Seven year old with ‘smokers’ cough

A 7 year old feline neutered domestic long hair presented for further investigations of a “smokers” cough, of one month’s duration. The cat was otherwise well, appetite was maintained.

Physical examination revealed a bright, alert and responsive patient. Mucus membranes were pink, the respiratory rate was mildly raised, attributed to nerves in the veterinary environment. Pulse rate and quality were normal. Thoracic auscultation revealed occasional moist crackles suggesting discharge accumulation in the upper airways. No abnormal heart sounds were heard. There was a pronounced, productive cough on tracheal palpation. Abdominal palpation was unremarkable and the rectal temperature was normal.

Thoracic radiographs demonstrated a moderate diffuse bronchointerstitial pattern, slightly more pronounced in the left caudodorsal lung field. Following pre-medication to minimise bronchospasm, bronchoscopy showed mucoid and mucopurulent discharge in the trachea and bronchi both sides. Mucosa was mildly inflamed with slight rounding of the carina. Cytology of a guided bronchoalveolar lavage demonstrated an increase in neutrophils, macrophages and a lesser increase in eosinophils. Tests for various infectious diseases were negative. There was no response to precautionary lungworm treatment. A diagnosis of feline asthma/bronchitis was achieved, and oral prednisolone therapy was commenced. Exposure to allergens and irritants was minimised. At 2 week follow-up, the cough had not been heard for 10 days. A transition to inhaled steroid medication was undertaken, and advice given to the referring vet on how to monitor the cat for signs of relapse or acute exacerbation, and how to approach these eventualities.

Feline respiratory disease patients can be challenging to investigate and treat. Anaesthesia and bronchoscopy/bronchalveolar lavage carry some risks which can be minimised with appropriate techniques. Interpretation of airway cytology is not always straightforward, and there are times where bacterial infection, mycobacteria, mycoplasma and lungworm infection should be considered and times when they can be easily discounted.

Aerosol treatment of respiratory disease is preferred where chronic therapy is required, as this maximises the drug concentration at the target site, while minimising systemic side effects.

I have a particular interest in respiratory disease in cats (and also lower respiratory tract disease in dogs). I have spoken on feline asthma/bronchitis for local BSAVA groups, and I have written for Veterinary Times and

Vet Expert on both lower and upper respiratory disease.