TV4101 - SAM - Upper Airway Disease

Two broad presentations - coughing and dyspnoea

In contrast to lower airway disease - wet productive cough

Cough is usally a protective mechanism to protect airway

Phases

Short sharp inspiration
Compressive phase against closed epiglottis

Mediastinal disease - could put pressure on airways

Physical exam - abnormal sounds, dyspnoea, trachea irritation?

Faecal flotation e.g. con sider it if there is high worm burden i.e. larval migrans or area endemic to lung worms

Blood smear - neutrophilia, evidence of infection

Radiograph is our bitch

CT increased prevalence

mri not really used - movement of airways in breathing makes it blurry so eh

bronchoscopy - flexible scope to look at trachea and airways

blood gas analysis - used when concern with chronic hypoxia rarely used

cardiac evaluation - to look for pulmonary hypertension or consequences of lung diseases causing cardiac issues

FNA - better than biopsy as biopsy is open chest procedure

Risk of lung rupture
We stick needle into solid lesion that we saw on US
May stick needle into actual lung if we need dx of pneumonia

Bronchoalveolar lavage - 2ml per kg of saline given - don’t usually give that entire amount rather give in 2-5 ml minute amounts one syringe at a time then percuss

Relatively low risk procedure
If pulmonary bullous or moving tube and back forth could rupture ariway but very rare

Little area of consolidation but nothing else significant

DX - chronic cough suspicions for airaway disease due to chronic unproductive cough

On left hand side (actually right ariway) airway is compressed

Wouldn’t be ablse to see mass on radiograph as heart borders block ti

Bronchoscopy - wouldn’t be able to see the mass - only see the collapse but not what caused it

CT is our bitch

Common cause of cough

Breed and size predisposition implies genetic component

Weakening of trach rings → trache a collapse → activate mechanoreceptors → dry harsh cough

Tracheal stenting isn’t usually used, the above medications and weight loss aids enough to not need it

Tracheal stenting - to prevent life threatening airway obst

will continue to cough even if stented

Infectious - adeno, parainfulenza, boradtella

Non-infectious - separation anxiety barking lots → tracheitis

Compression of trachea → tracheitis

Infectious cases usually cough goes away on its own

May also use a nebuliser

Short term corticosteroids 5-7 d tx won’t cause immunosuppression

Immunity is not long lived

More in youngins

Most vax don’t prevent transmission

If cough is still there after 21 days - consider doxycycline to battle bordatella

Obesity a complication for resp pathology due to pigwiggian? syndrome → big belly push on diaphragm → extra layer of insulation and requires more air to cool down → more constriction of airway which is bad with resp pathology

Histology - mucus hypersecreion and hypertrophy of goblet cells

Important to rule out other diseases and we are left with chronic lower airway disease

Start with RGs,

Cardiac eval - may be helpful if very large chamber pushing on airway

Insidious - gradual, subtle and progressive

Sometimes cough is productive from increased mucus however hard to tell

TTA: neutrophils seen are non regen neutrophils

Culture for bal - hard to be pure from mouth contamination

Corticosteroids - oral prednisolone is the best

Astham pump - not tolerated very well by lots of dogs

2ndary

e.g. owner reduce smoking
Clean the house

Harness - less psi on cervical trachea

Bronchiectasis probably connected to chronic bronchitis

Can follow bronchi to the edge of the lung i.e. cylindrical bronchiestasis

TX - helpful to just treat with ABs

Prednisolone - can be helpful in bronchiestasis with a chronic cough (lots of inflam with no infection indicated) - don’t use long enough to suppress immune sys

Cats

Feline asthma - most common airway issue in feline - constrictive

Dogs have bronchitis as most common - infiltrative