predominantly eosinophils - R/O parasites and 2* bacterial infection
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23
Q

Emergency Tx of FAAD?

Study These Flashcards
A
  • oxygen
  • rapid acting corticosteroid eg. methylprednisolone succinate
  • bronchodilator (atropine/adrenaline)
24
Chronic maintainence of FAAD?
- corticosteroids tapered to lowest effective dose (nebulise) - bronchodilators (terbutaline, theophylline etc.) - other ways of controlling inflammatory process (cyproheptadine, LT inhibitor? unlicensed but may have some success)
25
Prognosis of FAAD?
- variable - some cats stabilise: find best tx for individual - some cases cannot be controlled and may die acutely - chronic, long term commitment!
26
What is THE feline lungworm?
Aeluostrongylus
27
What disease does aelurostrongylus cuase? Tx?
- alveolar/interstitial disease (LRT with eosinophilia) | - fenbendazole tx
28
Which parasites can affect the respiratory tract of dogs? Which is most common?
* Angiostrongylus vasorum* - Filaroides (Oslerus) Osleri - Dirofilaria > Young animals affected
29
What is angiostrongylus? Intermediate host?
Lungworm, slug
30
History signs of lungworm?
- Chronic cough unresponsive to convential tx - coagulopathy (angiostrongylus) - dyspnoea/wheezing - coughing up blood
31
PE findings of lungworm? Diagnostics?
- no specific findings on physical > Dx - Haem = Eosinophilia - Feacal exam or TTW = Larvae - Rads = broncho/alveolar infiltration, nodular interstitial pattern, pulmonary hypertension, nodules at tracheal bifurction with filaroides) - bronchoscopy = tracheal nodules (filaroides)
32
Is filaroides more or less common than angiostrongylus?
filaroides much less common than angiostrongylus
33
What pattern is typically seen with Angiostrongylus Vasorum?
- Air bronchograms | - Peripheral cloudy interstitial pattern with clear central area of lungs
34
What new test is available for detection of angiostrongylus vasorum?
Snap test by IDEXX - intravascular parasite > BUT may be subclinical angiostrongylus not related to clinical signs if this test is too sensitive!
35
Tx of lungworm?
> fenbendazole 7d tx all types of respiratory parasite | > recent licensing of milbemycin and moxidectin for angiostrongylus
36
Prognosis of lungworm?
- prognosis generally good - some present so severely that they die before you can treat - pulmonary vascular remodelling: Pulmonary hypertension and R heart disease (similar to dirofilaria immitus)
37
Pathophysiology of tracheal collapse
- loss of normal structure of tracheal rings - dorsal ligament stretches and trachea loses normal cylindrical structure - dynamic variation in tracheal diameter occurs - cervical trachea collapses on INSPIRATION - thoracic trachea collapses on EXPIRATION - > cough and dyspnoea (insp/exp/both)
38
History and PE findings of tracheal collapse?
- Yorkshire terriers and poodles - chronic cough with gradual progression - quacking or honking cough - may progress to severe dyspnea sometimes > PE - Normal - clicking sound when they breath (dorsal ligament) - tracheal malformation may be palpated - elicit cough on palpation
39
What diagnostics may be useful for tracheal collapse?
- fluoroscopy and endoscopy (dynamic problem, may not be seen on rads)
40
How is tracheal collapse graded?
``` 1-4 1 = slight dip 2 = semilunar shape 3 = banana shape 4 = inverted trachea ```
41
Tx of tracheal collapse
- medical management - similar to chronic bronchitis esp. cough suppressant - surgery available, ^ risk, only for v severe cases > intralumenal stent > rings round outside
42
Tx of pulmonary neoplasia?
1* without spread = can be resected, prognosis ok | 2* or 1* with spread = poor prognosis
43
What neoplasm commonly metastasises to the lungs?
Sarcoma
44
Hx with 1* neoplasia
- may be no clinical signs (found incidentally) - cough - haemoptysis - weight loss - rarely dyspnoea
45
PE with 1* kung neoplasia
- may be normal - may be assymmetric - movement of apex beat - unilateral v in resonance - unilateral ^ resp noise
46
Methods of definitive diagnosis of pulmonary neoplasia?
> Radiography - solitary soft tissue density - Ddx: neoplasia, granuloma, abscess, cyst, haematoma > CT better resolution > Bronchoscopy and trach wash - unlikely to be hepful unless affecting major airway or v exfoliative > Trucut / FNA biopsy if mass superficial
47
Tx pulmonary neoplasia?
- mass small and no mets = surgery, lobectomy (but ^ incidence recurrence) - adjunctive chemo possible (not much evidence)
48
Is 1* or 2* neoplasia more common in the lungs? Ddx?
2* - similar clinicalsigns and diagnostic findings but likely to be multiple masses - Ddx: granulomatous disease, parasitic, deep fungal disease, TB
49
Tx 2* neoplasia in lungs?
Not appropriate | - short term palliation of clinical signs
50
How may FBs present with resp disease?
- acute onset associated with recognised event eg. excercise in autumn with grass awns present (NB: kennel cough infectious tracheobronchitis highest incidence in autumn too) - do not respond to tx with ABx or antiinflams (though may respond sporadically) - halitosis as object rots
51
PE FB findings
- normal - intermittent pyrexia - localised ^ resp noise - focal area of dullness on percussion
52
Diagnostics for FB?
- radiography (focal involvement one lung lobe often caudal right lobe in dogs) - endoscopy for visualisation and retrieval
53
Tx FB?
Removal! - but may have fragmented and be irretreivable - Surgical removal may be necessary +- partial/complete lobectomy at same time
54
What is PIE?
- pulmonary infiltrate with eosinophils - syndrome in dogs - may be immune mediated (allergic) cause - hx chronic cough unresponsive to ABx - may be seasonal - may be association with other allergic disease eg. atopy
55
Dx PIE?
- eosinophilia - rads: bronchial/alveolar pattern - bronchoscopy: ^ mucous in airways - airway washes: eosinophils - NB: May be 2* bacterial infection and neutrophilic inflammation
56
Tx and prognosis of PIE?
- control 2* infection - corticosteroids at immunosupressive doses (taper to lowest effective dose) potentially wean off altogether - prognosis excellent for control of clinical signs > May require prolonged/lifelong tx with risk of iatrogenic HAC (cushings)
57
see notes for table of conditions causing coughing
***

Respiratory (18 decks)

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