Tracheobronchomalacia (weakened trachea and bronchi)
collapsing trachea is Progressive condition....what kinda stuff starts happening?
Weakening of cartilage or Redundant tracheal membrane (easier to trigger cough), or both, maybe plus inflammation
if you have a collapsing trache dog, what should you NEVER DO?
NEVER HAVE A COLLAR ON THEM. HARNESS ONLY. (every yorkie and pom should have a collar) no pressure on trach!
hallmark clinical sign of collapsing trachea?
goose honk cough that is inducible.
what are the different locations a trachea could collapse, and what determines WHERE it will collapse?
Extra or intra-thoracic-- difference is Inspiratory collapse vs. expiratory collapse (can have both). (Inspiratory= extrathoracic collapse)
GOLD STANDARD for dx tracheal collapse?
what are grades for tracheal collapse?
Grades 1-4, progressively getting smaller till 4 which is where it completely collapses.
WHO is most prone to getting collapsible trachea? How do you Dx?
Usually middle aged toy and miniature breed dogs. Usually look at breed (yorkie? pom?) and see CS....then start with Thoracic and cervical neck radiographs, there's a chance you will see it on rads and there's your dx . If you cant catch it on rads, THEN she would do fluoroscopy, bc its a real time rad and you can induce cough and then watch cough, and see what is collapsing . THEN if you don't get your answer after THAT, go to endoscopy (gold standard. but don't do first bc more invasive and expensive and requires anesthesia) with endo you can also look to see if there is a reason they need a BAL bc dont have normal anatomy so most likely can have 2* infxn
how effective is medical therapy with collapsing trachea dogs? what IS the medical therapy?
Really effective actually (71% will have resolution of signs for at least a year) but doesnt work for forever. You can use cough suppressants (Hydrocodone, butorphanol etc-- sedate a little too so can adjust the dose for better sleeping at night. Can also add in a bronchodilator which is quite nice, and maybe add in a short course of tapering glucocorticoids just to get rid of initial inflammation ), Weight loss, Harness, avoid overheating.
If the collapsing trachea is not medically manageable, what sx can you do? What might this sx not be so helpful with?
Self expanding stents (+/- concurrent medical management), May not help dogs with main stem bronchus collapse! So do a fluoro first to make sure you arent doing the sx for nothing.
what is a isuprel- elixir?
mixture of cough suppressant and bronchodilator- very handy for collapsing trachea
how does the anatomy of the resp tract change the farther down you go?
Extensive arborization (branching) terminating in alveoli, and Less cartilage, less goblet cells (mucus), less ciliated epithelium. AND More smooth muscle and elastic fibers, more bronchial glands (aqueous fluid), type 1 and 2 pneumocytes in alveoli
what are the major protective mechanisms of the resp system?
(1) Mechanical filtration (nose, nasopharynx, Mucociliary apparatus, Alveolar macrophages, Secretory IgA....if these fail, Inflammatory/allergic response will occur- lungs are SUPER inflammatory organs) (2) PNS (parasympathetic nervous system) and SNS (sympathetic nervous system) have the Vagus and thoracic sympathetic trunk which use: (a) Cholinergic (parasymp) action for Glandular secretion, contraction of bronciolar musculature, Increased mucus production and vasodilation (b) Adrenergic (symp) B2 receptors—activation causes bronchial relaxation and decreased mucus production
what IS idiopathic feline bronchitis ("asthma"), and WHO tends to get this?
it is a +/- Reversible (sometimes irreversible?) obstructive airway disease, and siamese are 5-15 times more likely to get it. And females seem to be predisposed. Not sure what causes it, probably many factors, think it might be one of 3 things or a combo: an altered immunosensitivity of the respiratory tract to inhaled allergens (allergens make problem worse but aren't root of problem) AND/OR have Hypertrophy of mucosa, goblet cells, or submucosal glands, AND/OR have Hyper-responsiveness of airways (Adrenergic/cholinergic imbalance, Narrowing of the airways, Abnormal mucous production, Mucociliary apparatus dysfunction) [[very complex, not sure how it all works and prolly diff things going on bc diff animals respond to diff tx]]
What are some of the histological things you might see with idiopathic feline bronchitis ("asthma")?
since it is an inflammatory dz you will see lots of Inflammatory cell infiltrates (Esp. Mast Cells and eosinophils), and Edematous bronchioles. KEY IS THAT YOU WILL SEE CHRONIC INFLAMMATION (remember that the diameter of the tube is the biggest part of how much air flow!)
what are the clinical signs of idiopathic feline bronchitis? what can Exacerbate the clinical signs?
Coughing- Often paroxysmal and associated with respiratory distress, Wheezing, Expiratory dyspnea (have trouble getting air OUT, so sound like heeeheeeeheeeee when struggling to breathe), and Often intermittent signs! Exacerbated by: Cat litter dust, cigarettes, perfume, hairspray, carpet fresheners, pollen/mold, infectious agents, parasites
whats up with T cell and eosinophil interaction??
helper T cells like to turn on immune cells. So in this case they are releasing lots of pro-inflammatory cytokines and not as many anti inflammatory cytokines (suspect cause) (also mentioned that eosinophils and mast cells work synergistically)
is it trouble getting air IN or OUT?
often cats with idiopathic feline bronchitis present as emergency dyspnea patients. Best thing you can do for them? (tx)
throw them in a box with some O2-- they can DIE EASILY IF STRESSED bc in severe resp. distress. You can also consider sedation, bronchodilators, steroids(cautious!! Not beneficial/dangerous if infectious causes and could obscure your diagnostic attempts later), +/- Intubation and positive pressure ventilation. But remember, if super stressed, let them just chill out in the O2 box first. In WORST case, might have to anesthetize, control airway with intubation, and then try to fig out what the prob is
how do you dx idiopathic feline bronchitis?
