The following papers were kindly provided by two respiratory specialists working in the UK, and deal with diagnosis and treatments. They are written in veterinary terms and we therefore recoomend that you print them off and take them to your vet for reference.
Dr. Andrew Sparks BVetMed PhD DipECVIM MRCVS-CA: Chronic Bronchial Disease in Cats
Dr. Danièlle Gunn-Moore BSc BVM&s PhD MACVSc MRCVS: Dyspnoea in Cats
Home Oxygen Therapy
Many animals are not properly diagnosed until a crisis occurs at which point, the natural instinct is to quite rightly get to the vet ASAP however, once diagnosis is confirmed and a management plan has been drawn up, it is worthwhile remembering that most respiratory patients do much better in their own homes and as stress plays a major roll in exacerbating symptoms, and can trigger them in the first place, the more that can be managed at home, the better for the cat. We have already discussed drug regimes and the tapering up and down of steroids to control symptoms however, home oxygen therapy can further compliment this, saving on unnecessary stress to your pet and huge vet bills! Common sense must be used, and if the animal is suffering severe respiratory difficulty, it is probably wise to get them to your vet ASAP however, a crisis can often be avoided by staying calm and trying to bring symptoms under control at home, if time permits. It is a fact that the respiratory system is naturally at rest at around 4am so it is not uncommon for these flare ups to occur in the middle of the night, when you cannot see your vet in any case and may end up seeing a duty vet in an emergency clinic who has no experience with your cats disease.
Home oxygen need not be complicated and there are various ways to administer it but first off, you will need the equipment. The photo below shows a portable valve system that clamps onto a portable oxygen cylinder. The cylinder shown is type E and contains 180 litres of oxygen. Your vet will be able to order one of these from his supplier. All vets also have an account with an oxygen supplier who delivers and then collects empty canisters at a later date. You could make arrangements with your vet to drop off empty canisters for refill although it is best to have at least one spare at home at all times. This valve system allows you to regulate the flow of oxygen and a fine tube is then attached through which the oxygen flows.
There are three ways to give this to your pet. Firstly, you can simply cover a pet cage with a towel and insert the tubing through. Most people may find this the easiest route but cats often turn away from the direct flow so you need to use it a fairly high flow rate, meaning more hiss to scare kitty and the quicker the canister will run out. The second route is to just hold the tube as close as possible to your cats nose, as illustrated. You need only use a little oxygen in this way, with far less hiss and this will greatly improve your pets oxygen concentration.
The third route if kitty will allow, and fairly simple if there is a degree of open mouth breathing, is to insert the tube between the teeth so the flow is directed towards the throat, as illustrated. Some cats allow a thinner tube to be inserted into the nostril but for most, even when taped on, they tend to pull it free in a short amount of time. Cats can improve very quickly with just ten to fifteen minutes of oxygen therapy and you will likely notice the gums and tongue are nice and pink when you have finished which means the cat is adequately oxygenated. If this is not the case, you should seek veterinary help. A good oxygen supply is vital for all major organ function and can help to fight infection too so it's certainly worth considering for the chronically sick pet that has frequent bouts of breathing difficulty and these episodes are then easily managed without fuss. Remember, animals pick up on our vibes, if you panic, they do to and this is the last thing you want with a respiratory patient.
Put the Albuterol solution into a little chamber by a mouth piece, then place the mouth piece that is attached to a plastic tube into a vent of my cat's carrier. The carrier is covered with a towel to keep the Albuterol mist inside. Turn on the nebulizer and this sprays a fine mist of Albuterol into the cage.The cat just leisurely breathes it in at his own pace while he's resting inside of the carrier. You don't have to give exact, measured amounts, as with the mask. The whole process takes about ten minutes and does not seem to be stressful at all.
Nebulizers can also be used to decongest mucous in pneumonia, and in some cases, both steroids and antibiotics can be administered by this route. However, the droplet size of the medication is crucial andf therefore should be strictly under the guidance of your vet.
With this chamber the efficiency of absorption of medication is greatly enhanced so the dosage of medications can be decreased. This mask was designed specifically for usage by cats and therefore is much more effective than previous masks.
