Respiratory

Atrophic Rhinitis in swine tx and prevention

No effect on age to market if ventilation is excellent, esp if Bordetella only Antibiotics in feed and water not very effective for prevention Bordetella and Pasteurella vaccines often disappointing Early medicated weaning or SPF (Specific Pathogen Free)

Retroviral Pneumonias in small ruminants etiology

Ovine Progressive Pneumonia = OPP Caprine Arthritis-Encephalitis = CAE Maedi is European name for OPP (Maedi- Visna) closely related retroviruses serological cross reactions virus upregulated by bacterial infections

Mycoplasma Pneumonia in swine impact on economics

Unthriftiness, poor weight gain 4% increase in affected lung tissue slows growth to market weight by about 1 month Very low mortality unless PRRS also present in herd 50% prevalence in slaughtered pigs

"Pasteurella" Pneumonia prevention in small ruminants

adequate colostrum vitamin E / selenium to prevent inhalation, support immune system barn construction and ventilation (shouldn't have high humidity in winter from plastic covering holes) avoid dusty feed and bedding vaccination against leukotoxin? - not effective to protect against strains metaphylaxis with oxytetracyline or tilmicosin

Retroviral Pneumonias in small ruminants CS + DX

adult sheep and goats dyspnea weight loss interstitial pattern on Xray (like CLA) ultrasound guided percutaneous lung biopsy more expensive than necropsy

Ddx for coughing in small ruminants

ammonia or dust? tight collar, pushing against barrier? chronic in otherwise healthy animal? Think mycoplasma enlarged retropharyngeal node? Think caseous lymphadenitis possibly lungworms, but Muellerius often subclinical pneumonia, especially bacterial

Respiratory Syncytial Virus in small ruminants

caprine strain? strong serologic reaction with BRSV high fever, cough, drop in milk spread by showing goats BRSV vaccination? Efficacy not tested - if try, use the Zoetis monovalent product (Bovishield BRSV)

Lungworms in small ruminants CS

cough secondary bacterial bronchopneumonia chronic weight loss - esp goats Baerman on feces for larvae: Muellerius has dorsal spine worms in trachea, lesions in dorsal diaphragmatic lobes

Caseous Lymphadenitis Prevention in small ruminants

cull wasting sheep and goats cull before abscesses drain don't buy from infected herds serology (SHI U.C. Davis) before purchase - not great test shear youngest sheep first disperse immediately after shearing Vaccination (Case-Bac, Colorado Serum Co; new bacterin for goats from Texas Vet Labs)

Inhalation Pneumonia in small ruminants

drenching white muscle disease cleft palate R cranioventral lobe most severe

Jaagsiekte CS

fluid out nose when wheel-barrowed weight loss multifocal tumor may look grossly like OPP focal alveolar proliferation metastasis to thoracic and abdominal nodes possible very rare in US, killed Dolly the cloned sheep

Lungworms in small ruminants TX and Prevention

importance depends on region treatment: levamisole (Dictyocaulus), ivermectin, fenbendazole Muellerius probably not all killed Prevention: keep off pasture (usually not an option) adult sheep develop immunity Scandinavia: 2 mg/kg fenbendazole per day for 14 days to kill Muellerius in dry goats, but selects for resistant strongyles

Nose Bots in small ruminants

larvae of Oestrus ovis, a fly larvae deposited into nostrils - migrate nasal exudate and sneezing larva may rarely penetrate to brain ivermectin kills all larval stages: 200 ug/kg sheep AND 300 ug/kg goats Oestrus ovis in cornual sinus at dehorning

Jaagsiekte Dx and TX

no treatment do not buy from infected flock no serologic test new PCR for proviral DNA in leukocytes cull all thin animals promptly

PE of Small Ruminants for respiratory

observe animal at rest body score (1-5 scale) and mucous membranes - anemia can cause dyspnea - FAMACHA SCALE (BETTER SHEEP THAN GOATS) - 5 fat and 5 fatal observe after exercise or holding off nose check airflow (bilateral) from nostrils, odor peripheral nodes, including retropharyngeal auscultation, esp right side also listen ahead of shoulder on right normal small ruminant lungs sound "harsh", *panting is normal* thoracic radiographs - pull front limbs forward, blindfold aids restraint - listen near manubrium chest ultrasound most rewarding if have sector scanner - narrow intercostal space

Thyomoma in small ruminants

old sheep and goats space occupying mass in thorax muffled heart and lungs sporadic may be incidental at necropsy differentiate from lymphosarcoma malignant population is epithelial cell

Ddx for dyspnea in small ruminants

upper respiratory tract disease lower respiratory tract disease toxemia metabolic problem (hypocalcemia, acidosis) anemia, hydrothorax differentiate from normal panting

Retroviral Pneumonias prevention in small ruminants

virus in colostrum and milk - especially goats remove young at birth and rear artificially OR two herd approach based on repeated serology (AGID or ELISA) (separating lambs from adults after weaning often works) pasteurize colostrum 133oF = 56oC one hour sterile needles and surgery equipment include all small ruminants in program Genetic Resistance to OPP

Jaagsiekte etiology

"driving sickness" sheep pulmonary adenomatosis, SPA retrovirus etiology an associated herpesvirus is apparently reactivated when immunosuppressed, does not cause the disease adult sheep and goats, 2 to 4 years old

Caseous Lymphadenitis Etiology and CS in small ruminants

Corynebacterium pseudotuberculosis long incubation, often 6 months or more some sheep or goats in herd may have abscesses in external nodes - parotid nodes cough if retropharyngeal lymph node enlarged wasting, dyspnea, cough if pulmonary abscesses

Lungworms in small ruminants

Dictyocaulus filaria - direct life cycle, in trachea and bronchi Protostrongylus rufescens - indirect life cycle with intermediate host snails or slugs; in trachea and bronchi Muellerius capillaris - indirect life cycle with snails or slugs; in alveoli - common in pastured sheep and goats in NY

Inclusion Body Rhinitis in pigs

Discharge plugs nostrils so breathe through mouth 1 to 2 week old piglets No turbinate atrophy Some stillbirths Endemic in many herds without signs

