Page 342 - Clinical Small Animal Internal Medicine

310 Section 4 Respiratory Disease

A simple technique using a modified stomach tube has
VetBooks.ir ● Supplemental oxygen should be available during this ● Bronchoscopic bronchoalveolar lavage can be used to
been used successfully.
procedure and for recovery.
Blind bronchoalveolar lavage (BAL) is performed similarly
to an ETW with the exception of the following. collect samples via bronchoscopy by flushing sterile 0.9%
saline through the chamber of a sterilized scope and
The flexible catheter is advanced until it is lodged in the
● reaspirating it back through the biopsy channel.
lower airways.
A larger volume of 0.9% saline is used, dependent on the
●
patient’s size.

Antibiotics are warranted in dogs with an acute exac- widely used. Butorphanol (0.5 mg/kg PO q6–12h) may
erbation of their clinical signs of CCB, or in those with also be considered as a primary cough suppressant. A
evidence of an infection on airway cytology and/or cul- human study has recently reported on the efficacy of
ture. Doxycycline and azithromycin have antiinflam- gabapentin for control of cough in humans though data
matory and antimicrobial properties, and should be in dogs are lacking.
considered in CCB patients with no specific bacterial
culture and sensitivity data. Clinician preference is
often influenced by cost, formulation, and availability Prognosis
of products. Fluoroquinolones are also a good choice
for patients with CCB due to their high airway tissue The clinical course of CCB is highly variable. In the
concentrations although it is important to remember majority of patients, permanent changes are present in
that concurrent administration of fluoroquinolones the airways at the time of diagnosis, and as a result treat-
and theophylline may results in theophylline toxicity. If ment is not curative. Appropriate medical management
simultaneous administration of both drugs is necessary can typically help ameliorate the clinical signs and palli-
then the theophylline dose should be reduced by ate the disease by stopping or slowing progression of
approximately 30–40%. bronchial damage. Periodic relapse of cough is not
Cough suppressants are typically used to reduce the uncommon, and will frequently respond to temporary or
positive feedback cycle of cough begets inflammation permanent adjustment in the therapeutic regimen, or
and inflammation begets cough, and to improve the treatment of a developed concurrent illness such as
quality of life of the patient and owners. Over‐the‐coun- pneumonia. As techniques are developed to screen for
ter cough suppressants are rarely effective in dogs. and diagnose CCB at earlier stages and more directed
Narcotic cough suppressants are the most effective, with medical therapy is established, the prognosis for and
hydrocodone (0.22–0.5 mg/kg PO q6–12h) the most probability of cure of CCB will improve.

Further Reading

Amis TC, Kurpershoek C. Tidal breathing flow‐volume Chandler JC, Lappin MR. Mycoplasmal respiratory
loops analysis for clinical assessment of airway infections in small animals: 17 cases (1988–1999). J Am
obstruction in conscious dogs. Am J Vet Res 1986; Anim Hosp Assoc 2002; 38: 111–19.
47(5): 1002–6. Creevy KE. Airway evaluation and flexible endoscopic
Bexfield NH, Foale RD, Davison LJ, et al. Management of procedures in dogs and cats: laryngoscopy,
13 cases of canine respiratory disease using inhaled transtracheal wash, tracheobronchoscopy, and
corticosteroids. J Small Anim Pract 2006; 47: 377–82. bronchoalveolar lavage. Vet Clin North Am Small Anim
Bolongin M, Kirschvink N, Leemans J, et al. Characterization Pract 2009; 39: 869–80.
of the acute and reversible airway inflammation induced Hawkins EC, Berry CR. Use of a modified stomach tube for
by cadmium chloride inhalation in healthy dogs and bronchoalveolar lavage in dogs. J Am Vet Med Assoc
evaluation of the effects of salbutamol and prednisolone. 1999; 215(11): 1635–9.
Vet J 2009; 179(3): 443–50. Hawkins EC, Basseches J, Berry CR, et al. Demographic,
Brownlie SE. A retrospective study of diagnosis in 109 clinical, and radiographic features of bronchiectasis in
cases of canine lower respiratory disease. J Small Anim dogs: 316 cases (1988‐2000). J Am Vet Med Assoc 2003;
Pract 1990; 31: 371–6. 223(11): 1628–35.