Respiratory Problems:
On This Page:
As with most of our other treatment pages I'll start with a description of what to expect if you were to bring in a cat or dog into our clinic with respiratory symptoms. After that; articles, discussion, & information about different respiratory topics. And, of course, links to other sites about respiratory disease in pets. Hopefully I will be able to attract other vets to also contribute to this topic an as time permits, and as always, I will continue to update this page.
I know my site is a bit disorganized, but I have additional articles that I wrote about Feline Asthma and Feline Respiratory "Colds" on our Cat Pages
And coming soon...
Respiratory Infections, Pneumonia, and other BronchoPulomonary Disorders
Obstructive Upper Airway Diseases
on Respiratory; page 2
Fungal Respiratory Infections
Chronic Nasal and Sinus Diseases
What to Expect at our Clinic:
(Of course,Other Veterinarians Might approach similar cases differently)
If your cat or dog has respiratory symptoms (coughing, sneezing, wheezing, nasal discharge, lung congestion, or any other trouble breathing) here's what to expect and consider when you bring your pet in for examination.
A good exam and history: Pertinent history includes whether or not any other cats or dogs in your house or immediate neighborhood also have respiratory symptoms (some respiratory diseases are contagious to other animals of the same species, but USUALLY NOT contagious to other species)
Was the pet recently boarded or under stress? And as always when we go over a pet, we want to know about how long the problem has been going on, is it getting worse, is it only after exercise, is the appetite normal, is the energy level normal, and so on.
In addition to looking at the whole patient well, we will be checking carefully for nasal discharge, infected gums, swollen glands in the throat, and the swallowing reflex. We will also try to determine if the problem is truly respiratory or is it really a heart condition, or anemia, or a possible diaphragmatic hernia, heartworms, or a hairball (in addition to making cats gag or cough, sometimes hairballs ferment which causes a bloat and fever combination that makes cats look like they're having trouble breathing.) We will make sure there isn't a foreign body in the throat or a plant awn up the nose.
Once we're pretty sure the problem is respiratory, we will narrow it down to upper respiratory or lower lung disease. We will try to determine if the problem is infectious or allergic in nature.
If we think the problem is a simple cold or a fairly minor disease like kennel cough, we will probably treat the symptoms and wait the disease out as long as it doesn't get worse...but if the problem is a little more serious, we will recommend a respiratory lab work up. Here's what might be involved:
Laboratory and Radiographic Options appropriate for respiratory disease in cats and dogs:
Heartworm testing in both dogs AND cats: Heartworms are a common cause of respiratory problems in both dogs and cats, so if you haven't been giving heartworm preventive to your pets regularly we will probably run a heartworm test.
If by any chance you don't know that your pet should be taking once a month heartworm preventive, please click here for more information about this common disease and the inexpensive, chewable preventives that are available at veterinarians everywhere.
Leukemia and Aids Testing for cats: Unfortunately, both of these terrible diseases are common, especially in young and poorly vaccinated cats, so if the history and the symptoms fit, we will probably run screening tests for these diseases.
(just in case you're wondering, Aids disease in cats is similar but is NOT THE SAME as the AIDS disease in people.) For more information about these infectious diseases of cats; please go to our Cat Page.
Other Blood Work. As with other serious cases, we rely on the information we learn from a CBC (complete blood count) and Chemistry. The CBC, for example, gives us clues as to whether or not the respiratory problem is bacterial, viral, or allergic in nature.
Cultures: Some vets like to culture suspected infections before using antibiotics and others culture only if their first choice antibiotic isn't working. In some parts of the country, discharges and abscess' are sometimes fungal and not bacterial, so your vet may want to do a fungal culture. The problem with cultures is in addition to another expense, they take 3-21 days to get results back. In addition, they are not always accurate. Nonetheless, they are sometimes critical.
Endoscopy and TransTracheal Washes: Some vets like to get samples from the windpipe or bronchi in a procedure called a transtracheal wash which has the advantage of bypassing all the germs in the mouth and throat that are present normally and may not be the cause of the infection. Other vets use an endoscope to actually look inside the bronchi. These techniques are very useful, but the down side is that the needed equipment is expensive and the possibility for damage to sensitive lung tissue if done by someone who isn't experienced is possible, so I, personally, leave these more advanced diagnostic techniques to the specialists.