Mycoplasma Pneumonia in swine etiology and DX

Enzootic pneumonia Etiology: Mycoplasma hyopneumoniae (HYO means swine) DX: coughing in young pigs - dry, nonproductive red then pale, firm, cranioventral lesions invaded by Pasteurella estimate percentage of lung involved on slaughter checks

Enzootic Intranasal Tumor in small ruminants

Etiology: retroviruses - herd outbreaks support infectious etiology may have genetic predisposition may import with exotic breed closed herd helps to prevent slaughter, as tend to regrow after surgery CS: unilateral stertor wt loss exophthalmos - *NASAL FROTHY DISCHARGE* DX: DV radiographs and Necropsy (IHC)

"Pasteurella" Pneumonia etiology and CS in small ruminants

Mannheimia haemolytica Pasteurella multocida less common Mycoplasma may be involved PI3 or BRSV may initiate some infections CS: found dead dyspnea, froth at mouth poor doers *beware hypocalcemia in late pregnancy or lactation - looks like pneumonia!*

Mycoplasma Upper Respiratory Tract Infections spp of small ruminants

Mycoplasma conjunctivae - pink eye Mycoplasma ovipneumoniae - chronic cough - Until ~ 8 months - Kills bighorn sheep Mycoplasma mycoides subsp capri (was M. mycoides subsp mycoides large colony type) - California goats Mycoplasma ovipneumoniae less severe, commonly isolated (S&G) Mycoplasma capricolum subsp capripneumoniae (F38 mycoplasma) Contagious Caprine Pleuopneumonia - exotic

What is Canine nasal neoplasia? TX

A. *Multi-fractionated radiation therapy*: tx of choice and MST is ~1 year, but may be improved depending on tumor type. B. *Stereotactic radiation therapy*: delivery of a 1-2 doses of high dose of radiation had a MST of 8.5 months in dogs with carcinoma, sarcoma, and osteosarcoma. C. Palliative therapy: CS and Piroxicam - 75% of nasal carcinomas are COX-2 positive, which is believed to be involved in tumorogenesis.

Bull nose in pigs

Asymmetrical or symmetrical facial cellulitis secondary to lip or oral lesions

What is canine aspergillosis? Signalment, CS, PE

Signalment: SNA mainly affects dogs of *mesocephalic and dolichocephalic breeds.* Most dogs are young to middled aged (1-7 years) CS: Most dogs present with profuse mucopurulent nasal discharge. A blood component or epistaxis typically develops later in the disease process. PE: nasal pain and *depigmentation of the nasal planum* and increased nasal airflow from destruction of turbinates

Atrophic Rhinitis in swine necropsy findings

Necropsy findings: cut between 1st and 2nd premolars (at commissures) bilaterally symmetrical atrophy of scrolls = turbinate atrophy no inflammation

What is canine lymphocytic plasma rhinitis? signalment, CS, PE

Signalment: most often affects young to middle aged dogs. *Dachshunds* may have an increased susceptibility. III. CS: Sneezing, reverse sneezing nasal discharge (any type but typically mucoid or mucopurulent). *Discharge is typically bilateral.* IV. PE: typically no significant abnormalities, airflow is generally preserved unless severely congested, do not show signs of nasal pain.

What is epinephrine?

as a very potent, prompt and transient bronchodilator action. It produces both -adrenergic receptor stimulation (e.g., bronchodilation, cardiac stimulation) and alpha adrenergic receptor stimulation (e.g., vasoconstriction action). Is useful for acute situations (e.g., anaphylaxis) where it can be given parenterally.

Caseous Lymphadenitis DX and TX in small ruminants - *DDX?????*

culture transtracheal wash (48 hr to grow) radiographs and ultrasound show abscesses and large nodes, may resemble OPP - *DDX can be lymphosarcoma* TX: no response to routine antibiotics chronic weight loss condemnation at slaughter slaughter or euthanize pet might get longterm penicillin and rifampin, or maybe tulathromycin

What is Canine nasal neoplasia? Signalment, CS, PE

most common cause of nasal disease in dogs - *adenocarcinoma #1 type* Signalment: Primarily a disease of *older dogs* CS: May include sneezing, epistaxis, stertor, or nasal discharge. *Discharge is often unilateral* but may become bilateral. Neurologic abnormalities such as *seizures or behavior changes can be seen alone or in conjunction with respiratory signs and is highly suggestive of tumor invasion into the CNS.* PE: *Loss of nasal airflow is common. Facial deformity is possible*. Retropulsion can be abnormal. Regional lymphadenopathy present with metastasis.

Rule outs for Feline Asthma

no "one test" for asthma. A. Ddx: Chronic bronchitis Aelurostrongylosis Heartworm Associated Respiratory Disease (HARD) infectious airway disease (mycoplasma etc)

partial pressure of oxygen

* PaO2: the partial pressure of oxygen in the blood, represents the ability of the lung to oxygenate the blood (N = 80-120mmHg @ sea level)* - arterial blood gas - Allows direct assessment of gas exchange via measurement of arterial pH, PaO2, and PaCO2 I. Most commonly obtained form the *femoral or dorsal metatarsal arteries*. II. The *partial pressure of oxygen (PaO2)* in the blood represents the ability of the lungs to oxygenate the blood. III. Normal PaO2 at sea level in room air (21% oxygen) is 80-110 mmHg. IV. *PaO2 < 80 mmHg indicates hypoxemia, <60 mmHg indicates severe hypoxemia.* V. The *alveolar-arterial (A-a) O2 gradient* gives an estimate of the effectiveness of gas transfer and is independent of the effect of ventilation

What are examples of CNS depressants used as antitussives?

