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Feline Bronchial Disease - Coggle Diagram

- - - - Inhaled allergens
        
        Th2 driven inflammatory reaction
    - - The primary effector cell in feline bronchospasm
    - - Airborne irritants
        
        Litter dust
        
        Powders
        
        aerosols
        
        Smoke
      - Bronchial infection
        
        Viral
        
        bacterial
        
        Mycoplasma
        
        parasitic
      - Underlying allergy
      - Idiopathic
  - - - Tachypnea
      - Dyspnea
      - Wheezes
      - Crackles
      - Cough
      - Naso-ocular discharge
      - May be normal
      - acute respiratory distress
  - - - Interstitial pattern
        
        Blood vessel margins are indistinct/hazy
        
        Infiltration within extracellular space of lung
      - Bronchial pattern
        
        "Donuts"
        
        "tramlines"
        
        Thickening of airway walls, infiltrates in or around airway walls
      - Alveolar pattern
        
        Air bronchograms
        
        Fluid/infiltrate within airspace, alveolar space
      - Interstitial to patchy alveolar possible
      - Collapse of right middle lung lobe 10%
      - Overinflation of the lung
        
        Increased lucency of the lungs
        
        Flat, caudally displaced diaphragm
        
        Ventral bowing of the caudal vena cava
        
        Extension of the lung past L1
    - - Response to treatment
        
        Treatment trial with oral steroids and airway dilator
        
        If poor response, additional diagnostics
    - - Eosinophilia possible
    - - Increased total protein possible
    - - Feline bronchial disease
      - Laryngeal disease
      - Tracheal disease
      - Heart disease
      - Heartworm infection
      - Pleural effusion
      - Neoplasia - bronchogenic carcinoma
      - Parasitic disease
      - Pneumonia Airway wash
      - Endotracheal wash
        
        Feed catheter
        
        Inject saline 3. Aspirate saline
      - Bronchoalveolar lavage (BAL)
      - Reasons to perform airway wash
        
        To characterize the inflammatory response
        
        To identify
        
        infectious agents
        
        culture
        
        neoplastic cells
        
        atypical radiographs
        
        don’t respond to treatment normal:
        
        Predominant cell types are alveolar macrophage and lymphocytes
        
        Less than 10% of cells are PMNs
        
        Total cell count is less than 400/ul
        
        Eosinophils can be present
        
        Epithelial cells, goblet cells, mast cells may be seen
        
        Some normal cats have a positive culture
      - asthmatic:
        
        Increase in total cell count
        
        Eosinophils
        
        Neutrophils
        
        Macrophages
        
        Mixed
        
        Excessive mucus seen
        
        Culture is positive in 10-25% of cases
        
        Pasteurella multocida
        
        Moraxella sp
        
        Probably play a minor role in the disease
        
        The exception may be Mycoplasma
- - - - Bronchial pattern usually
      - Interstitial to patchy alveolar possible
      - Bullae (emphysema) may be seen
      - Collapse of the right middle lung lobe
    - - Neutrophils
      - mucus
      - positive culture
  - - - Remove any underlying etiology
        
        Treat any identified infectious agent
      - Provide anti-inflammatory therapy
      - Provide bronchodilator therapy
    - - Unscented, dust-free cat litter
        
        Sand, ‘Yesterday’s news’
      - Remove hood from litter box
      - Change air filters in the home
      - Minimize exposure to smoke, aerosols, powder
      - Outdoor cats should become indoor cats
      - Humidification
    - - Can be given orally or by injection
        
        Aminophylline
        
        theophylline
        
        theophylline ER
      - Phosphodiesterase inhibitors
        
        Increases cAMP and cGMP
      - Inhibits calcium influx into cells
      - Blocks adenosine receptors
      - Adenosine leads to contraction of bronchial smooth muscle in some species side effects
        
        Gastrointestinal upset
        
        Vomiting
        
        diarrhea
        
        anorexia
        
        Neurologic signs
        
        Hyperexcitability
        
        Seizures
        
        Availability and cost Beta2 agonists
        
        Can be given orally, by injection or as inhalants
        
        Terbutaline
        
        Albuterol
        
        Used to reverse acute bronchoconstriction
        
        onset of action is within 5 minutes of inhalin
        
        duration 3-6 hours
        
        Chronic therapy can lead to
        
        airway inflammation
        
        drug tolerance
        
        Relax bronchial smooth muscle
        
        Decrease airway mucus viscosity
        
        Enhance mucociliary clearance
        
        Do not control inflammation
        
        Expensive
      - Glucocorticoids
        
        Remain the most effective long term therapy
        
        Anti-inflammatory effect
        
        Permissive effect on Beta2-receptors
        
        Can be given orally, by injection or as inhalant
        
        High dose is initially recommended
        
        Slow taper over 2-3 months
        
        Use the lowest effective dose
        
        Can combine with a bronchodilator Inhalant
        
        Minimizes side effects
        
        Fluticasone (Flovent) most commonly used
        
        Starting dose 40-110 ug BID
        
        Improvement is generally seen within 2 weeks
        
        Oral prednisone can be weaned
        
        Very expensive Other treatments
        
        Antibiotics against Mycoplasma
        
        Cyproheptadine
        
        Serotonin inhibitor
        
        Appetite stimulant
        
        Omega-3 fatty acids
        
        Cyclosporine
        
        Hyposensitization
        
        Mesenchymal stem cell therapy (decreases airway remodeling) If patients are not responding
        
        Consider an airway wash
        
        Cytology
        
        Culture
      - Consider a thoracic CT scan Cheat sheet: How do I treat?
      - Mildly affected asthmatic
        
        Environmental changes
        
        Oral prednisone, slowly tapered
        
        Bronchodilator
        
        Oral BID
        
        inhalation PRN
        
        Availability?
        
        Moderate to severely affected asthmatic
        
        Discuss environmental changes
        
        Oral prednisone for at least 2 weeks
        
        Fluticasone 40-110 ug BID initially
        
        Bronchodilator (either beta agonist or methylxanthine)
        
        Can be started orally
        
        Can be started with an inhaler
        
        BID or PRN
        
        Availability and cost?
        
        Emergency case/dyspnic cat
        
        Minimize handling
        
        Oxygen cage
        
        SQ terbutaline (bronchodilator)
        
        Can be given at home by owner
        
        IV dexamethasone
        
        Lasix if concurrent heart disease Prognosis