Page 483 - Cote clinical veterinary advisor dogs and cats 4th

Cough 217

Prevention • Contact time is important (should be left SUGGESTED READING
Animals affected with primary (genetically on the dog for at least 5 minutes before Miller WH Jr, et al: Muller & Kirk’s Small animal
VetBooks.ir not be used for breeding. • Use enough shampoo to cover the dog AUTHOR: Stephen Waisglass, DVM, CertSAD, DACVD Diseases and Disorders
rinsing).
determined) cornification disorders should
dermatology, ed 7, St. Louis, 2013, Saunders, pp
630-646.
without overdoing it.
Technician Tips
Regarding baths: Client Education EDITOR: Manon Paradis, DMV, MVSc, DACVD
• Most medicated dog shampoos do not lather Explain the concept of control versus cure.
well.

Cough Client Education
Sheet

BASIC INFORMATION HISTORY, CHIEF COMPLAINT ○ Can help differentiate referred upper
Owner description of cough is subjective. For airway noises from lower airway or pul-
Definition example, cough in cats is frequently mistaken monary sounds on thoracic auscultation
Respiratory protective mechanism characterized for vomiting or hairballs. ○ Stridor, stertor, tracheal snap/click may
by inhalation followed by forceful expulsion of • Duration: time course varies with underly- be appreciated in animals with laryngeal
air from the lungs and airways against a closed ing cause (e.g., infectious tracheobronchitis paralysis, nasopharyngeal disease, or col-
glottis. Cough is distinct from a throat clear/ [acute], chronic bronchitis [chronic]) lapsing trachea, respectively.
expiration reflex, in which inhalation is absent. ○ Acute ≤ 3 weeks • Pulmonary auscultation
○ Subacute 3-8 weeks ○ Crackles (often inspiratory) suggest edema,
Epidemiology ○ Chronic ≥ 8 weeks pneumonia, contusions, or fibrosis.
SPECIES, AGE, SEX • Character ○ Crackles often heard best immediately
All animals cough; predispositions exist for ○ Productive versus nonproductive/wet after a cough (post-tussive crackle).
some of the disorders that cause excessive cough. versus dry: considerable overlap and ○ Wheezes (often expiratory) suggest airway
does not routinely provide discriminating narrowing (e.g., bronchoconstriction,
RISK FACTORS information exudate).
May be precipitated by factors related to ○ Harsh versus soft: harsh cough tends ○ Dull lung sounds may be noted with an
underlying disease process: to be associated with airway disorders, intrathoracic mass effect.
• Infection: exposure to bacterial, viral, fungal, and soft cough is often associated with ○ Muffled heart and lung sounds suggest
protozoal, or parasitic pathogens parenchymal lung disease, although pleural space disease.
• Irritant/allergen exposure: asthma, chronic overlap occurs • Cardiac auscultation
bronchitis ○ Hemoptysis: infectious/inflammatory, ○ Tachycardia is more typical of heart disease
• Aspiration pneumonia: dysphagia, regurgita- trauma, neoplasia, foreign bodies, coagu- while sinus arrhythmia more typical of
tion, vomiting, recent anesthesia lopathic, and thromboembolic disorders; lung/thoracic disease
• Impaired respiratory protective mechanisms: warrants prompt investigation ○ Cardiac causes of cough are very unlikely
ciliary dyskinesia, bronchiectasis, laryngeal ○ Repetitive swallow/changes in appetite: in dogs with neither a murmur nor
paralysis suggest reflux or postnasal drip arrhythmia
• Degenerative processes: collapsing trachea, ○ Honking character typical of collapsing ○ Cats with CHF may or may not have a
bronchomalacia trachea but not specific heart murmur.
• Heart disease: left-sided congestive heart • Exposure history ○ Characteristics of a heart murmur may
failure (CHF), compression of bronchi by ○ Indoor: cigarette smoke, molds, wood suggest a type of heart disease (p. 414).
enlarged atria burning stoves, deodorants, cleaners, and ○ Murmurs may be coincidental and not
aerosols related to the cause of cough.
CONTAGION AND ZOONOSIS ○ Outdoor: boarding kennels, grooming • Complete physical exam can provide clues.
Pathogens of tracheobronchitis (pp. 271, 545, facilities, dog parks, and general exposure For example, cachexia is often due to
and 987) are highly contagious; rarely, Bordetella to other animals neoplasia, CHF, or chronic infection (e.g.,
bronchiseptica infects immunosuppressed people. fungal pneumonia).
PHYSICAL EXAM FINDINGS
GEOGRAPHY AND SEASONALITY • Changes in respiratory effort, if present, may Etiology and Pathophysiology
Infectious agents, including parasites (e.g., be helpful in localizing disease (p. 879). • See Cough, Section 3 (p. 1209).
Dirofilaria immitis) and fungal organisms (e.g., • Concurrent nasal and ocular discharge sug- • Cough is a somatosensory reflex arc involving
Histoplasma capsulatum, Blastomyces dermatitidis, gests an infectious process; use biosecurity visceral sensation triggered by receptors in the
Coccidioides immitis) endemic to certain areas precautions (p. 987). mucosa of the pharynx, trachea, and large
• Inducible cough on tracheal palpation airways, followed by a reflex motor response
Clinical Presentation does not definitively localize disease to intended to expel secretions or material from
DISEASE FORMS/SUBTYPES the large airways. (e.g., cough may be the airways.
Cough is a nonspecific respiratory protective induced in patients with pulmonary paren- • Most often, coughing is associated with
mechanism, but when excessive, it serves as a chymal disease and in clinically normal disorders of the airways, lungs, or heart. Less
marker of disease. Coughing may or may not patients) commonly, pleural disease, gastroesophageal
be accompanied by respiratory distress (p. 879). • Tracheal/laryngeal auscultation reflux, or drugs cause coughing.

www.ExpertConsult.com