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___________ is the main sign of chronic bronchitis, which is not a(n) _________; it is due to ___(2)___.
Chronic or recurrent cough; primary diagnosis (it is rather an end-stage syndrome of clinical signs a pathologic changes);chronic inflammation and excessive mucus production
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What are a few causes of chronic bronchitis? (4)
- inhaled irritants- air pollutants, second-hand smoke, carpet cleaners, cat litter dust
- infectious agents- Mycoplasma, Bordatella, pulmonary parasites, heartworm infection, adenovirus, PI
- ciliarty dyskinesis
- gastroesophageal reflux
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What are the subcategories of chronic airway obstruction? (3)
- Intraluminal: mucus and plugs
- Intramural: inflammatory thickening, irreversible bronchiectasis w/ chronicity
- Extramural: dynamic tracheo-bronchial collapse
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What are radiographic findings associated with chronic bronchitis? (5)
- bronchial pattern- bronchial wall thickening and opacity, peribronchial infiltrates, donuts, tramlines
- bronchiectasis
- secondary RV enlargement (cor pulmonale)
- secondary traceo-bronchial collapse
- resorption atelectasis
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What is bronchiectasis, and why does it occur? What are sequelae?
- pathologic dilation of the bronchi; usually relate to chronic inflammation and damage to the bronchial walls
- predisposes to mucus retention and bacterial pneumonia
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Why can chronic bronchitis lead to cor pulmonale?
presumed to be secondary to chronic hypoxemia--> hypoxic vasoconstriction pulmonary hypertension--> right-heart failure
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What can be found on respiratory cytology with chronic bronchitis? (3)
- increased mucus
- mixed inflammation +/- eosinophils
- usually no growth on culture, but can have Mycoplasma/ Bordatella
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What is the therapy for chronic bronchitis? (6)
- antibiotic response trial
- antacid (PPI) response trial
- steroids
- bronchodilator (inhaled)
- facilitate mucus clearance with hydration, mild exercise
- dental care
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What factors are incriminated in causing feline asthma? (4)
- allergies (hypersensitivity to dust, mites, pollen, mold, etc)
- airborne irritants (cat litter dust, powders/ sprays, smoke)
- infectious bronchial infections
- mostly idiopathic though!
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What are the 3 components of feline asthma, and the implications with each?
- Bronchoconstriction: responsive to bronchodilators
- Inflammation: responsive to corticosteroids
- Mucus: accumulation of excessive bronchial secretions in airway lumen
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What receptors are involved with bronchodilation?
beta-2 adrenergic
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What NS mediators are involved with bronchoconstriction?
- parasympathetic nervous system (acethylcholine and muscarinic receptors)
- serotonin
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Intramural airway obstruction with feline asthma occurs due to... (6)
inflammatory thickening, fibrosis, smooth muscle hypertrophy, mucosal edema, hyperplasia of airway epithelium, and goblet cell hyperplasia
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Extramural airway obstruction with feline asthma occurs due to...
emphysema, resulting in loss of normal tethering function of parenchyma to keep small airways open.
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PE findings and history with feline asthma. (9)
- Hx: episodic cough, dyspnea, wheezing
- PE: tachypnea, expiratory dyspnea, expiratory wheezes, increased bronchial sounds, barrel shaped thorax
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What are the 4 overlapping syndromes with feline asthma?
- Bronchial asthma: bronchoconstriction
- Acute bronchitis: inflammation and mucus accumulation
- Chronic bronchitis: bronchoconstriction, inflammation, and mucus accumulation
- Emphysema
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A presumptive diagnosis of feline asthma can be based on... (8)
- Clinical signs: cough, episodic dyspnea, wheezing
- PE findings: expiratory wheezes, increased bronchial sounds
- Radiographs: bronchial pattern, flat diaphragm, collapsed R middle lung lobe (atelectasis)
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What are radiographic findings with feline asthma? (3)
- bronchial pattern
- overinflation of lungs
- atelectasis of R middle lung lobe
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What are differentials for eosinophilia in a cat with chronic cough? (3)
- asthma (inconsistent finding with asthma)
- heartworm disease
- pulmonary parasites (aelurostrongylosis)
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What additional diagnostic procedures can be pursued to diagnose feline asthma? (2)
ETW or BAL for cytology and culture: increased mucus, eosinophilic inflammation, mixed inflammation, no inflammation; culture usually NG, maybe Mycoplasma (normal flora tho...)
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What is the chronic therapy for feline asthma? (5)
- control airway irritants: use open and dust free unscented litter
- anti-inflammatories: inhaled fluticasone, inhaled pulmocort, oral prednisolone
- bronchodilators: inhaled albuterol, oral terbutaline, oral theophylline
- if infection suspected, antibiotics: Doxy for 3 weeks for Mycoplasma
- ASIT: intradermal allergy test, antigen-specific IgE injections, may or may not work
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Describe the acute management of feline asthma. (3)
oral prednisolone until clinical remission (2+ weeks), switch to inhaled steroid, oral bronchodilators
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What is the most important prognostic indicator with feline asthma?
response to therapy (high mortality with feline asthma)
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