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Flashcards in Coughing in dogs + cats Deck (39):
1

Most frequent cause in dogs is...

infectious tracheobronchitis (ITB) - aka kennel cough

2

Acute coughing DDx

Infectious tracheobronchitis Airway irritation Foreign body Pulmonary haemorrhage Acute pneumonia Acute oedema Airway trauma

3

chronic coughing DDx

Chronic bronchitis (tracheo-bronchial syndrome) Left sided HF Parasites Tracheal collapse Foreign body Bronchopneumonia Pulmonary neoplasia Extra-lumenal airway compression Eosinophilic diseases - PIE, FAAD Pulmonary fibrosis Pleural disease Ciliary dyskinesia

4

chronic bronchitis - clinical signs

Chronic irritation to bronchial mucosa Mucosal hyperplasia Increased mucous production Decreased efficacy of respiratory defence mechanisms Inflammation/secondary infection Bronchospasm Reduced airflow Chronic cough

5

chronic bronchitis - signalment + history

old, small breed, overweight dogs Insidious onset, dry hacking cough Rarely a history of known precipitating cause Cough paroxysmal and usually unproductive Exacerbated by excitement/exercise

6

chronic bronchitis - clinical exam

Dog usually otherwise well Often slightly overweight Increbronchial noise/wheezes on auscultation Cough easily elicited on tracheal pinch Sinus arrhythmia + absence of murmur rule out cardiac cause

7

chronic bronchitis - diagnosis

“Diagnosis of exclusion” Blood tests usually normal Radiography - Incr bronchial markings, False +ves + -ves Endoscopy - irregular airways and mucous hypersecretion Tracheobronchial wash - Chronic infl +/- +ve culture

8

chronic bronchitis - treatment

Client education Management alterations Drug therapy

9

chronic bronchitis - management

Clean atmosphere Humidification Diet Regular short walks Avoid pressure on neck

10

chronic bronchitis - drug therapy

Bronchodilators Antibacterial agents - Short courses for control of clinical signs, Chronic therapy may select for resistant infection Expectorants/mucolytics Cough suppressants Anti-infl

11

chronic bronchitis - bronchodilators

Indicated in most bronchial diseases Xanthine agents - Theophylline (Corvental-D) Beta-2 agonists - Terbutaline (Bricanyl), Adrenaline Anti-muscarinics - Atropine (multiple other effects preclude use)

12

chronic bronchitis - Antitussives and Mucolytics

Opiate derivatives - Butorphanol (Torbutrol), Codeine Advantageous when used to suppress non-productive cough Don't suppress a productive cough not patients with alveolar pattern on radiographs Tracheal collapse, Bronchial compression Bromohexine (Bisolvon) - management of productive bronchial disease + bronchopneumonia to assist the expectoration of respiratory secretions

13

chronic bronchitis - Anti-inflammatory medication

corticosteroids

14

chronic bronchitis - prognosis

therapy - reduce/minimise the frequency of cough Cure unrealistic and usually unobtainable Many dogs with chronic bronchitis live happily for years

15

feline asthma

“Feline Allergic Airway Disease” (FAAD) Most common cause of persistent coughing in cats Antigenic stimulus results in inflammation, mucous, oedema and bronchoconstriction Airway hyper-reactivity, smooth muscle hyperplasia and airway narrowing result

16

Feline Allergic Airway Disease (FAAD) - history + PE

Intermittent dyspnoea and coughing acute and life-threatening bouts Rarely identifiable stimulus PE - May be normal between bouts, incr resp effort, audible wheezes esp on expiration, Hyperinflation of lung

17

Feline Allergic Airway Disease (FAAD) - diagnosis

Blood tests - eosinophilia Radiography - Bronchial pattern, Hyperinflated lung Tracheal wash - Infl cells - mostly eosinophils R/o parasites and secondary bacterial infection

18

Feline Allergic Airway Disease (FAAD) - emergency therapy

Oxygen Rapid acting corticosteroid e.g. methylprednisolone succinate Bronchodilator, Atropine, Adrenaline

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Feline Allergic Airway Disease (FAAD) - prognosis

Variable Some cats stable on therapy long term therapy will be necessary to find the right regime in each individual Some cases cannot be controlled Some cases will die acutely

20

Feline Allergic Airway Disease (FAAD) - maintenance

Corticosteroids - tapered to lowest effective dose Bronchodilators - Terbutaline, Theophylline etc. control of infl process Zafirlukast (Accolate) Leukotriene inhibitor

