Tracheobronchial diseases--cats Flashcards Preview

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Flashcards in Tracheobronchial diseases--cats Deck (15):
1

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

2

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

3

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

4

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

5

What's wrong with these radiographs? What disease is most likely associated with them?

  • Left: collapsed right middle lung lobe
  • Right: patchy alveolar/interstitial alveolar pattern
  • Idiopathic feline bronchitis

6

Idiopathic feline bronchitis

Bronchoscopy

  • Mucosal hyperaemia
  • Increased mucous
  • Perform broncho-alveolar lavage

7

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

8

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
    1. Albuterol via metered-dose inhaler (MDI) or orally
    2. Terbutaline (0.01mg/kg SC)
      • Bronchodilation w/in 15-30min
      • Cats can become dazed/disoriented
      • Also comes as MDI

9

Idiopathic feline bronchitis

Long-term management

  1. Environmental management
    • Improve indoor air quality
    • Eliminate potential allergens/irritants
  2. 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)

10

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

11

Idiopathic feline bronchitis

Chronic clinical signs?

Intermittent coughing and wheezing

12

Idiopathic feline bronchitis

Other possible long-term treatments?

  1. 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
  2. Antibiotics
    • Therapeutic trial for mycoplasma
      • Doxycycline, chloramphenicol, azithromycin
    • Give bolus of water after doxycycline

13

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

14

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

15

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