Radiographs: X rays of the chest can tell us a lot about the lungs and heart, so if the problem is lower lung disease, we will probably recommend radiographs of the chest.
Steroid Trial: This is not a common test but it is used IF we think your cat has asthma or other allergic respiratory disease. Basically we suspect a diagnosis of asthma or similar allergies if we can't find anything else but steroids give a lot of relief. The most common type of steroid used is either prednisone tablets or methylprednisolone Injection. Go to the Medication section for more information on steroids and their possible side effects.
Treatment Considerations and Options for Respiratory Disease in Cats and Dogs:
Antibiotics: Most respiratory diseases are at least partly caused by bacteria and prior to the invention and use of antibiotics not that long ago, respiratory disease was a very common way to die. Shoot, most people didn't get old enough to die of cancer or heart disease because pneumonia got them first.
As you might guess, despite an interest in Eastern and "alternative" medicine, I'm a big fan of antibiotics. However, for more information on the problems of inappropriate antibiotic use, go to the medication section.
Each veterinarian seems to have a favorite antibiotic so don't be surprised if your vet recommends something different. I usually give a combination injection of penicillin, gentocin, dexamethaone, benadryl, and B12 followed by 10 days of generic Keflex in dogs and for cats I give the same injection but use either once a day Zeniquin for adult cats or Clavamox for kittens. I switch antibiotics if they aren't working well or if culture results suggests a better medication. Other antibiotics, if needed, can be much more expensive. Zeniquin, for example, one of the great new antibiotics available for treating severe infections, while inexpensive for small pets like cats, costs more than $50/week for large dogs.
Another comment about antibiotics: If the gums are inflamed or infected, I like to get this bacterial load under control while fighting respiratory disease by using topical Oral Gel or CHX antiseptic toothpaste and by giving an anti microbial medication called metronidazole (Flagyl).
Anti-Fungal Medications: Luckily, respiratory fungal infections are rare in our area of the country, but if diagnosed; I refer these cases to a specialist. Respiratory Fungal Infections are complicated by being possibly contagious to people, often difficult to cure, and the needed medications are both expensive and potentially dangerous.
Anti-histamines: Somewhat helpful for some respiratory problems so we will sometimes try them. I usually use chlorpheniramine or benadryl which are very inexpensive. One of the minor problems of using antihistamines in pets is that it's hard to tell if they're a little lethargic from the disease or the medication.
Oxygen Therapy: Very helpful for severe lung congestion but difficult to administer in pets unless small enough to fit inside an incubator or willing to hold still for a nose cone. Also, more appropriate for emergency respiratory relief; not home treatment.
Vaporizers: At home, some badly congested pets respond well to being put into a small room such as a bathroom with a vaporizer. If needed, a little Vick's Vapor Rub (or similar) on the nose will open up clogged up nasal passages which is important in cat's because they won't eat if they can't smell, but cats hate vapor rub and will probably salivate like crazy it they lick it. Use very little.
Cough Tablets and Suppressants: Just like in human medicine we have inexpensive, mildly effective cough suppressants and fairly expensive strong cough suppressants if needed. I don't use these medications much except with Kennel Cough in dogs. I often tell people to try any reasonable thing that the dog likes that soothes the throat such as ice cream, ice water, and for the adventurous; a little Rock 'N Rye whisky. Don't let your dog drink and drive.
Supportive Care: It's important that sick animals eat and are kept warm and that we control any secondary diarrhea and so forth to help maximize their chances of a quick recovery. So in addition to some of the more obvious medications listed above, we may also recommend special diets, vitamins and supplements etc
Kennel Cough Disease in Dogs:
Luckily this common disease in dogs is usually not too serious, but it sure can be a nuisance...especially for people like me who offer boarding services.
In a nut shell, Kennel Cough is a disease caused by an airborne germ (bordetella) that is highly contagious among dogs, especially dogs under stress. The germ can (rarely) cause damage to the heart muscle, but it's usual place to cause havoc is in the tonsils or lymph tissue in the throat where it can induce severe hacking, mucus production, and hoarse coughing for 2-6 weeks.