21

Aelurostrongylus

Feline lungworm Occasionally results in clinical signs Alveolar/Interstitial disease Prolonged course of Fenbendazole required

22

canine lungworm - history

Chronic cough unresponsive to conventional therapy Coagulopathy (Angiostrongylus) Dyspnoea/wheezing Haemoptysis

23

lungworm treatment

7 days of fenbendazole - all types of resp parasite Milbemycin and Moxidectin specifically - angiostrongylus Prognosis good for cure Some cases of Filaroides have residual nodules at the tracheal bifurcation which result in cough Clinical signs may take many weeks to improve due to granulomatous reaction to killed parasites in lung parenchyma

24

tracheal collapse - pathopysiology

Loss of normal structure of tracheal rings. Dorsal ligament stretches + trachea loses normal cylindrical structure Dynamic variation in tracheal diameter occurs Cervical trachea collapses on inspiration Thoracic trachea collapses on expiration cough and dyspnoea

25

tracheal collapse - history

Yorkshire Terriers and Poodles

Chronic coughing - Gradual progression

 

Quacking or Honking cough

May progress in severely affected individuals to bouts of dyspnoea

26

tracheal collapse - PE

Affected dogs appear fairly normal

audible clicking noise as airway collapses during respiration

Tracheal malformation may be palpable

Feel edge of deformed cartilages

Characteristic cough may be elicited on tracheal palpation

27

tracheal collapse - diagnosis

Collapse dynamic and therefore stationary radiographic images may not capture collapse

Fluoroscopy - demonstrates and classifies severity of collapse

Endoscopy may also be used to demonstrate collapse

Collapse graded I-IV

28

tracheal collapse - treatment + prognosis

Medical management

Similar chronic bronchitis esp. cough suppressants

Surgery available but r high risk and only considered for most severely affected individuals

Intralumenal stenting 

Prognosis dependant upon severity

Mild cases inconvenient

Severe cases life threatening

29

pulmonary neoplasia - history

May be no clinical signs

Some found incidentally on radiography •

cough due to airway involvement/erosion/compression

haemoptysis

Weight loss

Rarely cause dyspnoea unless very extensive

30

pulmonary neoplasia - PE

May be no abnormalities

May be asymmetric findings

Movement of apex beat

Unilateral decrease in resonance

Unilateral increase in respiratory noise

31

pulmonary neoplasia - diagnosis

Radiography - Solitary soft tissue density

 

CT – better resolution where available

Bronchoscopy - tracheal wash - Unlikely to be helpful 

Biopsy - percutaneous “Tru-cut” or FNAB possible if mass superficial

32

pulmonary neoplasia - management

mass small + shows no evidence of metastasis - surgery 

Surgical lobectomy

High incidence of recurrence of clinical signs

Some cases may be cured

Adjunctive chemotherapy described

Average survival about one year

33

foeign bodies - history

acute onset with recognised event

halitosis as foreign body degraded

Variable response to antibiotics/anti-inflammatories

34

foerign bodies - PE

•Often fairly normal •May be intermittently pyrexic •May have localised increase in respiratory noise •May have focal area of dullness on percussion

35

foreign bodies - diagnosis

Radiography - focal involvement of one lung lobe often right caudal lung lobe in dogs

Endoscopy allows visualisation and retrieval

36

foreign bodies - treatment

Endoscopic retrieval - may have fragmented and be irretrievable

Surgical removal - Often need to carry out partial/complete lobectomy at the same time

37

Pulmonary infiltrate with eosinophils (PIE)

in dogs

May be immune-mediated (allergic) 

History of chronic cough unresponsive to antibiotic therapy

May be seasonal

May be association with other allergic diseases e.g. atopy

38

Pulmonary infiltrate with eosinophils (PIE) - diagnosis

Eosinophilia

Radiographic evidence of bronchial/alveolar pattern

Bronchoscopy - increased quantity of mucous in airways

Airway washes reveal population of predominantly eosinophils

N.B. may be secondary bacterial infection and neutrophilic inflammation

39

Pulmonary infiltrate with eosinophils (PIE) - treatment + prognosis

Control secondary infection

Corticosteroids at immunosuppressive doses - gradually tapered to the lowest dose that controls the clinical signs

 

Prognosis - Excellent for control of clinical signs but may require prolonged/lifelong therapy with risk of iatrogenic HAC