Lecture 22: Airway disease part 2: lower airway

Question 1

What are some ddx for lower airway disease causing cough

Answer 1

1. Chronic bronchitis
2. Chronic bacterial tracheobronchitis
3. Asthma (cats)
4. Eosinophilic lung disease
5. Bronchomalacia
6. CIRDC
7. Parasites
8. FB
9. Microaspiration
10. Lung lobe torsion

Question 2

what is distinctive characteristic/sing of lower airway coughs

Answer 2

coughs with terminal retch

Question 3

what dogs is canine chronic bronchitis most common in

Answer 3

older small breed dogs

Question 4

what are the 4 criteria for canine chronic bronchitis

Answer 4

1. Cough > or = 2 months
2. Evidence of excessive mucus secretion
3. Exclusion of chronic cardiopulmonary disease
4. BALF cell distribution >7% non-degenerate neutrophils

Question 5

what are some clinical signs of chronic bronchitis

Answer 5

Persistent cough with paroxysms of coughing following by terminal retch

Question 6

what is pathophysiology of canine chronic bronchitis

Answer 6

inflammatory changes within bronchial mucosa with increased mucus production

Question 7

T or f: must do diagnostics can’t assume all dogs with chronic cough have chronic bronchitis

Answer 7

true

Question 8

what is most useful test for dx canine chronic bronchitis if diagnostic testing is limited

Answer 8

thoracic rads

Question 9

t or f: can rule out canine chronic bronchitis with normal rads

Answer 9

false- sensitive 50%, so 50% dogs with chronic bronchitis missed with rads

Question 10

dog presents with chronic coughing, based on rads what is likely dx

Answer 10

canine chronic bronchitis

Question 11

what is the best way to investigate for chronic bronchitis

Answer 11

bronchoscopy

Question 12

identify what wrong in images

Answer 12

left: normal
Right: chronic bronchitis

Question 13

what BALF findings are consistent with chronic bronchitis

Answer 13

predominately non-degenerate neutrophils >7%, excessive mucus, small # other cells, cell count >200-400/ul

Question 14

what is tx for chronic bronchitis

Answer 14

1. Eliminate environmental pollutants
2. Air purifiers
3. Obesity tx
4. Glucocorticoids: prednisone (except DM), inhaled fluticasone
5. Cough suppressants

Question 15

how/what steroids should you start dog on for chronic bronchitis

Answer 15

start on oral prednisone, once clinical signs controlled recheck at 4 weeks and transition to fluticasone with a 2-4 week overlap between pred and fluticasone

Question 16

if tx for chronic bronchitis should have marked improvement within __ days of starting oral prednisone, if not __

Answer 16

14 days, if not rethink dx

Question 17

t or f: dogs with chronic bronchitis never enter remission

Answer 17

true

Question 18

what are some sequela of chronic bronchitis

Answer 18

bronchiectasis, bronchomalacia, fibrosis, pulmonary hypertension

Question 19

t or f: chronic bacterial tracheobronchitis is uncommon cause of chronic cough

Answer 19

true

Question 20

what are some signs of chronic bacterial tracheobronchitis

Answer 20

cough > or = 2 months, paroxysmal, dry to productive, normal appetite and energy

Question 21

how do radiographs appear with chronic bacterial tracheobronchitis

Answer 21

normal or bronchial pattern
Should not have heavy interstitial or alveolar pattern

Question 22

how do you dx chronic bacterial tracheobronchitis and what finding would support dx

Answer 22

airway wash +/- bronchoscopy

Evidence of septic neutrophilic inflammation

Question 23

what is tx for chronic bacterial tracheobronchtiis

Answer 23

abx for 14-21 days

Question 24

what is age range for feline chronic bronchitis and asthma

Answer 24

2-8 years

Question 25

what cat breed is at higher risk for asthma

Answer 25

Siamese

Question 26

what are some clinical signs of feline chronic bronchitis and asthma

Answer 26

1. Subclinical- pick up lung sounds on auscultation 2. Cough 3. Decreased activity 3. Increase breathing rate/effort or respiratory distress

Question 27

only cats with __have intermittent expiratory distress from bronchoconstriction

Answer 27

asthma

Question 28

Cats with chronic bronchitis compared to cats with asthma: cats with chronic bronchitis do not have __ therefore __ does nothing to tx CB. Whereas asthma has __ which is why they respond well to __

Answer 28

CB: not reversible bronchoconstriction, bronchodilators not helpful Asthma: reversible bronchoconstriction, bronchodilators helpful

Question 29

cats with chronic bronchitis do not have ___

Answer 29

reversible spontaneous bronchoconstriction

Question 30

how do you dx feline chronic bronchitis and asthma

Answer 30

1. Clinical signs 2. TXR or CT 3. BALF/cytology 4. Exclusion of other disorders when eosinophilic inflammation present

Question 31

suspected dx of chronic bronchitis and asthma can be made base don respond to empirical therapy in asthmatic patients with __ and __ with both

Answer 31

bronchodilators, glucocorticoids

Question 32

t or f: thoracic rads from cats with chronic bronchitis and asthma can look normal, up to 25%

Answer 32

true

Question 33

what do you see on rads of cats with chronic bronchitis or asthma

Answer 33

1. Variable bronchial and bronchiointerstitial patterns 2. Hyperinflation: increased radiolucency and flat diaphragm on lateral 3. Lung lobe atelectasis (not pneumonia)

Question 34

cat presents with chronic cough, based on rads what are 2 likely dx

Answer 34

1. Chronic bronchitis 2. Asthma

Question 35

cat presents with chronic cough, based on rads what wrong

Answer 35

chronic bronchitis