It's common for dogs to pick up this disease in boarding kennel or from dogs cruising around the neighborhood. One of the troubles for us in our boarding facility is that we often don't know a dog has the germ and is spreading it around because the symptoms are minimal in some pets and the pets that "catch" the germ don't show any symptoms for 2-7 days later...after they go home.
There is a vaccine for this disease, and like most kennels, we require all boarders to get this vaccine. The problem is that it doesn't work as well as other vaccines. It helps to prevent the disease. It helps reduce the symptoms, and dogs that are vaccinated get better faster, but it doesn't necessarily keep the dog from getting the disease all the time. Bummer.
So, if your dog gets a hoarse cough after boarding, don't go ballistic on your vet...be thankful that we have a vaccine that at least helps and that the disease isn't too serious.
Treatment is usually an antibiotic injection followed by antibiotic capsules if the case warrants it and stuff to soothe the throat and reduce the coughing. As a public relations gesture, we don't charge an exam fee in kennel cough cases if your pet boarded with us recently because it probably got it at our kennels despite our high standards for cleanliness and precautions. Think of it as trying to eliminate the spread of the common cold in an office building or school...there are lots of things that help like frequent hand washing but no guarantees.
One other comment; unlike most vaccines, there is evidence that giving this vaccine after your dog gets the disease may help speed up recovery.
Kennel Cough in Cats:
A lady was angry with me last year because her cat got a cold while boarding at our cute little cat boarding house and her vet said it was my fault because I didn't give the cat the new cat vaccine for bordetella (also known as kennel cough for cats). We used to give this vaccine to cats because the company that made this vaccine ran a big ad in our veterinary journals that more or less claimed to have cured the common cold. The ad basically said that a high percentage of cats with colds had bordetella germs in their sinuses and therefore their bordetella vaccine would prevent colds in cats.
This sounded great and we dutifully bought the vaccine and started spraying it up cats noses, but guess what? Not only did this vaccine seem to irritate the cat's noses, it didn't seem to work. And then I went to not one but two seminars where the viral disease expert (Dr Alice Wolf) explained that bordetella was found in most healthy cat sinus' too and was not the cause of the colds. Nor did she think that the new vaccine was very useful.
The reason I mention all this is mainly to let you know what people are talking about if you hear someone mention either kennel cough disease in cats or the kennel cough vaccine available or the new vaccine for colds in cats. As far as I can tell, it doesn't work well so I don't use it routinely. Your vet may feel differently or at the rate new improvements are being made in medicine, perhaps we will have an effective vaccine available soon.
The Common Cold in Cats:
Whatever controversy remains about the effectiveness of the cat vaccine for colds doesn't change the fact that we see lots of cats with colds. Sneezing, Sneezing, Sneezing. Very contagious (among cats; not humans), and a big nuisance for 10-30 days. Often with red, irritated eyes, sore throats, and coughing.
Since there is no great treatment, every vet has their favorite way of making your cat as comfortable as possible and of speeding up the recovery time. Here's what to expect at our hospital:
Don't give Tylenol and Aspirin: Cats should NOT be given Tylenol (acetaminophen). I mention this for the obvious reason that lot's of people take Tylenol for their own colds. Tylenol is poorly metabolized by cats and can cause liver disease and anemia. Aspirin is toxic too except in tiny doses.
Antibiotics: I give a combination injection of penicillin, gentocin, dexamethasone, atropine, and B12 that seems to help quite a bit for a couple of days and fights and prevents secondary bacterial infection. We sometimes repeat this injection every other day for a few times. We also dispense oral antibiotics such as amoxicillin...not because we expect it to cure the cold...but to help prevent secondary infections.
Interferon: I mix a little interferon with amoxicillin drops for kittens with severe colds. Interferon is an immune stimulant. The medication is experimental and not all vets are likely to have it or be enthusiasts about it's use.
Appetite Stimulants: Cats with colds have poor appetites, especially if they can't smell well. Offer them smelly foods like canned fish or microwave their dry food a little to bring out the aromas. Yum.
If needed, sometimes we give a tiny amount of Valium to cats or a medication called cyproheptadine, both of which are good appetite stimulants in cats with colds.
