Feline Asthma

Is your beloved furbaby wheezing, coughing and hacking? Perhaps after playing with another companion animal, being scared or chasing a bug? Have you ruled out hairballs, yet the problem persists? Issues affecting the respiratory tract is a very serious situation that needs to be addressed pretty quickly. After all, breathing is a very important function for any living thing. Any impairment could pose some serious and very life threatening concerns.

Feline Bronchitis is typically the correct term for any coughing or other breathing impairment that is the result of inflammation in the lower respiratory tract. Asthma is a form of this type of inflammation (1, 2).

Simply put this type of breathing difficulty is defined by:

-Hypersensitive response to a variety of stimuli

-Tightening or narrowing of the airways that can be corrected (3)

-Identification of inflammatory cells in the respiratory tract (1)

Coughing is not seen as often in illness and disease when it comes to our feline friends. A true cough will be noted by a hunched position with an extension of the neck. At times wheezing may be present as well. The cough which is typically dry sounding and may be accompanied by gagging, often continues for longer than a month. Signs and symptoms of asthma come and go as well as its frequency and duration. It can sound identical to the cough caused by a hairball (4, 5). As time passes you may notice your feline friend exerting less energy and their gums and/or tongue may exhibit a blue or purple color indicating more restrictive oxygen intake (1, 6). On the more technical side, Asthma is triggered first when your cat breaths in the particle that causes an allergic response. The body then has a blood protein known as an antibody to identify and fight the foreign body. Any encounter causes immune cells to come to the rescue. In order to tell the body there is a problem the immune cells signal other cells to illicit a reaction such as constricting the airways. Mucus may also build up here as well. Mucus can obstruct the airways which unfortunately can lead to a secondary infection. In addition when the airways are constricted air can be trapped in the alveoli (small channels in the lungs). This can result in the lungs being over extended. With the lungs overworking past its normal function, damage can occur leading to long term adverse effects (1, 4, 7, 8). In combination with airway constriction and mucus build up, our feline friends experience respiratory distress (7,9,10).

It is important to note even a very small amount of airway restriction can be extremely serious. If the airway is restricted by 50%, a 16 fold restriction of air flow is the result. On the flip side even a minute increase in airway relaxation can cause marked improvement. (11)

Asthma most noticeably affects 1-5% of felines (7) between the ages of 2-8 years and has a genetic proponent specifically with the siamese breed (12).

In addition cats that are obese or overweight are susceptible to Asthma (13).

Few causes are known but many believe it is allergen related, however genetics and other illnesses can be origins as well. Allergens that tend to cause a hypersensitive reaction and thus air restriction can include but is not limited to: Cat litter (dust, fragrances, small particles etc.) Perfume and Fragrances (for humans, carpet fresheners, in litter, air fresheners, plug ins, Laundry detergent, carpet cleaners etc.) Smoke (vapes, cigarettes, cigars etc.) Aerosols (cleaners, perfumes, air fresheners etc.) Mold/Mildew Essential Oils Chemical cleaning products (1, 5)

One condition most owners don’t realize can contribute to infections and respiratory distress is actually dental disease, a very common disease that afflicts our companion animals. Dental disease includes bacteria build up in the mouth that can travel to the lungs. Animals with tartar, plaque, stomatitis, bad breath can all lead to bacterial infections.

(1, 14)

Diagnosing asthma often includes ruling out OTHER illness and disease. Things that should be considered include: Pneumonia (fungal, bacterial or parasitic) Heart worm Lung Parasites Cancers and masses Dental disease Obstructions

(5, 15)

While there is no specific test to tell you “Yes, your cat has feline asthma”, aside from ruling out other illnesses and disease, your veterinarian may recommend blood tests, a fecal and/or a urinalysis. These tests primarily are to identify if there are underlying issues that may be causing respiratory distress. Blood work can identify allergies as well as parasites and a fecal can identify worms like lungworms for example. It's ideal for samples to be evaluated sequentially for three days to help identify the offender (8).

A urinalysis can identify Leukotrienes, a type of cell that tells the body to have an inflammatory reaction when fatty acids are oxidized. This results in Leukotriene E4 or LTE4 seen in high concentrations in feline urine. They are not seen like this in healthy cats or those with other diseases like chronic kidney disease or pancreatitis (3). Other tests you may consider is a: Heart worm test Chest X-ray/radiographs- this can identify lung abnormalities, lung lesions, masses and heart disease (8).

A Bronchoscopy can be performed as well. This is a procedure that allows a veterinary specialist to see the airways and take samples to grow and observe. Keep in mind that eosinophils, a type of white blood cell, are typically what is looked at however this is not always specific to asthma as healthy cats often have these cells in their respiratory tract as well (16).

