Cats can use inhalers to help with breathing problems

Schuey, a beautiful six-year old male neutered Siamese cat was presented to The Feline Centre with a six month history of coughing, wheezing and tachypnoea (rapid breathing). He had a routine background with a mixed indoor and outdoor lifestyle. One potentially important finding was that his owner was a fairly heavy smoker.

Examining Schuey

On presentation Schuey was bright and alert. His breathing rate was mildly elevated at 48 breaths per minute. He was also exhibiting increased effort during expiration (breathing out). On auscultation (listening to his lungs with a stethoscope) harsh sounds and wheezes were heard.

Blood samples were taken for routine haematology and biochemistry. Results were all within normal limits. Tests for FeLV and FIV were negative. Faeces were examined for evidence of lungworm which can cause coughing in cats, however results were negative.

Schuey was then anaesthetised so that X-rays of his chest could be taken. These revealed an increase in the bronchial pattern of the lungs, indicating that there was thickening of the small airways. In order to find out the reason for these changes bronchoscopy was then performed. This is a technique that uses a fibreoptic endoscope to enable us to look all the way in to the lungs. It also enabled us to take washes of the lungs (called bronchoalveolar lavage) which can then be examined under a microscope for the presence of inflammatory cells, bacteria and cancer cells. These washes can also be cultured to assess whether bacteria are present within the lungs.

Bronchoscopy allows us to examine the airways for evidence of an inhaled foreign body (eg, a piece of grass), airway irritation and inflammation and the presence of pus or mucus. Schuey's airways were reddened and slightly roughened in appearance and contained excessive amounts of mucus. Bronchoalveolar lavage was performed and samples collected as described above. Microscopic examination of the cells revealed a large number of inflammatory cells, damaged epithelial cells (cells that line the airways), and a lot of mucus. Bacterial culture of the fluid did not yield any growth.

Schuey's diagnosis and treatment

All these changes are consistent with feline allergic airway disease. This is a relatively common problem in cats, and most commonly seen in the Siamese. Little is known about the causes of the disease in cats, however it is thought to be most likely an allergic response, with similarities to asthma in humans.

The treatment most often used in the past has been oral or injectable corticosteroids. Most cats respond well to the treatment, however there are many recognised side effects associated with the long term use of systemic steroids and as treatment is required for life, an alternative treatment would be desirable.

More recently, inhalational drugs have been successfully used in cats and a special spacer chamber has been specifically designed for cats to enable successful delivery of these inhaled drugs into the lungs. The drugs that are used include fluticasone (an inhalational corticosteroid) and salbutamol (an inhalational bronchodilator).

The inhaler consists of a mask in which the cat's face is placed, attached to a spacer chamber where the drug is puffed in to (see picture above). Most cats tolerate this extremely well and they only need to have their face in the mask for a few breaths. This is the same system as is used for babies and young children but with a slightly differently shaped mask which fits a feline face more snugly.

Schuey was started on these treatments straight away. Another important points to consider are factors that may be contributing to the disease. In Schuey's case, his owner smoked cigarettes which certainly would not have been helping his breathing problems. Therefore, in addition to the treatments his owners were instructed not to smoke in front of Schuey.

Over the following few weeks Schuey's cough became less frequent, his rate of breathing slowed down and he became a lot more active. After four weeks his owners reported that he rarely coughed anymore and his respiratory rate varied between 28 and 36 breaths per minute, which is within normal limits for a cat.