*Narcotics*. - All opiates are potent antitussive agents. - Some opiate narcotics (*codeine, dihydrocodeinone hydrocodone*) seem to have a fairly high degree of selectivity for the cough center (mu and kappa opiate receptors). - While these drugs are highly efficacious, they are addicting, are subject to narcotic control laws and are relatively toxic in cats. *Butorphanol (Torbugesic)* is a mixed agonist/antagonist. *Nonnarcotics*. *Dextromethorphan* is a derivative of the opiate narcotics. - It has the ability to depress the cough center but is not addicting + produces CNS effects

Pulse oximetry

*Pulse Oximetry - Provides an estimate of hemoglobin saturation with oxygen (SaO2) as a percentage (SpO2)* Inexpensive, noninvasive, and easy to perform SpO2 of 95-99% is normal (PaO2 >80mmHg) SpO2 of 90-94% indicates moderate hypoxemia (PaO2 60-80mmHg) SpO2 <90% represents severe hypoxemia (PaO2 <60mmHg)

What are respiratory patterns?

*Restrictive*: short rapid shallow breaths - "Stiff lungs" (pneumonia, pulmonary edema, neoplasia) OR Prevention of mechanical expansion (pleural space disease, thoracic wall disease) *Obstructive Upper Airway*: prolonged, deep inspirations, stridor, stertor Ex. Brachycephalic airway syndrome, lar par, tracheal collapse* *Obstructive Lower Airway*: prolonged expiration, abdominal push Ex. Chronic bronchitis, asthma *Paradoxical Respiration*: opposing movements of the chest and abdominal wall during inspiration and expiration. Associated with respiratory muscle fatigue or chest wall disturbances. *rib fx, "flat chest"*

What is canine aspergillosis? TX

*Topical*: treatment with *clotrimazole or enilconazole* instilled into the nasal cavity +/- sinuses has greater success than systemic therapy. - under GA then debride and topical is infused - 50% dogs require 2nd treatment - Cribriform plate lysis without neurologic abnormalities is not a contraindication for topical therapy NOTE: *Ensure that the clotrimazole uses polyethylene glycol as a carrier, NOT PROPYLENE GLYCOL. Propylene glycol is extremely caustic and irritating* to mucosa and has resulted in severe pharyngeal swelling necessitating tracheostomy tube after treatment. *Meticulous debridement*: without concurrent anti-fungal therapy is mainstay of therapy in people and was successful in one report of 6 dogs up to 4 months post treatment *Systemic*: non invasive but requires prolonged administration because of poor to moderate efficacy - *Clinical cure is seen in up to 70% of patients treated.* - *itraconazole or posaconazole (very expensive - can combine w/ terbinafine or doxycycline)*

Four causes of bacterial pneumonia

*aspiration*, *community-acquired - aspiration*, community-acquired, foreign body, or secondary to immune dysfunction *foreign body* - inhaled foreign bodies carry mixed bacterial and fungal organisms into the lung *secondary to immune dysfunction* - Congenital immunodeficiencies are most often recognized in young animals that are already prone to the development of pneumonia due to their naive immune systems

What are types of methylxanthines used as bronchodilators?

*theophylline and aminophylline* are potent bronchodilators which act in a manner similar, but not identical, to the sympathomimetics. Used when refractoriness develops with prolonged use of the sympathomimetics. IV admin may be used in acute attacks. They can be given orally for the management of chronic bronchoconstrictor disorders. In addition to bronchodilation, methylxanthines also enhance mucociliary clearance and increase contractility of the diaphragm. Methylxanthines are potentially quite toxic. Toxic effects include CNS stimulation, cardiac toxicity and gastrointestinal irritation. Potential for drug interactions, *theophylline metabolism inhibited by erythromycin, fluoroquinolones, cimetidine.* *Owner compliance is usually better with sustained release preparations (less frequent administration).*

What are types of bronchodilators?

1. *Antihistamines* 2. *Anticholinergics* 3. Cromolyn sodium (Intal®) - Is not a bronchodilator and is of no value for acute bronchospasm. The drug is useful as a prophylactic agent to prevent attacks in chronic bronchoconstrictor disorders. - prevents histamine relaese and mast cell destabilization - HORSES 4. corticosteroids 5. methylxanthines 6. sympathomimetics 7. Combinations of Sympathomimetics and Corticosteroids- The 2 agonists in these preparations are longer lasting than those discussed in the table above - not as useful for "rescue" situations 8. Leukotriene Receptor Antagonists (e.g., zafirlukast [Accolate]; montelukast [Singulair]) - not super effective and competitive inhibitor

What are drugs that can be administered by nebulization?

1. Antibiotics - Poorly absorbed from the respiratory mucosa; good for aerosol therapy: gentamicin, amikacin 2. Bronchodilators - Selective bronchodilators (e.g., albuterol) 3. Bland solutions - Saline 4. Mucolytics - Acetylcysteine (Mucomyst®) 5. Steroids (in cats via aerosol inhalers, e.g. Flovent)

What are methods of administration of respiratory drugs

1. Exposure to steam in an enclosed room - This method provides humidification of the upper respiratory tract but drugs cannot be delivered this way. There is also a danger of exposure to excessive heat or cooling. 2. Steam vaporizers - Allows for humidification and drug exposure to the upper airways. Danger of overheating and cooling. 3. Ultrasonic nebulizers - The most effective way to deliver drugs to the lower respiratory tract. Produces particles of 0.5 - 5.0 micron diameter which can penetrate to the depth of the bronchioles. Animal can be exposed to nebulized air in an enclosed cage or, ideally, via a face mask.

Most common type of lower pulmonary neoplasia

85% of *canine = bronchoalveolar carcinoma*, with the remaining tumors being adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma. 60-70% of *feline = adenocarcinoma*, followed by bronchoalveolar carcinoma, squamous cell carcinoma, and adenosquamous

What isoproterenol?

A pure -adrenergic stimulant with no action on -adrenergic receptors. Action is comparable to that of epinephrine in its potency, speed of onset and duration of action. Most effective if given parenterally or by inhalation. Not too effective orally. It has potent cardiostimulatory effects. More effective and safer (selective beta agonists) alternatives available.

What are types of Anticholinergics used as bronchodilators?

Atropine and atropine-like compounds (e.g., ipratropium, [Atrovent]) can counteract acetylcholine-induced bronchoconstriction. *Atropine is a specific antidote for organophosphate-induced bronchoconstriction.* Bronchodilation associated with many side effects. Can decrease mucociliary clearance.