Prednisone: The use of prednisone in colds is controversial, mainly because prednisone is a steroid and steroids can cause immune suppression thereby preventing the body from fighting off the cold as effectively. The reason I like to use prednisone despite this potential problem is three fold:
1. It makes the cat feel better.
2. I don't think most cats immune systems are all that suppressed at the doses and duration we use (5mg daily for 3-7 days)
3. Short Term Prednisone therapy seems to make them get better faster
Isolation: If you have multiple cats, consider keeping them in separate rooms or parts of the house if possible. For one thing; cats without symptoms will often harbor the germ and give it back to the susceptible cat just when it was getting better.
Chicken Soup and "TOT": The expression TOT was taught to me by an older physician and means Tincture of Time. Colds can linger for a few weeks. So be patient. But return for rechecks if getting worse or not eating for more than a couple of days etc. I don't really know if chicken soup will help much, but I think it's a good source of electrolytes and nutrition...and it won't hurt.
Other supportive Care: I think vitamin supplementation are appropriate when fighting off a cold. Virasyl seems to be helping
Feline Bronchitis ("Feline Asthma")
TEXTBOOK OF VETERINARY INTERNAL MEDICINE
Client Information Series
Dr. Carol Norris
Feline bronchitis, commonly called feline asthma, is a disease in cats affecting the smaller airways that branch off the windpipe (trachea). These branches, called bronchi, allow the transport of air into and out of the lungs. When the bronchi become obstructed because of constriction or con-traction of the muscles in the walls of these airways, the inflammation or irritation of the airways, or excessive secretions that plug the insides of the airways, the end result is an impaired ability to bring oxygen into the lungs for delivery to the rest of the body. Although the term "asthma" is commonly used to describe this syndrome in cats, this term is somewhat misleading.
Asthma, in people, specifically refers to the reversible constriction of muscles in the walls of the bronchi. Some cats have true asthma, whereas others have bronchitis. Bronchitis is associated with inflammation and swelling of the walls of the bronchi that cause a narrowed passageway and airway obstruction by plugs of mucus or other secretions, which also narrows these tubes. Bronchitis can be acute (short duration) and associated with reversible changes in the structure of the airways or chronic (long duration, usually more than 2 to 3 months) and associated with permanent, irreversible changes in the airways.
Bronchitis and asthma can occur at the same time and can be caused by bacterial infections, parasites, allergies, or inhaled irritants; in many cases, the underlying cause cannot be found.
The most common signs of bronchitis in cats include constant, cyclic, or seasonal coughing; difficulty breathing; and/or wheezing. Episodes of coughing can mimic vomiting; some owners think their cats are vomiting up hairballs when they are truly having a coughing fit followed by retching.
Breathing may be rapid or require excessive effort; some severely affected cats may breathe with their mouths open. If your cat ever displays any of these symptoms, it should be promptly taken to your veterinarian for further evaluation, as these signs are a warning of potentially serious disease. These signs are not specific for bronchitis and can also be seen with many other diseases including heart failure, pneumonia, and lung cancer.
In the diagnosis of feline bronchitis by your veterinarian, the first test is usually to take a radiograph (x-ray) of the chest.
Second, your veterinarian may recommend obtaining a sample of cells from the trachea and bronchi to examine under a microscope and to culture for any infectious organisms.
It is also common to check the blood and feces for parasites (heartworm and lung worm, respectively).
There are several principles to follow in the treatment of feline bronchitis.
First, any underlying disease (for example, bacterial or parasitic infection) must be appropriately diagnosed and treated.
Second, changes must be made in the cat's environment, since cats with bronchitis often have sensitive, hyperactive airways, and inhalation of irritating particles from the environment can cause worsening of their disease. Consequently, it is strongly recommended that their exposure to smoke (cigarette or fireplace), dusts (cat litter, carpet fresheners, flea powder), and sprays (insecticides, hair spray, perfumes, and cleaning products) be eliminated or minimized.
Third, weight reduction in obese cats should be attempted under the supervision of a veterinarian. Finally, medication should be given to treat the airway obstruction directly.
Two classes of drugs are commonly prescribed:
bronchodilators (examples include theophylline, aminophylline, and terbutaline) and steroids (examples include prednisone, dexamethasone, and methlyprednisone).
Bronchodilators help to dilate or open the airways by relaxing the muscular walls. Common side effects of bronchodilators in cats can include gastrointestinal upset, restlessness, and lethargy.
