DIAGNOSTIC/MANAGEMENT TREE h RESPIRATORY MEDICINE h PEER REVIEWED

MANAGING FELINE ASTHMA & CANINE BRONCHITIS

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FELINE ASTHMATIC OR CANINE BRONCHITIS PATIENT PRESENTED

Exacerbation of asthma or bronchitis present with airway constriction causing respiratory distress?

YES NO

Ensure patient can breathe Reduce ongoing airway inflammation h Immediately dilate airways to h Provide 10-day, short-term course of systemic steroids1 provide respiratory relief • Cats: prednisolone (1-2 mg/kg every 24 hours)1 h Provide injectable steroid and • Dogs: prednisone (0.5-1 mg/kg every 24 hours)4 either inhaled or injectable h Review environmental factors and make modifications to reduce potential triggers bronchodilator (see Types of h Ensure pet owners understand corticosteroids are considered a mainstay of treatment and Inhaled Medication, next page) may be administered orally or via injection or inhalation; inhaled forms help limit systemic • Administer injectable absorption (see Adverse Effects of Systemic Steroids, next page) medications (ie, dexamethasone h Owners already providing inhaled steroids to their pet and who treated exacerbation with [0.1-0.5 mg/kg IM or IV], albuterol can continue with inhaled steroid therapy; those currently using other forms may terbutaline [0.01 mg/kg IM or consider transitioning to inhaled corticosteroids SC]) in clinic1,2 • Inhaled bronchodilator (ie, albuterol/salbutamol [1-2 puffs every 30 minutes for ≤4-5 hours]) may be administered in clinic or TRANSITION TO INHALED STEROIDS at home by owner.3 Owners unable to regain control at home should bring their pet to the clinic for veterinary care h Taper systemic steroids and introduce inhaled steroids • Fluticasone3 –Cats and dogs ≤44.1 lb (20 kg): 1 puff (110 µg) every 12 hours ■ Cats with more serious disease may require 220 µg every 12 hours –Dogs >44.1 lb (20 kg): 1 puff (220 µg) every 12 hours • Fluticasone/salmeterol5 –Cats and dogs ≤44.1 lb (20 kg): 1 puff (115 µg/21 µg) every 12 hours –Dogs >44.1 lb (20 kg): 1 puff (230 µg/21 µg) every 12 hours h Overlap systemic and inhaled therapy for 2 weeks3 • Inhaled steroids may require 2 weeks to take effect

MAINTAIN DISEASE CONTROL

h Use maintenance therapy to control inflammation and prevent exacerbation h Continue daily therapy for management of clinical signs • Fluticasone –Cats and dogs ≤44.1 lb (20 kg): 1 puff (110 µg) every 12 hours ■ Cats with more serious disease may require 220 µg every 12 hours –Dogs >44.1 lb (20 kg): 1 puff (220 µg) every 12 hours • Fluticasone/salmeterol –Cats and dogs ≤44.1 lb (20 kg): 1 puff (115 µg/21 µg) every 12 hours –Dogs >44.1 lb (20 kg): 1 puff (230 µg/21 µg) every 12 hours h Cat owners can administer inhaled bronchodilators during flare-ups secondary to exposure to triggers6 • Albuterol/salbutamol: 1 to 2 puffs as needed6 –Albuterol is a rescue medication and should not be used as monotherapy2,6 • Dogs have not been shown to experience bronchoconstriction7 –Little evidence exists for effectiveness of albuterol therapy to manage canine bronchitis DIAGNOSTIC/MANAGEMENT TREE h RESPIRATORY MEDICINE h PEER REVIEWED

TYPES OF INHALED MEDICATION ADVERSE EFFECTS OF SYSTEMIC STEROIDS1-4,8-11 h Corticosteroids (eg, fluticasone, mometasone, h Behavioral changes, including aggression budesonide) h Lethargy • Reduce airway inflammation and mucus production h Increased thirst and urinary incontinence • Used for ongoing management of conditions h Increased risk for infection (eg, UTI) even in absence of clinical signs h Diabetes mellitus h Bronchodilators • Open airways by relaxing smooth muscles to h Weight gain/obesity reduce bronchoconstriction h Vomiting/diarrhea • Not to be used as monotherapy • Available in short-acting and long-acting h Iatrogenic hyperadrenocorticism formulations1 h Immunosuppression –Short-acting formulations (eg, albuterol, salbutamol) ■  4- to 6-hour duration ■  Are considered rescue medications; may help coughing flare-ups and limit need for clinic 2 References visits 1. Sharp C. Treatment of feline lower airway disease. Today’s Veterinary Practice. 2014;4(2):28-32. ■ Albuterol is not to be used chronically, as it may 2. Lee-Fowler T. The asthmatic cat: management guidelines. Today’s Veterinary Practice. 2018. result in worsening of airway inflammation; 3. Padrid P. Use of inhaled medications to treat respiratory diseases in dogs and cats. J Am Anim Hosp Assoc. 2006;42(2):165-169. corticosteroids are the mainstay for long-term 4. Carey SA. Current therapy for canine chronic bronchitis. Paper presented at: 2011 ISVMA management and control Conference; Peoria, Illinois; November 11-13, 2011. –Long-acting formulations (eg, salmeterol)5 5. Olah G. Which drugs are used to treat feline asthma? Plumb’s Therapeutics Brief. 2015;2(3):18-30.  ■12-hour duration 6. Rozanski E. Aerosol therapy in dogs & cats. Clinician’s Brief. 2013;11(1):32-35. h 7. Padrid P. Diagnosis and therapy of canine chronic bronchitis. Paper presented at: 2001 WSAVA Combination inhalers (eg, fluticasone/salmeterol, Congress; Vancouver, Canada; August 8-11, 2001. budesonide/formoterol, mometasone/ 8. Palermo S, Plumb’s Veterinary Drugs. Prednisone/prednisolone. Veterinary Team Brief. formoterol) 2017;5(9):33. 9. Carey SA. Feline asthma: a pathophysiologic basis of therapy. https://www.michvma.org/ • Often a combination of inhaled corticosteroids resources/Documents/MVC/2018%20Proceedings/carey_02.pdf. Published 2011. Accessed and long-acting formulations February 12, 2020. • Reduce inflammation and relax smooth muscle 10. Rozanski E. Inhaled corticosteroids & airway disease. Clinician’s Brief. 2014;12(8):29-31. 5 11. Plumb DC. Prednisolone/prednisone. Plumb’s Veterinary Drugs website. https://www. • Indicated for disease management, not rescue plumbsveterinarydrugs.com/#!/monograph/sShl11M9aP. Updated July 2019. Accessed • May be used as a step-up therapy February 5, 2020.