Help with coughing cat

RE: Help with coughing cat

Freya . — Wed, 17 Mar 2021 22:24:56 GMT

Do you see much lungworm in cats? See it/suspect it weekly in the dog population I see but yet to diagnose in a cat, am possible just missing it though or treating accidentally...

RE: Help with coughing cat

Lucy Fleming — Tue, 02 Mar 2021 16:46:27 GMT

[quote userid="6353" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228850#228850"]Given the oesophageal issues with Doxy, does no-one use azithromycin for Mycoplasma? [/quote]

We tend to get the compounded paste which is the non irritant form (I want to say monohydrate rather than hyclate? but don't quote me on that), or crush and mix with food to try and minimise the oesophagitis risk. I do remember years ago a case belonging to a colleague coming in to the clinic daily for his tablet followed by water for a prolonged course as his owner couldn't tablet him at home!

RE: Help with coughing cat

Rob Loxley — Tue, 02 Mar 2021 14:20:34 GMT

[quote userid="5012" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228796#228796"]Routine treatment for parasites including lungworm[/quote]

Dose of Profender or Broadline, easier than course of panacur?

RE: Help with coughing cat

Chris Barker — Tue, 02 Mar 2021 08:01:09 GMT

Given the oesophageal issues with Doxy, does no-one use azithromycin for Mycoplasma? With its persistence in lung tissues one bottle of zithromax gives a useful one week course (3d loading then eod) - used this protocol since hearing it suggested by Danielle Gunn-Moore

RE: Help with coughing cat

Kate Richardson — Mon, 01 Mar 2021 18:31:37 GMT

Absolutely. Or at least some inflammatory process. Some will be asthma, just bear in mind lungworm, mycoplasma will improve with pred as well and (small) risk of more serious problems (so O conversation very important) to cover ones behind.

RE: Help with coughing cat

Tomas B — Mon, 01 Mar 2021 12:13:58 GMT

But if the cat improves on pred then that would make you think of asthma right? Then i am guessing that when you stop preds the symptoms sooner or later will come back. You would not go in that trial ad eternum right?

Thank you

RE: Help with coughing cat

Anthony Todd — Sun, 28 Feb 2021 14:30:42 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228799#228799"]

I wish we could move away from the dogma "oh we shouldn't use corticosteroids in the presence of infection"

110% agree!!

[/quote]

I suppose Donald Trump will get the credit? [sigh, so unfair];-)]

RE: Help with coughing cat

Kate Richardson — Fri, 26 Feb 2021 13:51:22 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228797#228797"] My approach to a well coughing cat is corticosteroids and lungworm treatment, can always revisit the diagnosis is not improvement. [/quote]

I don't think there's anything wrong with that approach at all.

Re doxy, having had a number of cats coughs completely resolve on doxy, then I believe they probably did have mycoplasma, and of the ones we have tested have definitely had lots positive on PCR BAL fluid. However, there is a proportion who have it but also have underlying asthma which resolve initially with doxy only to recur.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228797#228797"] I wish we could move away from the dogma "oh we shouldn't use corticosteroids in the presence of infection" [/quote]

110% agree!!

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228797#228797"]BAL / PCR you're looking at quite a lot of treatment (GA etc) for a poorly detailed diagnostic yield[/quote]

Not sure why you think there is a poor diagnostic yield?

RE: Help with coughing cat

David Mills — Fri, 26 Feb 2021 12:07:01 GMT

The problem with using doxycycline is that it has some immunomodulatory / anti inflammatory effect too so there may be a false "improvement" becauee of this.

Corticosteroids are being used at anti inflammatory doses so won't affect the immune response. I wish we could move away from the dogma "oh we shouldn't use corticosteroids in the presence of infection" - look at covid!

BAL / PCR you're looking at quite a lot of treatment (GA etc) for a poorly detailed diagnostic yield. My approach to a well coughing cat is corticosteroids and lungworm treatment, can always revisit the diagnosis is not improvement.

RE: Help with coughing cat

Clive Ansell — Fri, 26 Feb 2021 11:59:02 GMT

Going back to basics, how would folk manage a case like that in the OP if costs constraints prevent any investigation. Common scenario for me.

Kates seems to have answered it; maybe a week on Doxycycline, and if improving after a week extend to a 4 week course. If no improvement switch to preds. Routine treatment for parasites including lungworm.

I guess it's sensible to exclude infection before using corticosteroids, but there will always be those that will criticise antibiotic usage without establishing a diagnosis first. If the cat was otherwise well, I would be inclined to trial preds first.

I've not had great results with BAL. Many come back inconclusive, and don't seem to alter the course of events. In any event, many clients will just not pay for it.

RE: Help with coughing cat

Kate Richardson — Fri, 26 Feb 2021 09:38:46 GMT

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228792#228792"]Mycoplasma pretty rare without urt signs in my experience, and very rare are overall.[/quote]

My experience differs.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228792#228792"]Pneumonia in cats is even rarer. [/quote]

Agree.