Anti-viral treatment options for Kennel cough

B. Anti influenza drugs are not recommended. Uncomplicated cases are generally self-limiting without antibiotics Antibiotics are indicated for cases of secondary pneumonia and are ideally chosen based on results of culture and susceptibility, but empiric choices include doxycycline, azithromycin, chloramphenicol, or fluoroquinolone.

What is canine lymphocytic plasma rhinitis? DX

B. Skull Radiographs: normal or increased radiodensity in the nasal passages due to nasal discharge C. CT: typically non-destructive to turbinates, CT changes are minimal and often just show fluid accumulation in the nasal cavity or sinuses. D. Rhinoscopy:often shows hyperemic, friable and inflamed epithelium and mucus accumulation. E. *Histopathology (Definitive dx): demonstrates lymphoplasmacytic infiltrates of varying severity* reflecting chronicity of disease, occasionally with mild neutrophils or eosinophils. *NOTE: the same biopsy results can be seen with neoplasia, fungal disease, foreign body, etc. that can only be ruled out with CT and/or rhinoscopy.* Culture: aerobic, anaerobic, fungal to rule out a contributing infection.

Atrophic Rhinitis in swine etiology + CS

Bordetella bronchiseptica toxigenic strains - nonprogressive AR (piglets to 6 wks) Pasteurella multocida type D toxigenic strains - progressive AR (up to 16 wks) nutrition - calcium/ phosphorus theory now discounted CS: sneezing, nasal discharge, epistaxis, blockage of nasolachrymal duct and facial distortion

Risk factors for aspiration pneumonia

Brachycephalic breeds are at high risk for aspiration, as their conformation causes chronic upper airway obstruction This in turn causes increased negative thoracic pressure when breathing, which increases the risk of gastroesophageal reflux, regurgitation, and vomiting. Brachycephalic breeds may also have inherent laryngeal and pharyngeal dysfunction secondary to their conformation.

Breeds predisposed to and Treatment of Eosinophilic Bronchopneumopathy

Breed predisposition in *Siberian Huskies and Alaskan Malamutes and ROTWEILERS.* Treatment: A. Prednisone 2mg/kg/day for one week, then tapered to the lowest effective dose over several months. B. The response to steroids is generally rapid, with improvement seen within days. Some dogs may be cured, but others may relapse after discontinuing steroid treatment. Some dogs require long term low dose steroids. In patients who cannot tolerate oral steroids, inhaled fluticasone can be used. C. Hyposensitization against allergens detected by intradermal skin testing has resulted in improvement in some cases.

What is feline chronic rhinosinusitis? DX

CBC, Chem, UA:typically unremarkable and Retroviral testing (FeLV/FIV) Upper respiratory PCR panel: can detect DNA from Bordetella bronchiseptica, Chlamydia felis, feline calicivirus, feline herpesvirus-1, H1N1 influenza virus, and Mycoplasma spp. performed on a swab from the nasal passage, conjunctiva, or pharynx depending on primary site of clinical signs. Nasal discharge cytology: typically identifies neutrophils, significance of bacteria is questionable. Skull radiographs: may show unilateral or bilateral soft tissue and/or fluid opacification CT: rule out a mass lesion, severe turbinate destruction, dental disease Rhinoscopy: typically no overt lesions are seen in the choanae. Histopathology: typically blind biopsies are performed in both nasal passages. Inflammatory infiltrates are common and classified by predominant cell type to lymphoplasmacytic, neutrophilic, or mixed Bacterial and fungal cultures: see list of bacterial pathogens in CRS above.

Mycoplasma Pneumonia CS in small ruminants

CS pneumonia mastitis conjunctivitis arthritis septicemia special culture media required TX: tylosin tetracycline florfenicol tulathromycin Prevention: pasteurize colostrum and milk - septicemic in adult so super important closed herd (ear mites harbor mycoplasma)

Mycoplasma app (cats) - CS, best diagnostic test, and treatment of choice

CS: A. Rhinitis/Conjunctivitis: Mycoplasma spp. are commonly detected in cats with conjunctivitis and URI. Concurrent infection with other upper respiratory pathogens may contribute to clinical signs. B. Pneumonia: Clinical signs include fever, cough, tachypnea, lethargy, and decreased appetite. DX: by culture or PCR, but because Mycoplasma spp. are common flora, the positive predictive value of assays is likely to be low. TX: Doxycycline or Enrofloxacin

Bordatella bronchioseptica in cats - URI CS, best diagnostic test, and treatment of choice

CS: A. vary from mild fever, cough, sneezing, ocular discharge, and lymphadenopathy to severe pneumonia with dyspnea, cyanosis, and death. B. Pneumonia is typically seen in kittens <10 weeks old. C. Consider B. bronchiseptica in acute and chronic coughing cats. DX: Culture dx of choice - performed on nasal or oropharyngeal swabs, or BAL fluid TX: Antibiotics: Doxycycline + supportive care

Chlamydia felis - URI CS, best diagnostic test, and treatment of choice

CS: conjunctivitis, chemosis, serous to mucopurulent ocular discharge, and blepharospasm. Some cats have signs of nasal involvement such as stertor, nasal discharge, and sneezing. *OCCASIONAL RHINITIS* DX: PCR: test of choice, confirms active infection - rare healthy cats test positive TX: Doxycycline is the treatment of choice

"Pasteurella" Pneumonia dx and tx in small ruminants

DX: radiographs: cranioventral consolidation, air bronchograms ultrasound for consolidation, comet tails cranioventral bronchopneumonia, marbling,pleuritis at necropsy rt apical lobe most severely involved TX: cetiofur (ONLY LABELED FOR GOATS + SHEEP - best choice) Penicillin or ampicillin or tetracycline (pretty good) or tulathromycin (IF THINK GOING TO DIE) EXTRALABEL!!! *tilmicosin (Micotil®) to lambs > 15 kg but not to goats!*

What is Canine nasal neoplasia? DX

DX: CBC, Chem, UA + *FNA (metastatic neopalsia of LN)* + *Skull rads - increased opacity* *CT:demonstrates mass effect,tumor boundaries, assesses integrity of cribriform + detects CNS involvement, is useful for radiation therapy planning.* Rhinoscopy - visualize a mass lesion protruding between the turbinates, or swollen/deformed turbinates. * guided biopsy of the lesion* Histopathology - May show only inflammation if mass lesion was not biopsied or only superficial biopsies were achieved.

