Gandalf: Feline Asthma Case Overview

Case Presentation

• Patient: Gandalf, 8-year-old Neutered Domestic Longhair (DLH)

• Chief Complaint: Persistent cough for 6 months; miscommunication regarding the purpose of the appointment.

Patient History

• Source: Rescued from a Humane Society

• Household: Lives with one dog; single cat household

• Lifestyle: Indoor/outdoor access

• Symptoms:

  • "Always coughs a bit"

  • Episodes of orthopnea and open-mouth breathing after play or outdoor activity

  • Otherwise appears healthy

• Vaccination Status: Up to date with FVRCP, FeLV, Rabies, flea, and tick preventive.

Physical Examination

• Vital Signs:

  • Temperature: 99.5°F (normal range 100.5 - 103°F)

  • Pulse: 180 bpm (normal range 120 - 220 bpm)

  • Respiratory Rate: 40 bpm (normal range 16 - 32 bpm)

  • CRT: <2s, mucous membranes pink.

• Auscultation Findings:

  • Notable expiratory effort

  • Bronchovesicular sounds and occasional expiratory wheezes

• Body Condition Score: 6/9, weight at 12 lbs.

Initial Laboratory Testing

• Results:

  • CBC: Normal

  • Chemistry: Normal

  • Urinalysis: Normal

Problem List

• History:

  • Cough

  • Episodic orthopnea

• Physical Exam Findings:

  • Expiratory effort

  • Loud bronchovesicular sounds

  • Expiratory wheezes

  • Overweight status (BCS 6/9)

• Differential Diagnoses: Investigation ongoing.

Diagnostic Plan

• Planned Diagnostics:

  • Thoracic radiographs

  • Fecal flotation

  • Heartworm test

Radiographic Findings

• Thoracic Radiographs:

  • Mild, diffuse bronchial/bronchiolar pattern observed

  • Mild aerophagia noted

Additional Diagnostic Results

• Fecal Examinations:

  • Flotation: Negative

  • Sedimentation: Negative

  • Baermann: Negative

• Heartworm Antibody Test: Negative

• Other Tests: Aelurostrongylus abstrusus larvae and Snap Feline Triple test performed.

Importance of Problem List

• Chronic Cough Causes:

  • Heartworm disease

  • Chronic bronchitis

  • Asthma

  • Bronchopneumonia

  • Pulmonary parasites

  • Foreign bodies

  • Neoplasia

• Dynamic Lower Airway Disease Indicators:

  • Asthma

  • Chronic bronchitis

  • Heart disease

  • Neoplasia

• Radiographic Patterns:

  • Indicative of asthma or bronchitis (chronic, viral, etc) or neoplasia.

Anesthetic Protocol for Tracheobronchoscopy

• Preparation: Fasted overnight

• Medications:

  • Terbutaline (0.6 mg SQ) - beta-adrenergic agonist

  • Propofol - Short-acting injectable anesthetic

  • Pre-oxygenation prior to procedure.

Bronchoalveolar Lavage (BAL) Cytology Findings

• Cell Type Distribution:

  • Eosinophils: 75%

  • Macrophages: 15%

  • Neutrophils: 10%

  • Squamous epithelial cells present

  • Ciliated columnar epithelial cells present.

Pathophysiology of Feline Asthma

• Clinical Signs Associated with Persistent Inflammation:

  • Chronic cough

  • Bronchoconstriction

  • Mucus hypersecretion

  • Airway obstruction

• Morphological Changes:

  • Mucous cell metaplasia

  • Smooth muscle hypertrophy

  • Change from reversible to irreversible obstruction.

Acute Control of Inflammation

• Medications:

  • Short-acting corticosteroids (Dexamethasone) for emergency therapy, advantages include bioavailability, cost, and speed of action.

  • Consideration for additional respiratory support: oxygen therapy and bronchodilators (Terbutaline 0.01 mg/kg IV, SQ).

Chronic Control of Inflammation

• Medications:

  • Oral prednisolone (2 mg/kg/day divided BID), tapering to lowest effective dose.

  • Inhaled glucocorticoids (Fluticasone propionate) for less systemic effects but may be expensive and have a learning curve.

Metered Dose Inhaler (MDI) Therapy

• Purpose: Deliver glucocorticoids and bronchodilators for chronic airway disease.

• Features:

  • Designed to aerosolize medications for optimum deposition in airways.

  • Spacer device enhances efficacy of drug delivery.

Monitoring Treatment Efficacy

• Initial Evaluation:

  • Monitoring cough counts, resting respiratory rate, and general activity.

• If Ineffective:

  • Screen for complications and other co-morbidities.

  • Adjust anti-inflammatory therapy or consider bronchodilators.

Right Middle Lung Syndrome

• Characteristics:

  • Recurrent collapse of right middle lung; common in asthma and chronic bronchitis.

• Factors Influencing Syndrome:

  • Anatomical (narrow lobar bronchus, gravity effects)

  • Pathological (mucus hypersecretion, bronchospasm).

• Clinical Signs: Persistent cough and bronchial inflammation even with treatment.