Feline Inhalers

Re: Feline Inhalers

Martin Atkinson — Thu, 01 May 2014 14:50:38 GMT

I think that fluticasone is recognised as more effective than beclamethasone at much lower doses thus less potential side effects. I would say that if it is a choice of Becotide or squat diddly then use it if they can afford Flixotide then use that.

Re: Feline Inhalers

Jon Slattery — Thu, 01 May 2014 14:50:10 GMT

Kathryne

I believe (but stand to be corrected) that fluticasone is a more potent steroid and so you get a greater effect for the dose given. Perhaps as if not more importantly it is a much larger molecule and so there is much less cross over from the alveoli into the blood stream for a given dose.

In my experience and from feed back from other vets, a higher dose of beclomethasone may be almost as effective as fluticasone provided systemic side effects are not apparent.

Here is an abstract comparing the two in humans

Thorax 1993;48:817-823 doi:10.1136/thx.48.8.817

Research Article

Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year. International Study Group.

+Author Affiliations

Instituto di Mallattie, Infettive e dell'Apparato Respiratorio, Università di Ferrara, Italy.

Abstract

BACKGROUND--High dose inhaled glucocorticosteroids are increasingly used in the management of patients with moderate to severe asthma. Although effective, they may cause systemic side effects. Fluticasone propionate is a topically active inhaled glucocorticosteroid which has few systemic effects at high doses. METHODS--Fluticasone propionate, 1.5 mg per day, was compared with beclomethasone dipropionate at the same dose for one year in patients with symptomatic moderate to severe asthma; 142 patients received fluticasone propionate and 132 received beclomethasone dipropionate. The study was multicentre, double blind and of a parallel design. For the first three months patients attended the clinic every four weeks and completed daily diary cards. For the next nine months they were only seen at three monthly intervals in the clinic. RESULTS--During the first three months diary card peak expiratory flow (PEF) rate and lung function measurements in the clinic showed significantly greater improvement in patients receiving fluticasone propionate (difference in morning PEF 15 l/min (95% CI 6 to 25)), and these differences were apparent at the end of the first week. The improved lung function was maintained throughout the 12 month period and the number of severe exacerbations in patients receiving fluticasone propionate was reduced by 8% compared with those receiving beclomethasone dipropionate. No significant differences between the two groups were observed in morning plasma cortisol levels, urinary free cortisol levels, or response to synthetic ACTH stimulation. In addition, both the rates of withdrawal and of adverse events were low, and there were fewer exacerbations of asthma with fluticasone propionate than beclomethasone dipropionate. CONCLUSIONS--This study shows that fluticasone propionate in a daily dose of 1.5 mg results in a significantly greater increase in PEF and asthma control than the same dose of beclomethasone dipropionate, with no increase in systemic or other side effects.

And another link to a study in children comparing the two meds.

www.waojournal.org/content/pdf/1939-4551-3-10-250.pdf‎

Generally with my patients if the owners can afford fluticasone then I recommend that first line. If not then beclomethasone but warn that if poor control then may need to use fluticasone. I find it interesting how many owners with asthmatic/bronchitic cats/dogs are also on inhalers themselves - environmental factors?

Just to add into the mix as well an excellent small animal nebuliser called Flexineb SA was demonstrated at BSAVA and should be on general release around the beginning of June. It would allow for the (home) nebulisation of both saline but also soluble steroids such as dexamethasone at a fraction of the cost of MDI based steroids. There is good evidence to show that nebulised steroids are far more effective than MDI based particle steroids especially where there is a greater large airway component.

Allergology International Vol 61, No3, 2012 www.jsaweb.jp_ 411

Superiority of Nebulized Corticosteroids over Dry Powder Inhalers in Certain Patients with Cough Variant Asthma or Cough-Predominant Asthma

Mitsuhiro Kamimura1, Shinyu Izumi2, Yoichiro Hamamoto1, Akane Morita1, Emiko Toyota2,

Nobuyuki Kobayashi2 and Koichiro Kudo2

ABSTRACT

Background: The particle distribution might differ between nebulizer therapy and metered-dose inhaler (MDI)

or dry powder inhaler (DPI) therapy because the particles repeatedly enter_re-enter the airways with the nebulizer.

