Feline Lower Airway Disease

Question 1: Is the cat in respiratory distress? 

YES: Provide oxygen support in a low stress manner and administer mild intramuscular sedation ASAP.  When the cat is more stable, then perform 3 view chest x-rays and draw for blood work.

NO: Yeah! Perform 3 view chest x-rays and draw for blood work in a low stress manner - using sedation here too always helps!

Question 2: Is this a younger cat (1-7 years) or older cat (4-13 years)? 

Young-ish: chances are higher that it is asthma with an eosinophilic component

Silver Fox-ish: chances are higher that it is chronic bronchitis with a neutrophilic component

Question 3: Is more testing an option (eg., financial budget, time budget, emotional budget, kitty minutes budget…)

YES: Then arrange for airway sampling, which could include an endotracheal wash (ETW), which you could do in general practice…OR bronchoscopy with bronchoalveolar lavage (BAL), which you would probably refer to a specialist. The ETW technique collects airway fluid samples for cytology and culture in a “blind” manner whereas the BAL technique uses a camera to actually visualize the airways and collect more directed sampling (see pics below).

NO: Roll up your sleeves for some empiric treatment options!

Question 4: How do I interpret these symptoms and tests and how do I treat this cat?

In general:

• Cough is the #1 sign, with occasional nasal discharge
• Asthma and chronic bronchitis look about the same - no difference in duration of signs, lab or x-ray findings
• Asthma is reversible bronchoconstriction, usually resulting from an inhaled allergen
• Chronic bronchitis is more “chronic” and causes airway thickening and mucous production
• Treatment is similar - anti inflammatory dose of oral prednisolone with transition to inhaled steroid for maintenance
• Remember to think through common infectious causes in your area as empiric treatment with a deworming protocol and antibiotic therapy would also be reasonable

JVIM Bronchoscopic Findings in 48 Cats with Spontaneous Lower Respiratory Tract Disease (2002–2009)

References

1. Differentiating Feline Inflammatory Airway Disease, Laura A. Nafe, DVM, MS, DACVIM (SAIM), University of Missouri, Clinician’s Brief.com, September 2021

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 About the Guide: Jessica Larson, DVM, DACVIM (SAIM)

Dr. Jessica Larson started her career in private specialty practice, where she stayed for many years. She then transitioned to an industry role for a few years as a professional services veterinarian working to launch exciting therapeutics. Currently, she is in a mobile specialty practice where she literally walks in the back door of many vet hospitals and jumps in to help!