This has shown to be a good complementary method and can be used alongside all other medications and therapies. It is widely used in the treatment of asthma in humans and has shown to quite markedly reduce the amount and severity of attacks in a significant amount of people. Quite often they are then able to reduce the doses of steroids and the use of inhalers. It relieves Bronchospasm and re-balances the immune system.
Acupuncture on animals has to be carried out by a qualified veterinary surgeon.
In the first session, which will probably be between thirty to sixty minutes, the vet, working with Traditional Chinese Medicine, will take an extensive history of your cat from the time of him/her being a kitten, noting all the illnesses/problems that have occurred since then as well as looking at the general behaviour, habits, onsets of problems etc. After this, the vet will decide on the points to be used and draw up a treatment plan.
You can expect between 4 and 10 treatments before you see some response. The vet would usually start quite carefully using just a few adequate points since too many can over-stimulate the system and possibly trigger an attack. Depending on the response, the cat might then require treatment fortnightly, monthly etc. It varies from case to case. However, it must be stressed that this is not a cure but it will help to relieve and improve. Most animals find it quite relaxing and might even have a little snooze on the table with the needles in place!
The goal for asthmatic cats is to decrease inflammation, dilate the airway and diminish mucus production. Medications can be administered orally, inhaled, or intravenously. Some medications can also be made into liquid suspensions or transdermal gels. Commonly prescribed medications include broncodilators, steroids, inhaled steroids, antihistamines, leukotreine receptors, holistic, homeopathic & herbal medications and vitamins.
Albuterol: US Proventil®, US, UK Ventolin®; UK Salbutamol®
Terbutaline: Brethine®, Bricanyl®
Theophylline: Theo-Dur®, Aminophylline®, Corventil D®
There are two types of bronchodilators used in cats. Sympathomimetics (Albuterol, Terbutaline) primarily used for rapid relief of breathing difficulty, commonly known as revivers and to be used for sudden attacks. Albuterol is an inhaled medication that relaxes the muscle that surrounds feline and human airways, the muscle that can spasm in an asthma attack and cause cough and difficulty breathing. It may be used up to four times daily or as needed for asthmatic cats already on daily steroids and every half hour, for 2-4 hours in a crisis. Terbutaline is in oral, injectable and syrup form and is almost identical to Albuterol, although many owners report the drug makes their cats spacey and/or disorientated. Terbutaline is also available in a child's syrup called Bricanyl® in the UK and Canada. The feline dosage is 2ML twice a day. Can be used three times daily if needed. Salmeterol is a long acting inhaled bronchodilator. It lasts 8-12 hrs in cats. It takes 1-2 hours to take effects and should not be used in a crisis. Side effects can include palpitations and trembling, tachycardia and musculoskeletal twitchiness at the highest doses.
Xanthines (Theophyline). Used for the long-term prevention of breathing difficulty, in oral form. Theophyline when used with Prednisolone has a little understood action of increasing the anti-inflammatory process where others bronchodilators do not. Side effects can include headache and palpitations.
Current research suggests that bronchodilators when used alone may result in quiet progression of asthma and irreversible lung damage. This is because the inflammatory process is allowed to continue while symptoms are masked with the bronchodilators. Bronchodilators do not reduce the inflammation in the lungs. It is better to provide concurrent therapy with steroids. The use of bronchodilators is contraindicated in patients with cardiac disease. so this condition should be ruled out before use of bronchodilators.
Corticosteroid's work to reduce inflammation and are the most familiar long-term treatment of feline asthma. Steroids are available in many forms including oral, injectable and inhaled. Only oral and injectable steroids are discussed here, inhaled steroids have their own section.
Prednisolone may be administered in oral form or produced by the body from Prednisone which is activated by the patient's liver into Prednisolone. Depo-Medrol is idministered in injection form.
Although felines are considered "steroid resistant", they are still subject to steroid side effects. The side effects of oral and injectable steroids are essentially the same. Both being systemic steroids, you can expect increased thirst, appetite, and urination. Long-term use effects vary among different cats and according to dosage and they include kidney disease, liver disease, pancreatitis, diabetes mellitus, behavioral changes, polyuria, cystitis, and inappropriate urination, stomach or intestinal ulcers, weight gain, altered mood and personality, cataracts, glaucoma, hypertension, osteoporosis, aseptic bone necrosis, increased susceptibility to infections (immunosuppression), peptic ulcer disease, tuberculosis and Cushing’s syndrome.