Inhaled corticosteroids (ICS) were administered with a nebulizer to assess the benefit of changes in the

distribution of particles in patients with cough variant asthma (CVA) and cough-predominant asthma (CPA).

Methods: Patients whose symptoms were not controlled by their current therapy were enrolled. In patients receiving

high-dose ICS by MDI or DPI (ICS-MDI_DPI), steroid therapy was switched to 1,320 μg_day of nebulized

dexamethasone (1,600 μg as dexamethasone sodium phosphate) (chronic steroid-independent group). In

patients receiving systemic steroids regardless of their ICS-MDI_DPI therapy, nebulized dexamethasone was

added and any concurrent ICS-MDI_DPI therapy was halted to detect a steroid-sparing effect (chronic steroiddependent

group). In patients with acute exacerbation of CVA or CPA and persistent symptoms despite systemic

corticosteroids, nebulized dexamethasone was added to assess its effect (acute group).

Results: Superior symptom control was achieved in 10 out of 12 steroid-independent patients, 3 out of 6

steroid-dependent patients, and all 7 acute patients.

Conclusions: Delivery of ICS via a nebulizer has advantages over ICS-MDI_DPI in some patients with CVA or CPA.

Kind regards

Jon

Re: Feline Inhalers

kathryne hodgson — Thu, 01 May 2014 13:53:34 GMT

I would like to revive this thread.

I am actually treating a dog with chronic bronchitis with flixotide 25ug's 2 puffs BID.

I wonder has anyone tried the becotide inhalers that are used for human asthmatics, and does anyone know what the difference is between the two steroid products as the cost difference is huge (flix approx £55 and beco approx £7). I wonder if we are just using it out of habit and because its listed in the SA formulary.

Any thoughts/suggestions very welcome.

Many thanks,

Re: Feline Inhalers

Martin Atkinson — Thu, 05 Dec 2013 17:27:31 GMT

[quote user="Rebecca Benge"]

I'm sure it's about £56 from our supplier (that's without mark up to the client)! Salbutamol is much much cheaper - about £3 or 4!

[/quote]I tend to use the 125mcg size to start with (the dose is 50-250mcg once or twice daily) that is £30.77 from NVS with VAT + a 50% mark-up that is £54.67. The 50mcg size is only £7.78. Salbutamol is cheaper but it is not a preventative, its use in treatment of an acute asthma attack and we want to stop that in the first place so the Ventolin is only as standby.

Re: Feline Inhalers

Rebecca MacMillan — Thu, 05 Dec 2013 17:05:53 GMT

I'm sure it's about £56 from our supplier (that's without mark up to the client)! Salbutamol is much much cheaper - about £3 or 4!

Re: Feline Inhalers

Lucy Fleming — Thu, 05 Dec 2013 16:56:10 GMT

Just checked my own cat's record.... his inhaler is a 50microgram flixotide inhaler, 120 actuations. So at BID, would be 60d. With a prescription from the chemists, I don't remember it being too pricey (I'm sure it was less than a tenner...)

Re: Feline Inhalers

Rebecca MacMillan — Thu, 05 Dec 2013 16:48:10 GMT

I've dug out this old post as I've got a new case that wants to try inhaler. However what I wasn't sure of was how long does an inhaler tend to last? The flixotide ones aren't cheap, so I wondered how long a client could expect them to last at a dose of one puff BID?

Re: Feline Inhalers

Jon Slattery — Wed, 16 Dec 2009 18:40:10 GMT

Drug availability is still >50 % after 5 seconds and >30% after 10 seconds. I've e-mailed you an in-house white paper showing drug availabilty with time. If a patient is consistently breath holding for more than 5-7 seconds then it may be worth upping the dose temporarily. Having said that, the first breath that it takes will probably be a nice deep one with good drug penetration!

