Lower Airway Diseases Dogs and Cats

What is the signalment for a dog with bronchitis?

Middle aged and older small medium breeds

What are the C/S of canine bronchitis?

Chronic cough

Dyspnea

Describe the cough with canine bronchitis

Worse with exercise and excitement

Can be productive or dry

What do you see on an exam for canine bronchitis?

Overweight

Wheezes or crackles on auscultation

What species does not get bronchospasms?

Dogs

What is the pathophysiology of canine bronchitis?

Chronic airway inflammation

What causes chronic airway inflammation during canine bronchitis?

Excessive mucus production

Hyperplasia of secretory glands in bronchial walls

Inflammation of airway walls leading to narrowing

What is the etiology of canine bronchitis broadly?

Multifactorial

What are the multifactorial causes of canine bronchitis?

Response to a chronic infection

Response to inhaled irritants

Primary Immune-mediated airway disease

Ciliary dyskinesia

What is ciliary dyskinesia?

Congenital defect of cilia in airways

T/F dogs with chronic bronchitis are stable?

True

How do we decide treatment for canine bronchitis?

Fluid analysis using an endotracheal wash or bronchoalveolar lavage

What is a pro of an endotracheal wash?

Fast, cheap, easy

What are the cons of endotracheal wash?

May not reach lower airways

Cannot target specific lobes

What are the pros of bronchoalveolar lavage?

Can visualize airways and target fluid collection

What are the cons of bronchoalveolar lavage?

Requires general anesthesia

Inserting scope can irritate airways

What is the clinical diagnosis of bronchitis?

Coughing that occurs most days for at least 2 consecutive months with radiographic evidence of bronchial disease

How do you treat canine bronchitis?

Remove any triggers

Weight management

Treat infections if present

What can you tell owners to do to identify triggers of canine bronchitis?

Keep a journal of when cough is bad to identify changes in dogs environment

For chronic bronchitis what medication do you need to add?

Glucocorticoids, either oral or inhaled at the lowest effective dose

What are the side effects of long term glucocorticoids?

PU/PD/PP/Panting

Increased risk of infection

GI bleeding

Weight gain

What is fluticasone?

An inhaled steroid used to treat bronchitis

Why is fluticasone not a good emergency drug?

It takes 10-14 days to take effect

What oral medication types can help manage bronchitis?

Glucocorticoids

Bronchodilators

How odes aminophylline/theophylline help treat canine bronchitis?

Relaxes smooth muscles in airways with a weak chronotropic and inotropic action

What are the side effects of aminophylline and theophylline?

GI upset, increased HR, CNS stimulation

Drug interactions (Baytril)

What is the mechanism of terbutaline?

Beta-2 agonist (Bronchodilator)

What are the side effects of terbutaline?

Increased HR, tremors

How can you treat for too much mucus?

Nebulization with saline

Coupage

Exercise

T/F expectorants work on dogs?

False

When should you use a cough suppressant for canine bronchitis?

If the cough is dry only

What is bronchiectasis?

irreversible dilation of large aiways

What can cause bronchiectasis?

Increase in airway secretion secondary to bronchitis, infection, dyskinesia, smoke, radiation

What is the signalment for bronchiectasis?

Cockers, Westies, Poodles, Huskies, Springers over 10 years old

What are the signs of bronchiectasis?

Moist productive cough ± hemoptysis

How do you diagnose bronchiectasis?

CT (best)

Bronchoalveolar lavage

How do you treat bronchiectasis?

Antibiotics per culture

Remove surgically if focal

What is eosinophilic bronchopnuemopathy?

Inflammatory disease due to hypersensitivity, or endogenous antigen

What is the signalment for eosinophilic bronchopneumopathy?

Huskies young or middle aged

What are the signs of eosinophilic bronchopneumopathy?

Cough (green stuff can come up), dyspnea, nasal discharge

Decreased appetite, lethargy

How can you diagnose eosinophilic bronchopneumopathy?

Peripheral eosinophilia

Tracheal wash with high eosinophils

Thick green mucus with bronchoscope

What should you rule out before eosinophilic bronchopneumopathy?

Heartworms, parasites, fungal, neoplasia

How do you treat eosinophilic bronchopneumopathy?

Corticosteroids

What are you differentials for coughing cats?

Asthma/chronic bronchitis

Bordetella

Heartworms

What is the difference between asthma and bronchitis?

Asthma is an acute crisis

Bronchitis is a chronic disease

What is the pathophysiology of feline asthma and bronchitis?

Immune system dysfunction

Mucociliary dysfunction

Describe the immune system dysfunction during feline asthma and bronchitis?

Inflammatory cell infiltration

Release cytokines

Smooth muscle hypertrophy

Mast cell degranulation

All contribute to bronchoconstriction

Describe the mucociliary dysfunction during feline asthma and bronchitis

Mucosal injury leads to mucociliary dysfunction

Goblet cells increase mucus production

Mucous plugs cause obstruction

What is the signalment for feline asthma and bronchitis?

Young and middle aged cats, Siamese are predisposed

What can be seen in the history of a feline asthma or bronchitis cat?

1st time acute respiratory crisis

Can be a chronic cough (hacking up hairballs is what owner might say)

Episodes of lethargy

What can be seen on a physical exam of feline asthma/bronchitis?

Respiratory distress

Wheezes

Cough

Increased expiratory effort

What should you do first if a cat comes in dyspneic?

Provide oxygen before a physical exam

How do you diagnose feline asthma and bronchitis?

Clinical history

Eosinophilia on bloodwork

Thoracic radiographs

Cytology and culture

Response to treatment

What can you get with an endotracheal wash for feline asthma or bronchitis?

Look for underlying infection or neoplasia

Cytology will have mostly eosinophils

Culture aerobic bacteria

What should every coughing cat be tested for?

Heartworm

What is NT-ProBNP?

Biomarcer to detect cardiac disease

How do you treat an emergency feline asthma and bronchitis?

Oxygen

How do you treat feline asthma and bronchitis non emergency?

Bronchodilators (albuterol inhaler or terbutaline)

Fast-acting steroid (dexamethasone) IM

Why should you keep an asthma cat in the hospital for 48 hours?

Provide a break in case there is a break from asthma trigger at the house

How do you manage chronic asthma or bronchitis?

Identify and eliinate triggers

Low dose steroids or fluticasone inhaler

Bronchodilators

T/F most asthma cats need antibiotis?

False