What are abnormal breath sounds?

Decreased Breath Sounds: pleural effusion, pneumothorax, airway obstruction, obesity Increased Breath Sounds: referred upper airway vs. lower airways, further characterized by sound and part of respiratory cycle Stertor: snoring or snorting sounds due to soft tissue obstruction of the upper airways, can be inspiratory or expiratory. Stridor: loud, musical sounds heard at a distance from the patient, typically during inspiration and due to upper airway obstruction of the larynx Crackles: short, explosive, nonmusical popping sounds caused by air bubbling through through fluid in alveolae or rapid opening of airways, may be inspiratory or expiratory, "fine" or "coarse" Wheezes: musical sounds generated by air passing through airways narrowed by intraluminal mucus, extraluminal compression, or by collapse or constriction. Typically heard on expiration.

Diagnosis of Canine Chronic Bronchitis

Diagnosis: diagnosis of EXCLUSION!!! A. CBC/Chem/UA: rule out systemic Dz (pneumonia, parasitic or allergic disease). B. Thoracic Rads: broncho-interstitial or airway pattern with increased donuts and tram lines, but may be normal. rule out cough - CHF, neoplasia, pleural effusion, etc. C. Heartworm antigen D. Fecal analysis E. pro-Brain Naturietic Peptide (BNP): L atrial enlargement/congestive heart failure as well as pulmonary hypertension. F. Bronchoscopy: shows thickened, granular, or roughened appearance to mucosa with hyperemia and excess mucus. Allows documentation of concurrent tracheal or bronchial collapse. G. Tracheal wash: Generally submitted for cytology and bacterial culture. H. Cytology: *neutrophilic (non-degenerate) inflammation with Curschmann's spirals (casts of airways mucus).* I. Cultures: aerobic and mycoplasma should be submitted to rule out

What is ephedrine?

Differs from epinephrine and isoproterenol in the following respects: slower onset but more prolonged effect (4-6 hours) so it is better for chronic rather than acute disorders; is less potent; is orally effective; causes marked CNS stimulation.

What are types of antihistamines used as bronchodilators?

Drugs counteract the bronchoconstriction due to histamine released in allergic states. They are not too effective because a variety of other inflammatory mediators are also released against which the antihistamines have no neutralizing effect. *Combinations of antihistamines and glucocorticoids (e.g. Temaril P = trimeprazine + prednisolone)*

What are expectorants?

Expectorants act to increase the volume and fluidity of secretions in the respiratory tract. - encourages movement up escalator + soothing effect on irritated mucous membranes a. *Directly-acting expectorants*. These drugs act directly on the cells of the respiratory mucous membrane and provoke them to increase their secretory activity. They may be administered via *inhalation. Ex: eucalyptus oil, camphor.* b. Indirectly-acting expectorants. These drugs are administered orally. They irritate nerve endings in the stomach and provoke increased bronchial secretions via vagal stimulation - *ammonium salts, potassium iodide, potassium citrate, guaifenesen*. Clinical use: useful for drying of the respiratory mucous membrane + removal of inflammatory debris + cough suppressant action.

What is canine aspergillosis? Pathogenesis

Fungal rhinitis in the dog is most often caused by Aspergillus fumigatus, but has also been seen with Penicillum sp. and Rhinosporidium seeberi. Pathogenesis: A. fumigatus is a saprophytic opportunistic fungus that is ubiquitous in soil. A. Dogs become infected by *inhalation* B. Local immune dysfunction C. SNA causes marked destruction of nasal turbinates, and can erode through frontal bones, periorbital soft tissue, or through the cribriform plate

Treatment of pneumonia in small animals

IV fluids Nebulization Supplemental O2 Mucolytics

What are selective bronchodilators?

Include newer drugs such as albuterol (Salbutamol®), metaproterenol (Alupent®), terbutaline (Brethine®), and clenbuterol (Ventipulmin®). They have the ability to stimulate 2 receptors in the bronchi without stimulation of 1 receptors in the heart so there is less cardiac stimulation. Have a prolonged effect after oral administration. Some administrated via inhalation (see table). Can be administered by injection to relieve acute episode of bronchoconstriction (Terbutaline). *Administered by aerosol (Aerokat) in asthmatic cats.*

Nasal disease ddx in CATS

Infectious - Acute upper respiratory disease complex, fungal rhinitis (Cryptococcus sp., Aspergillus sp.) Inflammatory - Chronic Rhinosinusitis, nasopharyngeal polyps neoplastic - Lymphoma > adenocarcinoma > sarcoma Local - Nasopharyngeal stenosis, tooth root abscess, oronasal fistula, trauma, foreign body

Nasal disease ddx in DOGS

Infectious - Fungal rhinitis (Aspergillus sp.), Canine Infectious Respiratory Disease Complex, Nasal parasites (nasal worm, nasal mites) Inflammatory - Lymphocytic plasmacytic rhinitis, eosinophilic rhinitis Neoplastic - Adenocarcinoma > sarcoma> lymphoma Local - Tooth root abscess, oronasal fistula, trauma, foreign body Other - Primary ciliary dyskinesia, xeromycteria/neurogenic KCS

Anti-viral treatment options for feline URI

L-lysine or famcyclovir Calcivirus - largely supportive with SQ fluids, antibiotics for secondary infections, and enteral nutrition. A feeding tube may be necessary in cats with severe lingual ulcers.

What is feline nasal neoplasia?

