Page 103 - Problem-Based Feline Medicine

7 – THE COUGHING CAT 95

and divided into smaller doses by a compounding can be used to stabilize long-term patients. Use may
pharmacy. Beta -adrenergic agonists are more allow for a decrease of steroid dosages (beneficial in
2
effective than the xanthine derivatives (theo- diabetic patients). It may decrease eosinophil
phylline) in producing bronchodilation. chemotaxis. This drug should be considered in cases
of severe eosinophilic inflammation, or cases refrac-
Glucocorticoids
tory to standard therapy. Liver damage has been
● Prednisone 1 mg/kg PO q 12 h for 5 days, then
infrequently reported in cats.
1 mg/kg PO q 24 h and slowly weaned to a mini-
● Montelukast (Singulaire®, 0.25–1.0 mg/kg SID)
mum effective dosage over 2 to 4 months. For sea-
is a leukotriene blocker that has been used in cats
sonal allergy, prednisone may be weaned entirely
for maintenance therapy but by itself is rarely
until the following year. Alternatively, the cat may
effective. Although the cat has insufficient
require chronic low dose therapy, 2.5–5.0 mg PO
leukotriene receptors for cysteinyl leukotrienes to
q 48 h. Some cats respond poorly to oral pred-
cause bronchoconstriction, anecdotal evidence
nisone, and may respond better to dexamethasone
suggests that montelukast may reduce bronchial
0.25 mg/kg PO q 12 h for 5 days, then wean slowly
inflammation and coughing. This effect may be
or switch to oral prednisone. Other cats require par-
mediated through blockage of leukotriene-medi-
enteral dosing with 20 mg methylprednisolone
ated attraction of inflammatory cells such as
acetate IM q 3-6 weeks. However, this potentially
eosinophils and neutrophils and their subsequent
has greater side effects, including inducing diabetes
release of inflammatory cytokines and other
mellitus, than alternate day prednisone therapy. In a
chemicals. Montelukast may allow for the dose of
crisis, methylprednisolone sodium succinate (100
steroids to be reduced or for cyroheptadine to
mg/cat IV) or dexamethasone (0.5–2 mg/kg IV or
replace the steroids.
IM) can be given.
● Inhaled steroids scuh as fluticasone (Flovent®)
Other agents
are beneficial in cats that tolerate face mask
● Mast cell stabilizers
inhalers. Topical therapy has less systemic side
– Cromolyn is an inhalant that stabilizes mast cell
effects, which may be important in diabetic cats and
degranulation. It may be helpful for long-term
cats predisposed to diabetes. In general, inhaled
control, and to diminish maintenance doses
steroids are preferred because of their reduced side-
of steroids. Use 1 metered dose (800 mcg)
effects, but they are more expensive. Fluticasone
q 12–24 h.
may take 5–10 days to work, so oral steroids should
– Amitryptiline is a systemic mast cell stabilizer.
be administered concurrently for 5–10 days,
There is no information on its use in cats for air-
depending on the severity of signs.
way disease, but it has been used for urine mark-
Oxygen supplementation is required during respira- ing and psychogenic dermatoses at 1.1–2.2
tory distress and an oxygen chamber or tent seems to be mg/kg PO q 12 h.
best tolerated by air-starved patients. Oxygen hoods ● Antitussives
made with an Elizabethan collar and cellophane have – Debate exists whether the cough of bronchitis
proven very useful in cats. should be suppressed, as it is a protective mech-
anism of the airway.
Minimal handling and restraint of acutely dyspneic
– Butorphanol (Torbutrol) can be dosed at
patients is essential.
0.05–0.6 mg/kg PO q 6–12 h, prn to control
Serotonin antagonists cough. “Pulse antitussive therapy” may be
● Cyproheptadine (Periactin®) − 2–4 mg/cat PO q helpful. This involves treating for 2–3 days to
12–24 h. This drug blocks serotonin, the major break the cycle of the harmful effects of the
inflammatory mediator from feline mast cells in cough, then stopping for 2–3 days to allow
airway disease. improved airway clearance. Administration must
be judged on a case-by-case basis.
Leukotriene receptor blockers
● Zafirlukast (Accolade®) 0.5–1.0 mg/kg PO q Therapeutic protocol recommended by Dr Phil
12–24 h. This drug is not useful in acute attacks, but Padrid: