use of aerokat for feline asthma?

Re: use of aerokat for feline asthma?

Martin Atkinson — Wed, 05 Nov 2014 14:20:28 GMT

[quote user="Kate Richardson"]I can only speak for myself, but I don't think anyone intended to patronise Aisling; she asked for advice on using an Aerokat and I assumed she had little experience of using them, hence the advice given.[/quote]Don't take my comment seriously Kate, perhaps I should have added a smiley to soften it. If you think I'm out of order you can be rude back, I live by the mantra that if you can't take it don't dish it.

And thanks for the vote of confidence in my dosage suggestion.

Re: use of aerokat for feline asthma?

Kate Richardson — Wed, 05 Nov 2014 12:30:04 GMT

[quote user="Martin Atkinson"]I would also follow the advice on getting the cat used to the mask before using it in anger but didn't think it was necessary to teach granny how to suck eggs.[/quote]

I can only speak for myself, but I don't think anyone intended to patronise Aisling; she asked for advice on using an Aerokat and I assumed she had little experience of using them, hence the advice given.

As for doses, I would agree with your approach Martin re dose choice initially and reduce to the lowest effective dose as one would with oral medication

Re: use of aerokat for feline asthma?

Martin Atkinson — Wed, 05 Nov 2014 09:36:45 GMT

[quote user="Sean Henney"] The dose Martin advised is pretty high-most of us work on 50micrograms, 1-2 puffs twice daily.[/quote] I don't know about the 'most of us' part of that statement! The suggested dose is 50-250mcg q 12-24 hrs. I start with the mid-range dose and will adapt according to severity of symptoms and response as suggested. I did not cast it in a tablet of stone.

I would also follow the advice on getting the cat used to the mask before using it in anger but didn't think it was necessary to teach granny how to suck eggs.

Re: use of aerokat for feline asthma?

Hannah Wynne Richards — Wed, 05 Nov 2014 09:14:46 GMT

David Do you automatically hate all expensive medication?

Wynne

Re: use of aerokat for feline asthma?

David Mills — Wed, 05 Nov 2014 01:08:25 GMT

Bah, grumpy day, but, please, nothing 'bronchodilates'. All these drugs do (with very limited evidence) is prevent bronchocolapse or bronchoconstriction. They are bronchostabilisers only.

I've nothing to add on inhaled feline drugs except the evidence is almost nil. Is it more the fact that feline 'allergic bronchitis' naturally waxes and wanes?

Re: use of aerokat for feline asthma?

Sean Henney — Tue, 04 Nov 2014 22:08:58 GMT

I would agree with pretty much all that has been said. Flixotide is marketed as a 'preventer' in human medicine so salbutamol is only on PRN basis-exactly the same with cats (or dogs with chronic bronchitis); after all oral prednisolone or methylprednisolone acetate has no direct bronchodilatory effects. The dose Martin advised is pretty high-most of us work on 50micrograms, 1-2 puffs twice daily. Also remember to advise the owner to wipe the cat's face after use-there are several recorded cases of localised demodecosis starting at where the mask meets the cat's face

Re: use of aerokat for feline asthma?

Kate Richardson — Tue, 04 Nov 2014 19:58:57 GMT

Keep the cat on oral medication whilst you get the cat used to the inhaler and give it time for the cat to get used to it. Warn the owners it can take time but with patience most cats will get used to the inhaler. Start just with them getting used to it being around, then just the mask and then add the medication chamber before you even start any medications. Initially I would use both a bronchodilator and the corticosteroid so the airways are nice and open allowing the corticosteroid to penetrate deep into the airways. I tend to use salbutamol as a bronchodilator and fluticasone as the corticosteroid as in theory it is more potent and has less systemic absorption but it is more expensive than say beclamethasone, but this will still be effective and less side effects than oral prednisolone. It will take a couple of weeks minimum for the inhaled corticosteroid to take effect so don't stop systemic medications too early. Eventually you would aim to have as low a dose as needed of inhaled corticosteroid with salbutamol on hand to be given as needed ie in an asthma attack.