Kind regards

Jon

Re: Feline Inhalers

Mike Martin — Wed, 16 Dec 2009 17:53:40 GMT

Hi Jon,

So in practice, if the cat has not taken a good breath after 5 seconds, you need to start again?

Re: Feline Inhalers

Jon Slattery — Wed, 16 Dec 2009 17:33:07 GMT

The AeroKat has a 'Flow-Vu' indicator built in to it which allows the caregiver to see when the cat takes an effective breath and that the mask is making a good seal on the muzzle.

Unlike other spacers, the AeroKat still has 50% availability of medication five seconds after the drug has been introduced into the chamber cf 0% availability with a chamber usch as the Babyhaler.

Phil Padrid DVM in the USA suggests a starting dose of 250-500ug q12h of fluticasone )dependant on severity of signs) but often will also start off with oral prednisolone as well whilst the inhaled therapy kicks in. He uses Salmeterol for more severe cases in combination with fluticasone (Seretide) q12h.

Kind regards

Jon

Re: Feline Inhalers

Mike Martin — Wed, 16 Dec 2009 17:15:15 GMT

We start at 2 (or 3) puffs bid. But also influenced and adjusted by clinical response over time with the aim of getting the lowest effective dose, which might be 1 puff.

My concern is......how much do cats actually inhale when given with a spacer? Does it breath hold, or breathe well during that period? How well do owners maintain the mask around the cat's nose? Or a delay in doing so? So, unlike parenterally administered drugs, I'm not sure there is a set dose for all cats, but it should to be titrated for each individual based on response.

Does that make sense? Does that seem reasonable?

Re: Feline Inhalers

listhestar — Wed, 16 Dec 2009 14:31:47 GMT

[quote user="Mike Martin"]Salbutamol (bronchodilator) is then additionally used when the cat relapses with symptoms (cough, expiratory wheeze or crackles on auscultation[/quote]

Martin,

What sort of doses do you use?

Lisa

Re: Feline Inhalers

Rebecca MacMillan — Fri, 11 Dec 2009 18:57:15 GMT

Thank you very much everyone for all your useful help and advise!

Re: Feline Inhalers

Jon Slattery — Thu, 10 Dec 2009 21:51:21 GMT

Rebecca

Have a look at www.breatheazy.co.uk. There is loads of useful information in the vets only section including drugs, suggested starting dose rates, protocols, articles in PDF format to download and much more.

They also have a technical support line to chat to if you need more advice on the AeroKat.

Kind regards

Jon

Re: Feline Inhalers

Rajat — Tue, 08 Dec 2009 12:08:59 GMT

Hi Rebecca

Pitching in here as well as we tend to use inhlaers where possible in cats vs tablets..

I agree flixotide 125 1 puff bid is what I go with too. But just some words of caution. Fluticasone can take upto 4 weeks to reach therapeutic levels in pulmonary tissue. We need to provide additional anti inflammatory activity to cover for this period in another form. Some people use Beclamethasone but I am not sure we have more data for this cf fluticasone in cats...both have worked well before for me.

A bronchodilator such as salbutamol is v useful in acute flareups of the disease works v quickly) and some specialists advocate pre tx with this before the steroid puff in the initial period of treatment to allow the steroid to penetrate deeper into the airways. Inusually do this for the first 4-5 days. Once stable usually a steroid inhaler alone is sufficient.

Fluticasone is also available as Seretide- a combination of a bronchodilator with FLuticasone- this is considerably expensive when got through NVS but a human pharmacy is much cheaper. It does work well and eliminates the need for 2 inhalers (esp cats who dont always sit still for this!).

Aerokats and aerodawgs are great and ensure adequate particle size etc (theres a surprising amount of physics which goes into the design of these things!) and unless broke all clients get these...otherwise paediatric ones from boots usually have to do.

And plenty of client support helps fritzthebrave is a great site as is fabcat etc...

Hope you have success with your 'inhalers'!

