Please enable JavaScript.

Coggle requires JavaScript to display documents.

Coughing (SA) (Chronic (Bronchitis (Tx (Drugs (Expectorants and Mucolytics…

- - - - Usually otherwise well
        Increased bronchial noise/wheezes on auscultation
        Cough elicited on tracheal pinch
        Sinus arrhythmia and absence of murmur help rule out cardiac causes
    - - “Diagnosis of exclusion”
        1. Radiography
        Increased bronchial markings (tram tracts and doughnuts)
        Beware of false +ve and -ve results
        2. Endoscopy
        May help confirm Dx or rule out other causes
        Irregular airways, mucous hypersecretions
        3. Tracheobronchial wash
        Mixed inflammatory cells and respiratory epithelial cells
        +/- culture, often negative
        4. Blood
        Haematology/Biochemistry usually normal
    - - Client education
        
        Realistic aim is to minimise frequency of cough
        Usually more irritating for 'O' than dog
      - Management
        
        Clean atmosphere
        Humidification, allows easier MCE clearance
        Diet
        Avoid choke chains/collars
        Exercise regime, limited but regular to loosen secretions and prevent mucous pooling in LRT
      - Drugs
        
        Antibiotics
        Short: Ind if signs are worsening
        Long: Caution resistance
        
        Expectorants and Mucolytics
        Cough suppressants (Antitussives)
        
        Opioids
        Butorphanol (cough supp.)
        Codeine (cough supp.)
        Bromohexine (Bisolvon)
        Mucolytic
        
        Anti-inflammatories
        
        Low dose corticosteroids
        VERY effective, be careful of 'O' being too dependent --> Iatrogenic HAC
        Also makes weight loss difficult
        
        Bronchodilators
        SE: Tachycardia, excitability
        
        Xanthine agents
        Theophylline (Corvental-D)
        Beta-2 agonists
        Terbutaline (Bricanyl)
        Adrenaline
        Anti-muscarinics
        Atropine
    - - Old, small breed, overweight
        Gradual onset, dry hacking cough
        Usually unproductive, paroxysmal
        Worsens with excitement/exercise
    - - Chronic irritation to bronchial mucosa:
        Mucosal hyperplasia and production
        Inflammation/2' infection
        Bronchospasm
        Reduced airflow
  - - - Physiology
        
        Lungworm of dogs and foxes
        Typical metastrongyloid nematode (indirect life cycle)
        Adults worms (2cm) found in p.arteries and RHS heart
      - Hx/PE
        
        1. Cardio-respiratory signs (Worms obstructing airways)
        Chronic cough unresponsive to antibiotics
        Exercise intolerance (young dogs)
        Haemoptysis
        2. Coagulopathies (Thrombocytopenia, reduced clotting factors)
        Subcutaneous haematoma
        Internal haemorrhage
        Prolonged bleeding
        3. Neurological signs (CNS haemorrhage)
        Paresis, ataxia
        Behavioural changes
        Loss of vision
        Seizures
      - Dx
        
        1. Haematology
        Eosinophilia
        Hypochromic anaemia
        Coagulopathy tests
        Antigen snap test
        2. Radiography
        Broncho/alverolar infiltration
        Nodular interstitial pattern
        Pulmonary hypertension
        3. Faecal exam
        Baerman technique for L1 larva (stiletto tail)
        Collect samples on 3 consecutive days as intermittent egg production
        4. Bronchoscopy
        Tracheal nodules
        Tracheal wash may show larvae
      - Tx
        