Injectable steroids do carry more risks than oral because the dose cannot be reduced once it is in the body; you have to wait for its effects to wear off over potentially months. There is also a higher incidence of steroid induced diabetes associated with the long acting depo shot.
It is suggested that steroid doses be given in the evening to tie in with the body’s own production of anti-inflammatory hormones. (Cortisone).
Check out the pictures of Frankie and Keisha receiving their inhaled medications
Inhaled steroids usually do not get past the first few layers of cells in the lungs, though a tiny amount escapes into the system, therefore significantly reducing the likelihood of side effects associated with the oral route. They only affect the lungs while oral or injectable steroids are systemic and therefore affect the whole body. For this reason, there are far fewer side effects of inhaled steroids than oral or injectable steroids. There can be minor side effects such as throat irritation, voice loss, gag reaction and stomach upset from the swallowed medication.
The final Flovent® treatment protocol for the AeroKat has not been officially published by Dr. Padrid. In the meantime, he suggestions the following protocol (pdf) to get a feline started on inhaled steroids.
The only antihistamine that is useful in feline asthma treatment is Cyproheptadine: Periactin®. This is because the antihistamine portion of Cyproheptadine is not the useful portion for asthmatic cats. It is the anti-serotonin portion that helps. Serotonin is involved in feline asthma, but histamine is not, the standard dose for the asthmatic cat is 2mg twice daily however, many owners report their cats are extremely spaced out on this dose and should this hyper-sensitive reaction occur, it is worth trying the drug at a half or quarter of this dose, before deciding to discontinue. The drug also acts as an appetite stimulant and is commonly prescribed for non-asthmatics for this purpose.
This class of drugs include Zafirlukast: Accolate® and Montelukast: Singulair®. A very few patients are using these drugs however; studies would suggest they have not been shown to have a widespread use in feline asthma and more trials and data are needed.
The drug was being used by some specialists at a University veterinary hospital in the UK with reported success at doses of 5mg twice daily. The drug has a reputation of being tough on the liver so initial treatment needs to be monitored very carefully and any changes in behaviour whatsoever should be assessed by a vet. Some cats are unable to tolerate these doses and in those cases, it may be worthwhile to experiment with lower doses. Some animals were able to get away with as little as 2.5mg every other day.
Holistic, Homeopathic & Herbal Medications
Many pet owners opt for alternative therapies, particularly if the disease is mild or if they feel a product is beneficial, alongside the conventional meds. In this regard, we recommend that you employ a homeopathic or alternative medicine vet, preferably by a referral from your vet, or another person who has used their services. It is always very tempting to try some of the remedies available, especially with so many products claiming miracle cures however, while there is no doubt some therapies can be useful in some cases, certain herbal remedies for example can interfere with conventional medicines so these treatments are best left to the professionals although of course, many feline asthma members will share their own experiences which should help with your evaluation.
Many people choose to use vitamins for their pets to help boost the immune system and support the respiratory system generally. This can be particularly beneficial with the elderly patient where the immune system is already flagging. The vitamins listed below are suggestions only, drawn from list members who use them daily but again, vitamins can do harm as well as good so we therefore recommend that you discuss their use with your vet prior to treatment.
This list is a reference guide to assist with the chronically sick and elderly pets. A healthy cat or a cat with mild or well controlled asthma should not require any specifically targeted therapy and should receive all the nutrients required from a good balanced diet. There are also many multivitamin and mineral supplements available for pets as well as immune support supplements and these should be adequate in most cases. Please discuss with your vet.
Vitamin C - Ester C is recommended, as this is gentler on the stomach -250mg daily. The vitamin is well known for accelerating the healing of damaged tissue and for its role in maintaining healthy immune and circulatory systems, strong bones and teeth. There are also reports that it may minimize the risk of cancer. Cats do naturally produce a little vitamin C but with the chronically sick, a supplement is worthwhile.
Vitamin E - this should be the natural vitamin E, (look for d-alpha tocopherol) - 50 IU (international units) is a suitable dosage rate. This vitamin helps to fight infection and disease. It is an anti oxidant and helps preserve the activity of vitamin a and fatty acids in food. Wheatgerm oil is a good source and promotes a good glossy coat.