since we dont know what is actually causing the problems, this is a Dx of EXCLUSION. Get hx, PE, and then exclude parasites, allergic bronchitis, Heartworm disease, Idiopathic pulmonary fibrosis, etc
if it IS one of those cats that DOES respond to a B2 agonist, then you might wanna consider that as a therapeutic trial. BUT you need to be very careful with this bc...
if you think it might be heart dz instead of airway dz, be VERY CAREFUL if you are gonna start throwing around symp. and parasymp. drugs.
if you do rads to try to dx, what might you see?
either bronchial pattern or normal! If you see more than that, then have sthing else going on.
why might you wanna do ECG?
check for if there is a heart problem going on (esp if considering B2 agonists for tx)
heartworm might cause similar signs as idiopathic feline bronchitis. What should you check for to see if they have heartworm, and why?
Antigen tests for female worms, and cats usually have one big male worm so often need to check for Ab*** (this is what you should test for in cats) (dont try to remove heartworms from cats-- SEVERE ANAPHYLAXIS)
if you want to do airway washes... which wash tests, and what should you do?
Bronchoscopy with BAL, or endotracheal wash if theyre tiny. So Cytology and culture
what are two trials you can try which might help you dx the problem?
(1) Bronchodilator trial: Give 0.01 mg/kg terbutaline, Inhaled or parenteral, and Recheck in 5-10 minutes to see if there is improvement. if CS have gone away...maybe this is hyperresponsiveness problem (this is the bronchodilator thing) so if reversibly bronchoconstriction, likely feline asthmatic with sm mm issue so can try bronchodilator tx (2) Corticosteroid trial- try for 5-7 days and recheck (just be careful there is no pneumonia or some systemic dz)
feline idiopathic bronchitis vs heartworm on chest rads?
look the same-- bronchiolar pattern
should exercise extreme caution with bronchodilators if there are what conditions?
****caution with heart dz, DM, hyperT4, hypertension, or seizures
what are the ways you can tx feline idiopathic bronchitis? How important is it that you tx?
**Treatment is highly recommended to prevent permanent changes and emphysema!!!~ (lungs turn into floppy garbage bags) (1) avoid triggers (2) use Bronchodilators (2) Steroids
what are your options for using bronchodilators to tx idiopathic feline bronchitis? precautions?
can be systemic or inhaled (prefer inhaled bc systemic gives systemic signs) Theophylline, Terbutaline or albuterol (****caution with heart dz, DM, hyperT4, hypertension, or seizures)
what are your options for using steroids to tx idiopathic feline bronchitis?
can be systemic or inhaled. SYSTEMIC: 1-2 mg/kg PO q12h for 5-7 days then taper slow over 2 months...in reality prolly will be on steroids for life, but this is Better than treating for acute flare ups as they happen. Other option, INHALED steriods: more local, better effects where it needs to be and less systemic affects (WILL systemic tho, just less)
**what "tx" should you AVOID with idiopathic feline bronchitis?
avoid cough suppressants, bc if there is sthing down there that needs to be coughed up (like too much mucus in the case of hypertrophy) you are making it worse.
awesome we have an inhaler for cats. How to use, how to adjust cat to it, how long with cat attached?
get them used to it, piece by piece, slowly. should get 3-4 good breaths with that over their face
best bet for tx is the inhaled bronchodilators....what do you do if they dont respond to the bronchodilators? (3)
(1) MUCOLYTICS: (help treat cats which might be due to "hypertrophy/overproduction of mucus") N-acetylcystine is a mucolytic which you can put into your nebulizer. Also Bromhexine hydrochloride (europe thing- prolly wont ask this) (2) Cyproheptidine (this is an appatite stimulator!) but also is Anti-serotonin--> bc serotonin plays a role in the inflammatory cascade. (3) Anti-leukotrienes (eh...human thing...not much evidence and prolly doesnt work but might try if last ditch)
DX: Baermann, Fecal floatation, Airway washings-- might have to repeat tests. TX: Fenbendazole: 50 mg/kg 14 days...MUCH higher dose for logner time than for GI worms. (kills all the diff type of worms)
*lungworms on rads will look JUST LIKE A..
remember that any virus can cause pneumonia
(shes gonna focus on ones she cares about but here is your list to read over)
Viral Pneumonias--> Canine influenza--> who do you see this in?
any dog at any age is susceptible, but ESP SEEN IN DOG TRACKS (group home dogs) and FIGHTING RINGS.
Viral Pneumonias--> Canine influenza--> how is it spread?
Shed in respiratory secretions, can be spread by fomites.
presenting/ clinical signs of canine influenza?
Similar to kennel cough (horkey cough that doesnt go away, but then flu gets much worse:).... can be mild to severe. +/-Concurrent mucopurulent nasal discharge, Pneumonias, 2° bacterial infections (Fever, dyspnea, crackles)
how do you dx canine influenza? (lung patterns, other tests?) tx?
Bronchointerstitial to alveolar pattern. can do BAL or other wash technique, and can do Paired serology, Ag ELISA, VI, PCR* on Serum, wash samples, pharyngeal/laryngeal swabs. Treatment depends on severity (+/- 2* bact infxn)
if you have a pneumonia pt come in and they are really too unstable for you to do dx tests on them, what might you do?