Most common cause of nasal disease in cats. - *lymphoma (radiation therapy or CHOP or combo - MST 536) and carcinoma (radiation therapy MST 1y)* CS/PE: nasal discharge, sneezing, stertorous respiration, and change in phonation are common. Cats may also show epiphora, epistaxis, and facial deformity. Dx: CT: shows extent of mass and invasion into CNS, orbit, or sinuses. Rhinoscopy: only the choanae may be observed Histopathology

Know etiologic factors and agents involved in Canine Infectious Respiratory Disease Complex

Most infections result from B. bronchiseptica, CPIV, CIV, or CAV-2. VIRUSES Canine Parainfluenza Virus (CPIV) Canine Advenovirus 2 (CAV-2) Canine Distemper Virus (CDV) Canine Respiratory Coronavirus (CRCoV) Canine Herpesvirus (CHV-1) Canine Influenza Virus (CIV) Canine Reovirus (CRV) BACTERIA Bordetella bronchiseptica Mycoplasma spp. Streptococcus equi subsp. zooepidemicus Miscellaneous bacteria Dogs housed in kennels, pet shops, shelters, and boarding facilities are at significantly greater risk of exposure

Diagnostic testing and treatment for respiratory parasites (in general)

Paragonimus kellicotti (cats and dogs) Diagnosis: BAL cytology or fecal (Diagnosis: radiographic findings of cysts in dogs and granulomas in cats, ova in feces or BAL cytology.) Fenbendazole tx - (occasionally praziquantel)

What is feline cryptococcosis? Pathogenesis, CS, PE, Signalment, DX

Pathogenesis: Cryptococcus spp. is a dimorphic fungus that exists in the yeast form in the animal. Cryptococcus neoformans most common which is found in bird droppings worldwide. Cryptococcus gattii most common in Cali + in tree bark or decayed wood hollows. II. Signalment: Siamese and Abyssinian cats are overrepresented. III. CS/PE: sneezing, mucopurulent nasal discharge stertor, and facial distortion. *Lower respiratory signs are rare.* Occasionally extension into the CNS is seen (more common in dogs). The classic PE finding is a *firm swelling on the dorsum of the nose. A retinal exam may reveal chorioretinitis lesions.* DX - id fungus and Serology

What are the aims of aerosol therapy?

Provide humidification of the respiratory mucous membranes to prevent excessive drying and to decrease viscosity of secretions so they may be more readily expectorated. To deliver various types of drugs to the respiratory tract: *Drugs which are toxic systemically and best restricted to the respiratory tract.* *Drugs which are not absorbed systemically; are only effective topically so they must be introduced directly into the respiratory tract (certain antibiotics, Mucomyst®).*

treatment for Feline Asthma

Reduce environmental allergens Glucocorticoids: Oral *PrednisoLONE* - *Avoid long acting depot steroids like DepoMedrol due to propensity for insulin resistance and development of Diabetes mellitus.* *Fluticasone propionate* - Airway effects lag by 1-2 weeks, so continue oral prednisolone during the initial administration and then taper bronchodilators - critical to reduce bronchoconstriction in acute asthma attacks, but not appropriate as mono therapy - *albuterol inhaler* (exacerbates eosinophilic airway inflammation chronically), *terbutaline, methylxanthines (aminophylline, theophylline* - potential for adverse side effects) Antibiotics

What is canine aspergillosis? DX

Skull Radiographs: often shows increased radiolucency in the rostral nasal cavity CT: Classically shows *moderate to severe destruction of turbinates* Rhinoscopy: allows *direct visualization of fungal plaques* and provides method to obtain samples for cytology, histopathology, or culture - *off-white or green fuzzy plaques - think blue cheese - adhered to the nasal mucosa* Histopathology: provides direct evidence of fungal hyphae and a definitive diagnosis of SNA. - high sensitivity when fungal plaques sampled directly Serology: antibody test (AGID), mod sensitivity (~67%) but false positives are rare.

What are pros and cons of different imaging modalities for URT?

THORACIC RADIOGRAPHS: to rule out metastatic disease, concurrent bacterial pneumonia, etc. • Dental radiographs: assess integrity of tooth roots • Skull radiographs: identify filling defects, mass effects, erosions, and metallic foreign bodies. *Difficult to interpret and need to be performed under general anesthesia. Widely available and least expensive imaging option, BUT least sensitive.* • CT: *preferred imaging modality of the nasal cavities and nasopharynx. Allows visualization of any masses, structural abnormalities, integrity of the cribriform plate, destruction of turbinates, involvement of frontal sinuses, and allows future planning for radiation therapy.* Administration of contrast agent (ie. iohexol) enhances neoplasia or inflammatory lesions.

What are drugs that act as Antitussives (Cough Suppressants)?

The reflex, which involves the cough center in the brain, is characterized by a rapid contraction of the diaphragm + intercostal muscles + a forceful expulsion of air from the respiratory tract. 3 ways in which coughing may be suppressed: *(i) by decreasing the viscosity of secretions in the airways, (ii) by soothing irritated respiratory mucous membranes, (iii) by depression of the cough center in the CNS.* 1. CNS Depressants: These drugs depress the cough center in the medulla oblongata - Narcotics or nonnarcotics 2. Maropitant (Cerenia - May have antitussive action related to antiinflammatory effect - extralabel use of antiemetic. Clinical Use: *Use ONLY with NON-PRODUCTIVE COUGH*

What are types of corticosteroids used as bronchodilators?

They have a dual action to cause bronchodilation and to reduce inflammatory swelling of the respiratory mucous membranes. May be administered IV (dexamethasone SP) in acute attacks or orally (prednisone, methylprednisolone) for chronic bronchoconstrictor disorders. Widely used in feline bronchial disease, including intravenously in emergencies. Some products (e.g., fluticasone propionate [FLOVENT]) may be given by inhalation. Beclomethasone dipropionate aka Vanceril Budesonide aka pulmicort Flunisolide aka aerobid Fluticasone propionate (most potent) aka flovent Triamcinolone acetonide aka Azmacort

Breeds predisposed to Idiopathic Pulmonary Fibrosis

West Highland White Terriers raising suspicion for a genetic cause.