[quote userid="8991" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228792#228792"]I wouldn't rush to BAL. Can't remember the last time I did one. Diagnostic yield very low mostly, very rarely definitively.[/quote]

I don't rush to them, but they are very quick and easy and its rare for us not to get a diagnostic yield- maybe you need to look at your technique

The development of PCR testing is really useful on these as well, although expensive.

RE: Help with coughing cat

Tomas B — Thu, 25 Feb 2021 22:59:06 GMT

So you would be more inclined into feline asthma and you would start steroids in this case?

RE: Help with coughing cat

David Mills — Thu, 25 Feb 2021 21:16:13 GMT

Depomed or equivalent won't do any harm. Looks like asthma. Mycoplasma pretty rare without urt signs in my experience, and very rare are overall. Pneumonia in cats is even rarer.

Always cover for lungworm at the same time fenbendazole or moxidectin.

I wouldn't rush to BAL. Can't remember the last time I did one. Diagnostic yield very low mostly, very rarely definitively.

RE: Help with coughing cat

Tomas B — Thu, 25 Feb 2021 16:23:50 GMT

Thank you.

Those were my main 2 differentials as well, but then i thought probably heart related since it didnt appealed to me as the "classical" asthma x ray and symptoms

She had URT infections as a kitten so prabably Mycoplasma as the main cause. BAL or trial of doxy seems perfect, question was to use or not steroids due to asthma being also a possible differential?

I will first do the BAL or doxy trial and if no response then i would explore the asthma complex if no response to antibiotic treatment or absence of results in the lavage.

Thank you so much Kate

RE: Help with coughing cat

Kate Richardson — Thu, 25 Feb 2021 15:00:24 GMT

I would agree feline asthma or mycoplasma infection would be my top 2 diagnoses, lungworm less likely as she is totally indoors?

I tend to go with a week of doxycycline in the first instance and assess response. Often with mycoplasma it resolves the cough quite quickly but it then recurs a few weeks later in which case you might need to give a full 4 weeks of doxy to clear it. Ideally confirm the diagnosis with a BAL and do cytology, culture as well as PCR for mycoplasma, but if that isn't an option I just trial treat. If no response to doxy, then more likely asthma and cytology on the BAL will help with that diagnosis, but again, trial treat with pred is an option.

RE: Help with coughing cat

Tomas B — Wed, 24 Feb 2021 20:31:00 GMT

Lung parenchymal disease

RE: Help with coughing cat

Sarah Keir — Wed, 24 Feb 2021 20:27:22 GMT

[quote userid="15580" url="~/001/veterinary-clinical/small-animal/diagnostic-imaging/f/discussions/29685/help-with-coughing-cat/228782#228782"]parenquimal[/quote]

Sorry, I don't know what this is?

RE: Help with coughing cat

Tomas B — Wed, 24 Feb 2021 20:12:27 GMT

Hello Sarah, thank you first of all. I do not have concerns related to the heart other than the fact that VHS is 8.5 and i was scared that the X ray was suggestive of Pulmonary edema, auscultation heart is fine but we all now that the absence of gallop and murmur would not rule out heart disease as well.

My first thought was parenquimal disease but the age and the severity of signs (started very sporadically months ago and is now more frequent) would make me think of feline asthma, but the image is not that sugestive

RE: Help with coughing cat

Sarah Keir — Wed, 24 Feb 2021 19:17:30 GMT

In GENERAL cats don't cough with heart disease. Do you have any concerns about the heart - arrhythmia, gallop or murmur? If not then heart disease even more unlikely as a cause of this cat's cough.

I would recommend a BAL - Mycoplasma would be on ddx too.

RE: Help with coughing cat

Richard Huddart — Wed, 24 Feb 2021 18:42:16 GMT

Hi Jerry, we’re fine thanks, but Helena had a flashback and found herself writing this comment in my name!

RE: Help with coughing cat

Jeremy Davies — Wed, 24 Feb 2021 17:25:56 GMT

Hello Ern - hope you’re OK

RE: Help with coughing cat

Richard Huddart — Wed, 24 Feb 2021 17:13:38 GMT

Cats don’t cough with heart disease

RE: Help with coughing cat

Tomas B — Wed, 24 Feb 2021 11:44:13 GMT

Thank you for the response Jeremy. Would you not think of CHF and pulmonary edema? (VHS is 8.5)

RE: Help with coughing cat

Jeremy Davies — Tue, 23 Feb 2021 07:19:47 GMT

Based on the history and these images lower airway disease a strong differential. BAL should confirm/refute.

RE: Help with coughing cat

Tomas B — Mon, 22 Feb 2021 18:59:23 GMT

Sorry, thought i had written the age

2 yo