Endotracheal washings can also be performed. This involves a procedure where a fluid is washed into and out of the lungs and them examined. Unfortunately this technique is not commonly recommended as the use of anesthesia, which is required to perform the procedure, not only can perpetuate respiratory distress but cause further inflammation (17). The results of these tests can be helpful but at times an origin may not be identified unfortunately. However treatment based on symptoms can still provide a positive prognosis. While there is no cure for asthma, treatment is based on relieving inflammation and controlling impairing symptoms (18). Many companion animals can live a long and happy life with some simple adjustments to their lifestyle.

Adjustments you can make for your companion’s health include: Avoiding triggering events or products that complicate their breathing. This can be providing them a space from bothersome companions or loud rambunctious children, finding a dust free, fragrance free litter, and replacing chemical flea, tick, cleaning and other chemical based products. You may need to clean more to reduce dust accumulation and purchase an air filter to reduce airborne contaminants.

Feeding a species appropriate diet high in moisture (19) also is important. A species appropriate raw diet can mitigate food allergies as well as contaminants commonly found in dry kibble pet food. A fresh raw diet will help if your companion is overweight as well. Getting their weight under control is also important for managing asthma and respiratory related complications. Many cats do adapt and often naturally avoid triggers (3). You may also adjust your life for your companion as well for example if you smoke, smoking outside or a place your companion isn’t exposed would be helpful. Being cleaner, making sure to dust often and not wearing or using products with a scent can also improve respiratory symptoms. You will also need to implement treatment protocols.

The most common treatments for asthma are typically medications prescribed by your veterinarian. A bronchodilator helps to open the respiratory tract, relaxing the constricted state caused by the triggers. There are two types of Bronchodilators β2 agonists or methylxanthines which are given to your companion via an injection, oral medication or by inhaling. The most common form of these comes is an inhalant typically albuterol or salbutamol which are β2 agonists. Methylxanthines would be medications such as theoph­ylline and aminophylline.

Typically inhalants aren’t the primary method of medication administration unless an asthmatic attack is severe. They do not reach the lower respiratory tract, due to increasing constriction of the airways. If an injectable medication is not able to be administered, the inhalant is then the next best option, time is left to open the airways after a first dose then a second dose is administered to provide the most relief. Albuterol is the most effective when dosed with a face mask but s second less common option is nebulizing the medication (20).

Any oral medication should not be administered if your companion is in an attack, not only is relief delayed but additional respiratory distress can be induced by the stresses of trying to get a pill into your companion (16, 21, 22, 23, 24).

Corticosteroids or glucocorticoids (a subclass of corticosteroids) are also prescribed to provide anti-inflammatory actions. This can be prescribed as an injection to provide long lasting effects such as Depo-Medrol. Depo-Medrol should be avoided if other medications are available however. The effectiveness does decrease over time resulting in numerous dosings. Oral corticosteroids such as prednisolone can be prescribed at the onset of Asthma but then your companion is weaned onto an inhalant for maintenance. Other pharmaceutical options include inhalants that have a bronchodilator and corticosteroid all in one product such as fluticasone (which is known to reduce negative side effects) and salmeterol (20). Unlike inhalant bronchodilators, steroidal inhalants do make it to the airways effectively with the benefit of less side effects on the immune and endocrine system than oral medications. This is especially important for young cats or kittens needing steroid treatments for the rest of their life or another occurring condition like a heart disease or diabetes. The biggest con to this method of medication administration is the cost.

The final option is a transdermal steroid or topically applied medication. While this is one of the easiest dosing methods, studies have shown that even after 3 weeks of use, no detectable prednisolone (a commonly prescribed steroid) is present in the blood. Therefore this method is not commonly recommended or effective (16, 21, 22, 23, 24). While pharmaceutical medication is important for keeping the airways of your companion open and mucus at bay, long term or preventative use is not ideal unless your companion is experiencing a chronic infection. These medications can help but they are not free of side effects.

Bronchodilators can cause hyper­excitability, high blood pressure , and rapid heart rate. It should be noted they should not be used solely as it can cause asthma and breathing difficulty to worsen. Corticosteroids have several side effects as well. It can increase water and food intake and thus an increase in urination and weight gain. Our feline friends can also succumb to diabetes, pancreatitis and higher susceptibility to infections. So while this option may be the least expensive, you will be paying more in veterinary bills managing further illness and disease unfortunately making your companion worse off than what was initially being treated for (20, 25, 26). Many have also reported drastic changes in behavior.

Specifically, the steroid, prednisolone can also cause ironically shortness of breath mimicking the symptoms of asthma. Albuterol can cause chest pains or racing heart as well as shortness of breathing and wheezing.

While some of the medications suggested are readily used in humans as well, there are some considerations to take in which humans and cats are NOT the same. Cysteinyl leukotriene inhibitors for example are used with allergies and other respiratory conditions in humans as well as antihistamines like Cetirzine but they do not work for cats.