FHV-1 - URI type of virus, major clinical signs, shedding patterns

a large, double-stranded DNA virus with a glycoprotein-lipid envelope. Classified in the alphaherpesvirus family Most cats are exposed to FHV-1 during their lifetime and transmission occurs largely by close contact. A. Cats are infected by nasal, oral, or conjunctival exposure - Virus shedding occurs as early as 24 hours after infection and persists for 1-3 weeks. CS: A. Rhinitis B. Corneal disease - *Dendritic corneal ulcers thought to PATHOGNOMONIC* C. *pneumonia or generalized dz* - young/debilitated animals is uncommon D. Severe ulcerative + eosinophilic facial dermatitis is rare

Feline Calicivirus - URI type of virus, major clinical signs, shedding patterns

a small, non-enveloped, single-stranded RNA virus belonging to the Caliciviridae family. Pathogenesis: A. Cats are infected via the nasal, oral, or conjunctival routes. Transmission occurs via fomites, direct contact with respiratory secretions, or through aerosols. CS: 1. Oral ulcers - most strongly associated with erosive or ulcerative lesions of the tongue, lips, or nasal planum which generally heal over a period of 2-3 weeks. 2. Rhinitis: Sneezing, conjunctivitis, and ocular and nasal discharge typically occurs but are less prominent than with FHV-1 3. Synovitis: An acute lameness due to synovitis and pyrexia syndrome occurs in some cats days to weeks after clinical signs of acute FCV infection or after vaccination with certain FCV vaccines. 4. Stomatitis 5. Virulent Systemic Disease: Outbreaks of a highly virulent FCV strain known as Virulent Systemic Calicivirus has been described with cats presenting for fever, face/paw edema, URI, icterus, and hemorrhage from the nose and GI tract.

Understand pros and cons of different Bordetella vaccines available

a) A cellular antigen extract given SQ Avirulent live bacterial vaccine for intranasal administration (also protects against CAV-2) Avirulent live bacterial vaccine for oral administration. (GREATER THAN 8 WKS) b) All vaccines mitigate the severity of clinical disease and bacterial replication after challenge in vaccinated dogs, but only the intranasal vaccine has been shown to prevent bacterial shedding in secretions. Intranasal vaccine protects within 72 hours (GREATER THAN 3 WKS), while the SQ (not live) vaccine (GREATER THAN 6 WKS) requires 2 doses 2 weeks apart and protection not induced until 7-10 days after the 2nd vx. Onset of action for the oral (LIVE) vaccine is not published. d) Intranasal vaccines are occasionally associated with development of a cough, nasal discharge, or both 2-5 days after inoculation and lasting up

What drugs inhibit excessive respiratory secretions?

a. -*Adrenergic stimulants*. Drugs which stimulate the -adrenergic receptors produce a constriction of blood vessels in mucous membranes of the upper respiratory tract - shrinks engorged blood vessels, decreasing their excessive leakiness. Most effective route of admin is by external nares. Ex: *phenylephrine (Neosynephrine®), oxymethazoline (Afrin®); pseudoephedrine*. - *USE FOR ACUTE + CHRONIC RHINITIS* b. *Antihistamines*. Block the effects of histamine preventing increased blood vessel permeability + increased respiratory secretions. Not super effective c. *Anticholinergics*. usefulness is preventing excessive respiratory secretions due to cholinergic stimulation. May lead to production of excessively sticky secretions in the respiratory tract. E.g.; *atropine (decrease excessive secretions in organophosphate poisoning.); glycopyrrolate.* d. *Steroids*. Topically active steroid sprayed directly into nasal passages. Decreased inflammatory fluid production due to antiallergic and anti- inflammatory activity. Ex: beclomethasone dipropionate (Vanceril®), betamethasone valerate (Valisone®), fluticasone propionate (Flonase®) e. *Maropitant (Cerenia)*. Extralabel use of antiemetic to decrease nasal congestion; may be related to blockade of substance P/inflammation.

Treatment of Canine Chronic Bronchitis

aimed at reducing inflammation, limiting cough, and improving exercise tolerance while slowing disease progression. A. Eliminate environmental pollutants - vacuum with a HEPA filter may be useful. B. Weight loss should be recommended, as it worsens cough + lung function. C. Use a harness - avoid provoking a cough. D. Glucocorticoids are the mainstay of tx - Prednisone OR Fluticasone propionate (face mask and spacer chamber - More expensive but less systemic absorption improves steroid side effects) E. Bronchodilators: may reduce diaphragmatic fatigue + increase mucociliary clearance. - Theophylline F. Antibiotics: warranted in dogs with an acute exacerbation of chronic bronchitis G. Nebulization H. Cough suppressants:improve quality of life for dogs Hydrocodone, Butorphanol, or Maropitant (Cerenia)

What is feline chronic rhinosinusitis? TX

antibiotics - *Antibiotics should have good penetration to bone and cartilage and be prescribed for 6-8 weeks at a time* Nasal flushing: removal of large amounts of mucus results in clinical improvement in the short to medium term. Airway humidification via steam inhalation, nebulizer treatment, or instillation of nasal saline drops. Decongestants: might improve nasal airflow by reducing mucosal edema through vasoconstriction *- Ephedrine hydrochloride or Phenylephrine hydrochloride (Little Noses)* Antivirals: Famciclovir (FHV1 or CRS) and Lysine??? Antihistamines: controversial, as the may further dry out inspissated secretions. May be more beneficial in eosinophilic rhinitis. Anti-inflammatories *Glucocorticoids*(theoretically reduce mucosal edema and migration of inflammatory cells - but no studies show this) and *NSAIDs*

What are bronchodilators mechanism of action?

cause a relaxation of bronchial smooth muscle and increase the functional capacity of the respiratory tree - counteract bronchoconstriction and relieve dyspnea in certain disease states. The major components responsible for bronchorelaxation are the adrenergic receptors. *A distinct subcategory of adrenergic receptors, the 2-receptors, trigger relaxation of the bronchial smooth muscle* contribution of phosphodiesterase inhibition to the bronchodilatory action of methylxanthines has been questioned since the concentration needed to exert this effect may not be achieved in vivo.