Steroids decreases the inflammation and swelling of the airway walls. Side effects in cats are uncommon but may include behavioral changes.
It is important that your cat have regular rechecks with your veterinarian, as the doses of the medications commonly need to be adjusted. Prognosis is variable for this disease. If the underlying cause can be identified and successfully treated or eliminated, the prognosis is excellent. If permanent damage to the airways has occurred, the disease cannot be cured. With proper medical management, clinical signs can be controlled and the damage to the bronchi can be stopped or slowed.
Some cats suffering severe asthma attacks can die despite intensive medical efforts.
Pneumonia
TEXTBOOK OF VETERINARY INTERNAL MEDICINE
Client Information Series
Dr Alfred M. Legendre
Pneumonia is an inflammation of the lungs. It is rare in cats and less common in dogs than in people. There are many types of pneumonia, with bacterial and fungal infections being the most common.
The dog's lungs are not very susceptible to primary bacterial pneumonia, but prior lung damage predisposes them to secondary invasion by bacteria. The canine distemper virus causes severe damage to the cells lining the respiratory tract of dogs, making the lungs more susceptible to bacterial infection and pneumonia.
A common type of pneumonia is aspiration pneumonia, which occurs when dogs vomit and inhale that material into their lungs. Aspiration may occur when animals vomit after surgery because anesthetic drugs depress the swallowing reflexes.
Aspiration pneumonia may be caused by a condition called megaesophagus. In megaesophagus, there is abnormal movement of the esophagus (the tube that connects the mouth with the stomach), allowing food to accumulate instead of moving into the stomach. This pool of food and saliva is constantly regurgitated into the mouth and some of the material goes down the trachea into the lungs. Some diseases of the nerves that control swallowing can also allow entry of food into the lungs. The inhaled food contains bacteria and sometimes stomach acid that cause inflammation.
Dogs with pneumonia are usually brought to the veterinarian because of coughing, loss of appetite, depression, and difficulty breathing. They often have a fever. Lung sounds heard with a stethoscope are increased because of the abnormal pus and fluid in the airways.
The effort required to breathe gives an indication of the severity of the lung infection.
Identification of the cause of the pneumonia is necessary for optimal treatment. Chest radiographs (x-rays) are required for accurate diagnosis of pneumonia. Fungal pneumonias have a typical pattern of inflammation that helps differentiate them from bacterial pneumonia. In megaesophagus, there is an enlarged esophagus and the lung inflammation occurs in the lower part of the lungs. Diagnosis of bacterial
pneumonia secondary to distemper is difficult. Additional tests for distemper should be done in dogs whose vaccinations are not current. Bacterial pneumonia can also be secondary to tumors and foreign bodies, such as pieces of grass.
A complete blood count is helpful in assessing the severity of the lung inflammation and identifying secondary diseases. Obtaining pus and fluid from the airways is important in identifying the organism causing the problem. The type of bacteria and its antibiotic sensitivity determine the antibiotic needed. People can cough up a sputum sample for testing, but dogs are not as cooperative. A procedure known as a percutaneous (going through the skin) tracheal washing is an effective and relatively safe way to obtain material from the trachea and bronchi. A local anesthetic in the skin allows painless passage of a small tube through the skin of the neck into the trachea or windpipe. Fluid is injected through the tube to dilute the thick material in the airways, which can be sucked into a syringe. During the 2 to 3 days required for the bacterial test to be completed, an antibiotic likely to be effective may be started. This antibiotic may need to be changed when the culture results are obtained.
Antibiotics or antifungal drugs are the mainstay of bacterial and fungal pneumonia treatment, respectively. Dogs with severe respiratory difficulties may require oxygen treatment to improve their breathing. Nebulization of a fine water mist can help keep the airway moist, loosen thick mucus, and help the lungs remove debris through coughing.
The outcome of pneumonia in dogs depends on the cause of the pneumonia and the severity of the infection. There must be enough lung capacity to maintain an adequate oxygen supply to the body for at least 2 to 3 days until the antibiotics can begin to work.
Primary pneumonias without underlying disease are usually treated successfully. The prognosis for aspiration pneumonia depends on the ability to correct the cause of the vomiting and on the severity of the pneumonia. Pneumonias secondary to distemper or similar viral diseases have a guarded prognosis. At least half of dogs with distemper develop seizures because of the effects of the virus on the brain.