Cheers

Raj

Re: Feline Inhalers

Hannah Wynne Richards — Sun, 06 Dec 2009 20:06:43 GMT

Flixotide 125mcg 1 puff bid

Wynne

Re: Feline Inhalers

Rebecca MacMillan — Sun, 06 Dec 2009 17:25:48 GMT

What sort of doses do people tend to use?

Re: Feline Inhalers

Rob Loxley — Sun, 06 Dec 2009 15:39:11 GMT

http://www.fritzthebrave.com also has some videos and pictures and can be a useful resource to point an interested client at

Re: Feline Inhalers

Hannah Wynne Richards — Fri, 04 Dec 2009 17:03:11 GMT

NVS also supply Flixotide

Wynne

Re: Feline Inhalers

Mike Martin — Fri, 04 Dec 2009 15:55:39 GMT

Your usual distributor, or the local chemist, or provide the owner with a prescription for the chemist. We gets our via Dunlops.

Re: Feline Inhalers

Rebecca MacMillan — Fri, 04 Dec 2009 15:47:49 GMT

I'm still a bit confused, so you can buy the Aerokat aerosol chamber relatively easily, but where do you get the human inhaler bits with the drugs in from? Sorry if I'm being stupid!

Thanks for all your help and the great links

Re: Feline Inhalers

Mike Martin — Fri, 04 Dec 2009 14:32:39 GMT

We recommend it (and use it) a lot too. Sounds like good tips given by others here.

The Aerokat spacer can be bought from your usual distributor or from the UK supplier, here. We have an Information Sheet about feline asthma, but there is also good info on the FAB website including a movie on the use of the Aerokat. Apparently the Aerokat is better for cats than the paediatric spacer because of its size (volume) + the one-way valve mechanism.

In practice, we tend to start cats on preds + clenbuterol to get control, then wean onto the inhaler for long term use. So using a steroid for control (prevention), normally beclomethasone. I'm aware the fluticasone is not absorbed parentally in the human species, but I'm not sure if this is proven to be the same in cats, or relevant in cats. It is much more expensive. Salbutamol (bronchodilator) is then additionally used when the cat relapses with symptoms (cough, expiratory wheeze or crackles on auscultation).

Re: Feline Inhalers

Rosie_Skinner — Fri, 04 Dec 2009 14:16:52 GMT

There's a lovely video of a cat being given inhalation therapy on www.fabcats.org, I get owners of possible candidates to look at this and tell me if they think their cat would be up for it! The main thing is getting the cat used to the inhaler and not turning it into a battle of wills!

Re: Feline Inhalers

listhestar — Fri, 04 Dec 2009 13:57:53 GMT

[quote user="Rebecca Benge"] was wondering if anyone routinely uses inhalational medication for feline asthma cases[/quote]

I've put a couple of cats on inhalers- tend to use Flutixide and use a paedatric spacer devise. One cat is quite naughty with me but tolerates the spacer ok. Did try taking the cat off steroids orally as well but didnt work so now on 0.5mg/kg every 3 days alongside the inhaler. Worth trying esp if owners are worried about long term steroid use.

Lisa

Re: Feline Inhalers

Martin Jones — Fri, 04 Dec 2009 13:49:43 GMT

I probably haven't had quite as much experience as others, but we do use them.

Basically, they come as a mask, with an attachable chamber. At the end of this is a slot to take a standard human inhaler. Squirt into the chamber, press mask to cat's face, allow it to breathe calmly and deeply a few times et voila!

It sounds like the start to that internet piece on how to pill a cat, mainly because it is. Once cat is used to inhaler, it works a treat and everybody's happy. It's the getting used bit that's the problem. We find introducing the mask as a routine part of the day helps - and it further helps if the cat is bribable with anything (use it as a positive association). Once the cat doesn't mind having the mask on its face, attach the chamber (we often initially remove the little flappy one-way valve, so there's no increased resistance to breathing, but be sure to replace it before dosing). After that, start using inhalant.

They work, they're whizzy, apart from the start-up costs they're generally cheap (provided you go for the brown or blue; the orange ones are a bit pricey), and definitely a Good Thing. Whether they work on your patient is an altogether different thing.....

Martin