        1. Fenbendazole (Panacur)
        Off-licence, but should treat all resp parasite
        Daily for 1 week
        2. Moxidectin (Advocate)
        Single dose, prevents infection for 1 month
        3. Milbemycin (Milbemax)
        Once a week for 4 weeks
    - - Same as Angiostrongylus
        Expect nodules at tracheal bifurcation
        Good prognosis, may have some residual nodules that cause cough
    - - Feline lungworm
        Occasionally results in clinical signs
        Alveolar/interstitial disease
        Tx: Prolonged course of fenbendazole
  - - - Loss of normal structure of tracheal rings due to dorsal ligament stretching. Dynamic variation in diameter leads to cough and dyspnoea
    - - Typically yorkies and poodles
        Gradual, chronic cough
        Quacking/Honking
        If very severe, can progress to dyspnoea
        Affected dogs appear fairly normal
        +/- Audible clicking as airway collapses
        +/- tracheal malformation on palpation
        Cough elicited on tracheal pinch
    - - 1. Fluroscopy
        Collapse is dynamic, so xrays might not be enough. Can use to demonstrate and classify severity of collapse
        2. Endoscopy
        Use to demonstrate collapse
    - - Surgery
        Available but high risk, only consider for most severely affected patients.
        Intralumenal stenting, extralumenal stenting (?)
      - Medical
        Similar to Tx of chronic bronchitis
        Aim to reduce clinical signs of cough
  - - - Acute onset with recognised event (e.g: exercise)
        Halitosis as FB degrades
        Variable response to antibiotics/anti-inflammatories
        May have intermittent pyrexia
        May have localised increase in respiratory noise
        May have focal area of dullness on percussion
    - - 1. Radiography
        Focal involvement of one lung lobe, usually right caudal in dogs
        2. Endoscopy
        Visualise foreign body and retrieve
  - - - May be no clinical signs, incidental findings on xray
        Can be coughing due to airway involvement/compression/erosion
        Haemoptysis
        Weight loss
        Rarely causes dyspnoea unless very extensive
    - - May be no abnormalities, may be asymmetrical
        Movement of apex beat (PMI)
        Unilateral decreased resonance
        Unilateral increased respiratory noise
    - - 1. Radiography
        Neoplasia
        Granuloma
        Abscess, cyst
        Haematoma
        2. CT
        Better resolution
        3. Bronchoscopy + Tracheal wash
        Unlikely to help unless affecting major airway
        4. Biopsy/FNAB
        May be able to if mass is superficial
    - - Average survival 1 year
        Surgical lobectomy if no mets
  - - - CS
        
        Syndrome recognised in dogs
        May be immune-mediated (allergic) cause
        Hx of chronic cough unresponsive to antibiotics
        May be season or associated with other allergic diseases (e.g: atopy)
      - Dx
        
        1. Haematology
        Eosinophilia
        2. Radiography
        Broncial/alverolar pattern seen
        3. Bronchonscopy
        Increased mucous in airways
        Washes reveal predominantly eosinophils
        N.B: May be 2' bacerial infection with neutrophil inflammation
      - Tx
        
        1. Control secondary infection
        2. Corticosteroids
        Immunosuppressive dose, gradual taper to lowest dose
        
        Prognosis excellent but may require prolonged/lifelong therapy with risk of iatrogenic HAC
    - - Physiology
        
        Most common cause of chronic coughing in cats
        Antigenic stimulus causes:
        Inflammation
        Mucous
        Oedema
        Bronchoconstriction
        Results in airway narrowing
      - PE
        
        Intermittent dyspnoea and coughing
        Can be very acute in onset
        Rarely identifiable stimulus
        +/- Respiratory effort
        Audible wheezes especially on expiration
        Hyperinflation of lung
      - Dx
        
        1. Radiography
        Bronchial pattern with hyperinflation
        2. Tracheobronchial wash
        Inflammatory cells, predominantly eosinophils
        Can rule out parasites and 2' bacterial infection
        3. Bloods
        Haematology may show eosinophilia
      - Tx/Mx
        
        May be an emergency
        Oxygen
        Fast acting corticosteroid IV (e.g: methylprednisolone succinate)
        Bronchodilator IV (atropine, adrenaline)
        
        Corticosteroids
        Taper to low dose, use for nebulistion
        Bronchodilators
        Terbutaline
        Theophylline
        Anti-histamine
        Cyproheptadine
        Leukotriene inhibitor
        Zafirlukast (Accolate)
        Unlicensed but some reports in difficult cases