Maropitant, a neurokinin-1 receptor antagonist should not be used in the middle of an asthmatic attack and is relatively not effective when used long term as an injected medication.

Finally N-acetylcysteine, a drug known to relieve mucus, when nebulized is very dangerous for cats with feline asthma (16, 21, 22 , 23, 24) In addition while this product is claimed to be natural and is the prime supplement for breathing distress there are many concerns that come with its use even when it is not nebulized.

Its general use can cause rash, urticaria, itchiness and anaphylaxis reactions. If inhalation symptoms reported include “nausea, vomiting, stomatitis, fever, rhinorrhea, drowsiness, clamminess, chest tightness, and bronchoconstriction”

If consumed orally symptoms have been reported for nausea, vomiting, rash, and fever.

Large doses in a mouse model showed that acetylcysteine could potentially cause damage to the heart and lungs following a 3-week exposure to an oxygen-deprived environment (chronic hypoxia). Furthermore studies have shown that not only growth of preexisting tumors, but new growth of tumors emerged from the use of acetylcysteine (27).

While conventional medications are quite effective in relieving current symptoms, long term use often affects the immune system poorly as well as organ disease and other unfavorable side effects (28). Therefore it is important to consider natural treatment as well.

A species appropriate diet should be fed. These diets provide very natural, minimally processed ingredients that support the immune system. Dry pet foods have many concerns however when it comes to the respiratory tract we become concerned with grain bases and other ingredients known to cause allergies as well as contain molds and aflatoxins that can cause respiratory problems. The wet diet format prevents ingestion of dry particles and keeps the body hydrated. Acupuncture in many western cultures has readily been used to improve the function of the lungs, the immune system and has been known to reduce or even eliminate the need for pharmaceutical medications. Many veterinarians are employing acupuncture for many conditions afflicting our companions (29, 30, 31).

Diffusing colloidal silver 6-8 hours per day is also beneficial. Colloidal silver has antibacterial properties and can really get into the lungs via this method (32). Humidifiers to increase moisture, open airways and break up mucus. Keep in mind that too much humidity can cause issues so use this method in moderation and watch humidity levels. Too much humidity can promote the growth of molds and other allergens that can trigger breathing difficulties. Plant Extract Treatments

Full Extract Cannabis Oil (THC) is known to open up airways, reduce coughing and improve the function of the lungs without causing damage to lung tissues. FECO has the added benefit of eliminating the smoke component and provide anti inflammatory properties. (33, 34) Ivy leaf extract has effectively been used in humans including children to aid in symptoms of Asthma and other breathing concerns. It is a known anti-inflammatory, antiarthritic, antioxidant, antiviral, antispasmodic, antimicrobial and antitumor (35, 36).

Homeopathic Treatments

Aconitum- for the beginning stages of an asthma attack

Antimonium tart: for a rattling cough in the late morning with trouble expelling mucus

Arsenicum: Restlessness and anxiety typically from midnight or 2 am with breathing eased by sitting up. Chamomilla: for asthma brought on by high excitement accompanied by a deep drier cough while sleeping Ipecac: for a broken cough and wheezing with trouble expelling mucus. Symptoms tend to be complicated with hot weather that is humid as well. Drooling and vomiting may be present. Lobelia: aids in asthma based breathing complications brought on by the cold and occurring with vomiting and nausea. Nux vomica: Asthma associated with hay fever. Pulsatilla: Asthma brought on by warm air typically in the evening as well as consuming foods higher in fat. Behavior is often needy. Sambucus: for Asthma symptoms brought on while sleeping, waking the patient around 3 am and complicated by laying down. Spongia: for dry deep coughs with hoarse meows typically presenting in early night and worsening with chill air or water, smoke and warm confinement. (37)

Herbal Treatments:

Mullein

Lungwort

Irish moss

Hawthorn

Elecampane

Goldenrod

Liquorice

Horsetail

Nettle

Please view our Asthma Herbs Article for more detailed information and sources on herbal remedies for Asthma. Additional Treatments Creating an oxygen tank/nebulizer is an inexpensive in-home project owners can do to provide relief and help administer medication to your feline friends.

The oxygen tank/nebulizing tank is very important for cats experiencing shortness of breath or difficulty breathing (dyspnea). They should be put in the tank while minimizing stress as much as possible so that the air and medication can easily be delivered. It is important to recognize breathing patterns of your cat not only at rest but when in an asthmatic state. Normally a cat has 20-30 breaths per minute with a pulse of 110-140 per minute. Anything above these numbers should be noted and considered (9).

