Page 104 - Problem-Based Feline Medicine

96 PART 2 CAT WITH LOWER RESPIRATORY TRACT OR CARDIAC SIGNS

● For mild signs (cough only): fluticasone 110 mcg q Recently, there appears to be epidemologic evidence of
12 h and albuterol prn decreased risk of asthma in male cats neutered before
● For moderate signs (cough and tires easily, 5.5 months of age.
and sleep disruption for client): prednisolone
1 mg/kg PO q 12 h for 5 days, and on an ongoing
PULMONARY INFILTRATES WITH
basis, fluticasone (Flovent®) 220 mcg q 12 h and
EOSINOPHILS (PIE) (EOSINOPHILIC
albuterol prn;
BRONCHOPNEUMOPATHY)*
● For marked signs (cough and dyspnea at rest with
diminished quality of life): prednisolone 1 mg/kg
Classical signs
PO q 12 h for 5 days, q 24 h for 5 days, q 48 h for
5 days, and on an ongoing basis, fluticasone 220 ● Coughing – mild to severe.
mcg q 12 h and albuterol prn; ● Crackles, wheezes or diminished lung
● For severe signs (dyspnea, open mouth breathing sounds.
+/– cyanosis) which are a life-threatening emer- ● Possible peripheral eosinophilia on CBC.
gency, it is important not stress the cat as this may
precipitate death. Administer oxygen via oxygen
cage or nasal canula, methylprednisolone sodium Pathogenesis
succinate (100 mg/cat IV) or dexamethasone
Interstitial or alveolar infiltration of pulmonary
(2 mg/kg IV) and terbutaline (0.01 mg/kg IV) q 30
parenchyma with eosinophils. The infiltrate may form
minutes for up to 4 h until a response is observed.
space-occupying eosinophilic granulomas measuring
Once stabilized, cats can be discharged with fluti-
up to 20 cm diameter. Varies from mild, self-limiting
casone 220 mcg q 12 h and albuterol q 6 h as
disease, to severe and life-threatening.
needed.
Antigenic source, such as migrating parasites (Toxocara
spp.) or heartworms may be found. Eosinophil-derived
Prognosis
cytokines (leukotrienes, major basic protein, etc.) can
Patients in status asthmaticus are extremely fragile, and damage the offending parasite or the host tissue, depending
may decompensate and die without rapid therapy on the circumstances or severity.
administered with minimal handling.
In most cases, the inciting allergen is not identified.
Chronic cases, or once status asthmaticus resolves,
have a fair to good prognosis with prolonged therapy.
Clinical signs
Cure is rare, but with long-term therapy, management is
frequently quite successful. Mild to severe coughing for weeks to months prior to
presentation is common.
Prevention Signs of systemic illness such as weight loss, anorexia
and depression, may be present.
Identification and removal of the offending antigen is
highly desirable, but often difficult. Adventitial lung sounds such as crackles or wheezes, or
areas of diminished lung sounds may be present on tho-
Clean the furnace or air-conditioning air ducts, shampoo
racic auscultation.
carpets (avoiding perfumed cleansers), remove scented
candles or potpourri, avoid using hair spray or aerosol Coughing may be elicited on tracheal palpation or
cleaners near the patient, switch to dust-free and coupage of the chest.
unscented cat litter, and quit smoking.

High-quality home air-filtration systems have been
Diagnosis
shown to help human asthmatics, and it is logical that
cats would also benefit. HEPA filters (class III and Peripheral eosinophilia is present on CBC in 50–75%
above) decrease inhaled particles significantly. of patients.