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Eosinophilic Bronchopneumopathy 299

DIAGNOSIS Infectious agents, neoplastic cells, or evidence Possible Complications
of respiratory parasites are absent. • Side effects of oral glucocorticoid therapy
Diagnostic Overview
VetBooks.ir Clinical presentation is similar to other causes ○ Abundant green to yellow-green mucus • Long-term inhalation fluticasone therapy Diseases and Disorders
• Bronchoscopic (p. 1074) abnormalities
(e.g., polyuria, polydipsia, polyphagia) are
expected in treated animals.
of chronic cough. Peripheral eosinophilia may
is commonly found in airways.
be seen on a CBC, and nonspecific bronchoin-
terstitial changes and peribronchial infiltrates ○ Airway mucosa may appear reddened, may induce inhibition of pituitary-adrenal
axis but rarely signs of hypercortisolemia.
thickened, nodular, or polypoid; airway
are commonly seen on thoracic radiographs. collapse may be evident during expiration. • Untreated or inadequately treated patients
Clinical diagnosis rests on identifying sterile Bronchiectasis may be observed in severe may develop bronchiectasis (an irreversible
eosinophilic airway inflammation by respiratory and chronic disease. airway change) (p. 132).
cytology and exclusion of other eosinophilic • A positive standard bacterial culture of respi- • Acute severe bronchoconstriction has been
diseases. ratory washes reflects a secondary bacterial described after bronchoalveolar lavage (rare).
infection, and clinical signs persist despite
Differential Diagnosis antimicrobial therapy. Recommended Monitoring
Other diseases associated with eosinophilic • Crenosoma and Angiostrongylus polymerase • Clinical signs
respiratory inflammation: chain reaction (PCR) detection in respiratory • Thoracic radiographs
• Respiratory parasites (Oslerus osleri, Fila- washes is negative.
roides hirthi, Eucoleus aerophilus [formerly • CT: Various lesions reported; increased PROGNOSIS & OUTCOME
Capillaria], Crenosoma vulpis, Paragonimus peribronchial cuffing, bronchiectasis, mucous
kellicotti, and others) plugging, and pulmonary nodules • Prognosis is generally good. Some animals can
• Chronic respiratory infection (bacterial, • Intradermal skin testing (not routinely be completely weaned from glucocorticoids.
fungal) performed): positive tests do not neces- • Excessively rapid cessation of glucocorticoids
• Pulmonary neoplasia (primary or metastatic) sarily indicate the allergen identified is may provoke a relapse of clinical signs.
• Vascular parasites (Angiostrongylus vasorum, responsible for disease. Test before starting
Dirofilaria immitis (heartworm) infections glucocorticoids. PEARLS & CONSIDERATIONS
• Eosinophilic granulomatosis (nodular
pulmonary disease on radiographs) TREATMENT Comments
• Hypereosinophilic syndrome The beneficial role of hyposensitization against
• Eosinophilic leukemia Treatment Overview antigens identified by allergy testing has not
Glucocorticoids are needed to resolve eosino- been documented.
Initial Database philic inflammation and associated clinical
• CBC signs. Technician Tips
○ Inflammatory leukogram Eosinophils are easily recognized with rapid
○ Occasional peripheral eosinophilia Acute General Treatment staining methods. If sputum is expectorated
(50%-60%) Glucocorticoids (e.g., prednisone 0.5-1 mg/ (productive retch), it can be used to make slides
• Serum biochemical profile and urinalysis kg PO q 12h) for cytologic review.
results are usually unremarkable.
• Thoracic radiographs: bronchial/peribronchiolar Chronic Treatment Client Education
patterns; increases in interstitial markings and Glucocorticoids on a slowly tapering (weeks to Clients should understand the importance of
occasionally alveolar patterns. Lobar consolida- months) schedule are often needed for control consistent treatment with glucocorticoids. Dogs
tion, bronchiectasis, and/or miliary pattern in of clinical signs: being treated should be regularly monitored
severe cases • Clinical signs are likely to recur if glucocor- to adjust therapy and because infection with
• Fecal examinations (flotation, sedimentation ticoids are administered inconsistently or if parasites or bacteria can always occur.
techniques [Baermann]) are negative for tapering occurs too quickly.
parasites and ova. Repeat fecal examinations • Low-dose glucocorticoid therapy may SUGGESTED READING
in suspect cases due to intermittent shed- be needed indefinitely for some animals. Clercx C, et al: Canine eosinophilic bronchopneu-
ding. Empiric treatment with an appropriate Administer the lowest dose q 24-48h to mopathy. Vet Clin North Am Small Anim Pract
anthelmintic may also be considered. control clinical signs. 37:917-935, 2007.
• Heartworm and Angiostrongylus blood tests • Inhaled steroid therapy (IST) (e.g., flutica- AUTHOR: Cécile Clercx, DVM, PhD, DECVIM
are negative. sone 40-250 mcg q 12h) is well tolerated EDITOR: Megan Grobman, DVM, MS, DACVIM
and allows a reduction of oral glucocorticoid
Advanced or Confirmatory Testing dosage in steroid-dependent animals; long-
• Respiratory washes/brush cytology shows term IST alone does not allow optimal
a mix of neutrophils and eosinophils with management in all affected dogs.
increased total cell numbers in wash samples.

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