Much more about respiratory diseases coming soon...
Respiratory Infections, Pneumonia, and other BronchoPulomonary Disorders
Respiratory Cancer
Primary cancers of the respiratory tract are not too common compared to cancers starting in other organs...BUT...the lungs are a common site of secondary tumors...cancers that have spread from other places in the body. The large majority of cancers that do occur in the respiratory system...the most common type being in the nasal sinus of dogs...are malignant, so anytime a mass is detected within the nasal passages, the larynx, the trachea, or in the thorax, we're usually dealing with a very serious disease.
Nasal Tumors: Male cats are more prone to nasal cancer for unknown reasons, and certain breeds of dogs of both sexes are predisposed: Airdales, Bassetts, Old English Sheep Dogs, Scotties, Collies, Sheperds, Keeshonds, and German Short Haired Pointers. Most of the information for this article, by the way, is from "Saunders Manual of Small Animal Medicine"...a very respected text book. But my experience differs a little in that three of the 7 or so cases of nasal cancer I've seen have been in the Artic Breeds; Malamutes and Siberian Huskies. I only mention this to highlight that any breed can get cancer and if your pet is having trouble with nose bleeds, sinus congestion, facial disfiguration, or just a snotty nose that lasts more than a week, please get your pet to your veterinarian.
Other signs include behavioral changes (possibly from pressure on the Brain), seizures, and blindness. As serious as respiratory tract cancers tend to be, great improvements and success rates have been made in their treatment...especially if detected before excessive destruction and spreading of the cancer occurs. Unfortunately, most respiratory cancers have been growing, on average, for about 3 months before symptoms are obvious. Another reason for regular check ups. By listening closely to lungs, examining the oral and nasal passages, and by the palpation of lymph nodes, your vet is likely to detect trouble in the early stages when treatment is most likely to be curative.
For cancers within the thorax...usually carcinomas of the lungs...the main initial symptom is coughing; usually harsh and non-productive. And this is interesting...a lot of lung tumors are associated with arthritic (hypertrophic osteopathy) disease; so lameness may be a first clue. The trouble with all this is that most lung cancers are in older patients, and in older patients we often expect a little arthritic lameness and a little bit of a cough. It takes vigilance and extra effort to tell the difference...and sometimes it simply requires a more complete diagnostic work-up: Multiple X rays, ultrasound, and blood work. Unlike in Western Human Medicine where all this would be routine with any patient with persistent symptoms, in Veterinary medicine we sometimes have to twist your arm a little to authorize what might very well turn out not to be productive, but is required, nonetheless, if our goal is to detect lung cancer soon enough to help the patient.
For more about cancer in general and about the great strides in treatment improvement and success rates, please check out our page about Cancer
Obstructive Upper Airway Diseases
Tracheal Collapse
The trachea (windpipe) is made up of about 40 C-shaped rings of cartilage that are joined by muscle and ligaments to create a tube-like structure. Sometimes the trachea collapses, much like a soda straw being sucked on too hard.
This causes the pet to gasp for air and cough and gag.
Possible causes include trauma, birth defects, degeneration of the cartilage (usually in older dogs), genetic reasons, and general poor health.
Affected animals are frequently middle-aged or old, overweight, small-breed dogs, especially toy and miniature breeds, who may have an associated bronchial, throat, heart or liver problem.
A large heart may compress the trachea, worsening the coughing. A large liver reduces the space for lung expansion, further compromising oxygen supply to the body.
This problem can be tough to diagnose. A good examination, history, observation, and chest x-rays are usually needed.
A suspected case may need to go to a specialist for endoscopy. This procedure allows the veterinarian to see the extent of the problem inside the trachea.
Because other problems are often associated with a collapsed trachea, blood work and other tests will probably be recommended so we can figure out the extent of the problem(s).
Treatment
Possible Treatments might include:
Cough medications
Bronchodilators
Antibiotics
Anti-inflammatories
Diet Changes, especially if obese
Surgery
March 2003: I've just written about a similar problem: Laryngeal Paralysis. As this page is getting too big, I've placed this article on a second page. Click here
Fungal Respiratory Infections
Chronic Nasal and Sinus Diseases
Links to other sites about respiratory disease in pets coming soon...