Re: use of aerokat for feline asthma?

Rob Loxley — Tue, 04 Nov 2014 19:56:17 GMT

I use Flixotide, though would be interested to see any evidence of superiority / less real-world side effects that beclomethasone at half the price...

Bronchodilators mainly for acute flareups rather than chronic usage

http://www.fritzthebrave.com/ is a good resource including http://www.fritzthebrave.com/meds/inhaled_protocol.pdf

and get the owners to give up smoking

Re: use of aerokat for feline asthma?

Busybee — Tue, 04 Nov 2014 19:45:14 GMT

another one that has had good success with them in the past. Agree with all that's been said so far re. Flixotide + Ventolin. I have asthma myself and am very well controlled on simply Ventolin as and when needed and steroid inhaler if I get a cold or a flare up.

The one other thing to suggest with reluctant cats is to train them onto the face-mask using treats in the mask itself which I've found has worked well.

Re: use of aerokat for feline asthma?

Martin Atkinson — Tue, 04 Nov 2014 16:59:52 GMT

[quote user="Aisling McGrath"]

So basically the flixotide, which is steroid, is used once or twice daily, but you only use the bronchodilator when the cat is having problems? You don't use the bronchodilator long term?

With this particular client, she has been googling and seen the aerokat online, so I think that I'll just let her buy direct, as I don't think she'd appreciate our mark up having seen how much cheaper it is online!

[/quote]Basically this how human patients manage themselves, they don't need the bronchodilator all the time. You may find it can come off the steroids and just use the Ventolin occasionally when there is an acute flare-up. I've found I've used all combinations with different cats, its trial and error.

Try the offer of the loan facility, she won't get that online and you will either make the sale or have an Aerokat on the shelf for the next patient. Incidentally, I (nearly) always have one in the clinic with a Ventolin inhaler in case of an emergency admission.

Re: use of aerokat for feline asthma?

Aisling McGrath — Tue, 04 Nov 2014 16:42:56 GMT

So basically the flixotide, which is steroid, is used once or twice daily, but you only use the bronchodilator when the cat is having problems? You don't use the bronchodilator long term?

This cat has only been on oral preds for only 2 days and isn't quite stable yet, he is also on corvental 50mg SID and bromhexidine 0.5g SID currently.

We use NVS, and just found the evohalers and aerokat on there - thanks!

Re: use of aerokat for feline asthma?

Hannah Wynne Richards — Tue, 04 Nov 2014 16:27:07 GMT

I use Flixotide bid

Wynne

Re: use of aerokat for feline asthma?

Hannah Wynne Richards — Tue, 04 Nov 2014 16:26:11 GMT

I like it. Most cats learn to tolerate it, though the tip about activating first is a good one. Far fewer side effects than with systemic steroids

Wynne

Re: use of aerokat for feline asthma?

Martin Atkinson — Tue, 04 Nov 2014 16:20:57 GMT

I've used them on several occasions with almost universal success. Sadly one cat hated it so much it ran away from home and didn't come back for days! All the others have tolerated it well although I tell the owners to activate the aerosols before placing immediately over the cat's face so there's less chance of spooking it. As they have non-return valve now this means the aerosol can't leak out. Most are well controlled within days and a couple of cats have become asymptomatic after a while and they could stop,

I use Flixotide 125mcg Evohaler for the average cat and start with 2 puffs twice a day in severe cases reducing to one puff once or twice a day according to response. I also give them a Ventolin 100mcg Evohaler to be used if there is an acute relapse: one puff every 4-6 hours to effect.

With new cases if there is significant respiratory distress I would keep on preds until stable but if it is already well controlled you can make a straight swap although normal advice on weaning off systemic steroids should be considered.

I get the Evohalers from NVS and mark-up 50%. I tend to loan the Aerokat out with a full price (again 50% mark-up) deposit and a £10 a week rental plus £10 admin fee, in case they can't use it. Once they've had it 9 weeks its their's to keep.

Go for it they're great.