Cod Liver Oil - 300mg capsule, one week in every four or twice weekly. Apart from its effect in helping to prevent and treat the symptoms of arthritis, and in helping to maintain a healthy skin and coat, the vitamins a and d in cod liver oil assist in the function and maintenance of eyesight, tooth formation, nervous tissue, bones and joints. Vitamin a is also an antioxidant and combats the effects of chemicals and pollutants. Due to the vitamin a content of cod liver oil, the dosage rate should never be exceeded, for in excessive amounts, vitamin a, which is stored by the liver, can cause damage to bones and joints.
Evening Primrose Oil - 500mg capsule daily. This has long been used to help promote a healthy skin and coat however; more recently, studies have shown it can have an anti-inflammatory effect. The oil contains not only the essential fatty acid, linoleic acid, but also the important substance gamma linolenic acid or gla. In the body, linoleic acid must be converted into gla before it can produce prostaglandins. These important hormone like substances enable the body to control and regulate a variety of such functions as cell growth and regeneration, muscle action, and healthy circulation. The conversion of linoleic acid to gla can be disrupted by modern food preparation, vitamin and mineral deficiency as well as metabolic disorders such as diabetes, viral infection, hormonal changes and aging. It is debatable how much anti-inflammatory action this oil may have when given to cats, because in one study, doses of 7000mg daily were used in dogs before any anti inflammatory action was observed. Although the dosage rate is not dangerous as such, it is unlikely that this amount of oil would be tolerated by the average kitty stomach!
Co Enzyme Q 10 - 10mg-30mg daily. This is a natural vitamin like substance that is essential for the release of energy from all cells in the body. The substance occurs naturally in foods and although the body can make CoQ10 from food, the ability to do this declines with age. It is an antioxidant and antioxidant nutrients are able to quench free radicals before they can damage cells or tissues. Recent studies have also shown it may help with heart disease. There are now veterinary products on the market, which your vet can provide if appropriate.
L Lysine - 500mg-1000mg once daily. This is one of the essential amino acids, the building blocks for protein, which is needed for normal growth and development in the body. Some owners have found this supplement useful where a viral element to their cats disease is suspected (Herpes) and symptoms such as excessive tearing and general signs of a viral flare up are said to improve with its use.
Vitamin B Complex - pediatric dose once daily. The B group of vitamins are vital to the feline and have many functions in the body, including that of helping to fight disease. The vitamins are water soluble (with the exception of B12, where small amounts are stored by the liver) are therefore need to be replenished daily. Vitamin B12 is stocked by all vets in injection form and is often prescribed to promote appetite, and help with anemia where a deficiency of vitamin B12 is the suspected cause.
Cranberry - Various doses, available in capsule and powder forms. Cranberry supplements can be used as a natural way to ward off urinary tract infection where this is a persistent problem. It willalso help with cystitis and bladder problems generally.
Probiotic Digestive Aids - many available, containing friendly bacteria essential for healthy gut flora. Particularly useful following antibiotic therapy to restore gut flora and in studies, it was shown that patients given a probiotic during antibiotic therapy recovered faster. The theory is that that probiotic contains billions of good bacteria and more than the antibiotic can destroy.
Some medications, including prednisone, can be made into a transdermal gel. it comes in pre measured syringes and you put on a rubber/vinyl glove and squeeze a dose onto your finger and rub it into the flap of the cat’s ear. These can be made at a compounding pharmacy.
From Dr. Padrid on Transdermal Gels
I wanted to remind us all that there is a significant potential risk in using medications that are compounded into creams to be applied to the skin: there are zero studies on how much, how quickly the drug of interest is actually absorbed. With a disease like hyperthyroidism, we can measure thyroid levels in the blood to tell us if the tapazole cream is effective, But, for other drugs, especially including steroids, there is just no way to know what we are actually giving when we apply a cream or compounded patch etc.
A recent pharmacologic study using steroids on the skin (inside flap of the ear) on the theory that they will be absorbed and therefore as useful as oral steroids, for kitties that are difficult to pill. First, remember, if it works, it carries the same side effects as pills. More importantly, the study demonstrated that even at 10 times the oral dose applied to the skin, no steroid could be detected in the blood stream after topical application.