What Drugs Degrade Inflammatory Debris?

liquify the debris so it may be expelled more readily by coughing *Acetylcysteine (Mucomyst®)*. A mucolytic agent which acts by neutralizing disulfide bonds in mucous, leading to its liquefaction. The drug is best given by direct instillation into the respiratory tract (nebulization). It is a relatively toxic drug which may cause allergic-like bronchoconstriction. Clinical Use: approach has not been too dramatic clinically. Difficulties in getting drugs to site of action.

What are types of sympathomimetics used as bronchodilators?

management of acute and chronic bronchoconstriction - direct stimulation of the 2-adrenergic receptors in the bronchial smooth muscle leading to relaxation of the muscle. most common adverse affect with -agonists is cardiovascular stimulation (tachycardia) and skeletal muscle tremors. Especially with 1 agonists but also with higher doses of 2 agonists. *cross tolerance so once tolerance develops to one sympathomimetic drug, all are ineffective* - Best to rely on them intermittently or allow for drug-free breaks 1. Epinephrine 2. Isoproterenol 3. Ephedrine 4. Selective bronchodilators

Endotracheal (ETW) or Transtracheal wash (TTW)

minimally invasive technique to sample the respiratory tract of dogs and cats I. Provides *cytologic and culture* information to evaluate large airways disease and bacterial pneumonia. Less helpful for alveolar or interstitial disease. II. TTW can be performed in awake or lightly sedated animals, useful in larger patients III. ETW requires *heavy sedation* to place ET tube, useful in cats and small dogs. IV. Adverse Events: Transient worsening of respiratory signs is possible with both procedures. Tracheal laceration or hemorrhage may result from TTW and should not be performed in uncooperative patients or pets with bleeding tendencies.

What is canine lymphocytic plasma rhinitis? TX

no definitive therapy - rarely cured Glucocorticoids: typically started at immunosuppressive doses and tapered over time to anti-inflammatory. May take weeks to months to see effect - *Prednisolone or Prednisolone* - taper to effect Immunomodulatory Medications - *Cyclosporine* Desensitization therapy - based on allergy testing - tx w/ prednisone Antimicrobials - secondary infections benefit from antibiotics. *Azithromycin* or *Doxycycline* longterm alone or in combination with *Piroxicam*

What is feline cryptococcosis? TX and Prognosis

requires prolonged treatment with oral -azole therapy (4-12 months) A. *Fluconazole* - until 3 months after serology is negative is the treatment of choice and ~97% effective - *CNS involvement is suspected, use in combo with flucytosine because of improved efficacy of penetrating the blood-brain-barrier* B. itraconazole - 50% efficacy but hepatotoxic C. Terbinafine - use in cats that dont respond to azole therapy or that develop side effects with azoles D. Amphotericin B is fungicidal and can be considered in severe cases - Nephrotoxic Prognosis: the latex agglutination titer can be used to follow the course of the disease and response to treatment. A two fold reduction in antigen titer per month is desired. *Treatment is continued until the titer is <1:1*

Three hallmarks of Feline Asthma

reverse bronchoconstriction, goblet cell hyperplasia, and eosinophilic infiltrate leading to mucosal edema

What is feline chronic rhinosinusitis? Pathogenesis, CS, PE

second most common cause of nasal disease in cats, often frustrating to manage. I. Pathogenesis: it is suspected that primary viral infection, particularly FHV-1, damages mucosal epithelium and turbinates predisposing to recurrent bouts of bacterial rhinitis. II. Clinical signs/PE: typically young to middle-aged, may have history of "cat flu" as a kitten, recurrent bouts of nasal discharge (typically serous progressing to mucoid or mucopurulent), sneezing, and sterterous breathing. During bouts cats may be inappetent due to inability to smell food, difficulty breathing, and pyrexia. Typically airflow is preserved. GUARDED PROGNOSIS

Bronchoscopy and Bronchoalveolar Lavage

utilizes a *flexible endoscope* to visually evaluate the trachea, carina, principle and secondary bronchi. It also allows procurement of *diagnostic samples deeper into the airway system*. I. Very useful to identify tracheal or bronchial collapse, stenosis, masses or tears. II. May be therapeutic as can remove tracheal or bronchial foreign bodies. III. Can collect brush cytology or biopsy of abnormal lesions. IV. Can wedge the bronchoscope into smaller airways or a specific bronchus if disease is focally affecting one lung lobe and collect BAL fluid for culture/cytology. V. BAL more often detects hemorrhage, infectious agents, and neoplasia as compared with tracheal washes but is more invasive and requires advance equipment and user expertise.

What are PE findings of nasal disease?

• *Facial distortions or "holes"* in the facial bones - *neoplasia* • Patency of airflow through each nostril - *Decreased or diminished airflow is more indicative of a space-occupying lesion* *Increased airflow is seen with turbinate destruction.* • Condition of *teeth and gums - tooth root abscess, oronasal fistula* • Examination of *roof of mouth and pharynx for cleft palate, ulcers, possible mass effect of NP polyp* • Ability to *retropulse eyes - if abnormal can indicate space occupying lesion* involving orbit • *Depigmentation of nasal planum - classic for aspergillosis in dogs* • *Tonsils and submandibular lymph nodes - enlarged with neoplasia, dental disease, cryptococcosis* • *Retinal examination - evidence of chorioretinitis (particularly with Cryptococcus sp.), evidence hypertension (retinal hemorrhages, degeneration, detachment)* • If *epistaxis* is present, look for *evidence of petechiae or ecchymoses to indicate a systemic coagulopathy or vasculitis*

What are the clinical signs of nasal dz?

• Nasal discharge: serous, mucoid, mucopurulent, purulent, epistaxis, or mixed. • Sneezing AND Reverse sneezing • Pawing or rubbing at muzzle • Facial deformity, asymmetry, or ulceration • Epiphora • Loss of pigmentation of the nasal planum • Open mouth breathing AND Halitosis • Stertor AND Coughing Systemic Manifestations: Coagulopathy: primary vs. secondary, Severe hypertension, Hyperviscosity syndrome, Systemic infection, Vasculitis, AND Pneumonia