You will need:

Large plastic bin with a top, preferably one with latch handles.(make sure the plastic is not thick and hard when you go to drill into it later if it’s thick and hard you will not be able to drill a perfect hole, the material will crack) A nebulizer with inhalation tubing and mouthpiece (i purchased this one)

½ inch Poly Insert Female (I purchased this one)

A drill

Medical Tape Plumbing putty

1. Connect the tubing of the mouth piece/mask and screw it into the poly insert

2. Drill a hole about ¾ of the way up the shorter side of the plastic bin

3. Then fit the end into the hole in the tub creating a tight fit. You

may need to add some putty to make a good seal. I also added some medical tape to further hold it in place

4. To the open end of the mouth piece seal with medical tape. 5. Another hole can be drilled in the opposite side of the bin to release any CO2 if needed. 6. Connect the medication holder and the nebulizer tubing to the mouthpiece 6. Connect the tubing to the nebulizer.

While there is a lot to consider when it comes to breathing concerns in our companion animals, there is a lot we as their guardians can do to get to the root of the problem. Asthma doesn't have to stop you or your companion's life and there are many treatment options to further improve it. REFERENCES

1. Williams, Krista, et al. “Asthma and Bronchitis in Cats.” VCA Hospitals, 2018, vcahospitals.com/know-your-pet/inhalant-treatment-for-feline-asthma-and-bronchitis.

2. McKiernan, Brendan. “Chronic Bronchitis in Cats - WSAVA2008 - VIN.” Powered By VIN, World Small Animal Veterinary Association World Congress Proceedings, 2008, www.vin.com/apputil/content/defaultadv1.aspx?pId=11268&catId=32724&id=3866625.

3. “Clinical Approaches to Zoonoses, Toxicants, and Other Shared Health Risks.” Human-Animal Medicine, by Peter MacGarr. Rabinowitz and Lisa A. Conti, W.B. Saunders, 2010, pp. 43–49.

4. Brooks, Wendy. “Asthma in Cats - Veterinary Partner.” VIN, 1 Jan. 2001, veterinarypartner.vin.com/default.aspx?pid=19239&catId=102903&id=4951536.

5. Little, Susan, and Matthew Kornya. “Feline Asthma.” The Winn Foundation, 2015, www.winnfelinefoundation.org/docs/default-source/cat-health-library-educational-articles/feline-asthma-2015.pdf?sfvrsn=0.

6. Johnson L. Diseases of the bronchus. Textbook of Veterinary Internal Medicine, 5th ed. Philadelphia: WB Saunders Co; 2000: 1055-1061.

7. Carey, Stephan A. “Feline Asthma: A Pathophysiologic Basis of Therapy.” Michigan Veterinary Medical Association , Michigan State University, 2018, www.michvma.org/resources/Documents/MVC/2018%20Proceedings/carey_02.pdf.

8. “Clinical Approaches to Zoonoses, Toxicants, and Other Shared Health Risks.” Human-Animal Medicine, by Peter MacGarr. Rabinowitz and Lisa A. Conti, W.B. Saunders, 2010, pp. 43–49.

9. King, Lesley. “Understanding and Treating Feline Asthma (Proceedings).” DVM 360, 1 Aug. 2009, www.dvm360.com/view/understanding-and-treating-feline-asthma-proceedings.

10. Karman, Rachelle. (2016). Assessing the Effectiveness of Mullein on Respiratory Conditions Such as Asthma. 10.13140/RG.2.2.28242.76483.

11. Wojciechowski, William V. Respiratory Care Sciences: an Integrated Approach. Cengage Learning, 2015.

12. Moise NS, Wiedenkeller D, Yeager AE, et al. Clinical, radiographic, and bronchial cytologic features of cats with bronchial disease: 65 cases (1980-1986). JAVMA 1989; 194: 1467-1473.)

13. Venema CM, Patterson CC. Feline asthma: what's new and where might clinical practice be heading?. J Feline Med Surg. 2010;12(9):681-692. doi:10.1016/j.jfms.2010.07.012

14. Lonsdale, Tom. Raw Meaty Bones: Promote Health. Rivetco P/L, 2001.

15. Hospitals, BluePearl Pet. “Cat Asthma (Feline Bronchitis): BluePearl Pet Hospital.” BluePearl, 17 Mar. 2020, bluepearlvet.com/medical-articles-for-pet-owners/bronchitis-feline-chronic-aka-feline-asthma/.

16. Reinero, Carol. “Treatment of Feline Allergic Asthma.” American Veterinarian, 12 Oct. 2018, www.americanveterinarian.com/journals/amvet/2018/october2018/treatment-of-feline-allergic-asthma.

17. Johnson, Lynelle R. “Ettinger: Textbook of Veterinary Internal Medicine, 7th Edition Tracheal Wash and Bronchoscopy.” Veterinary Emergency and Referral Center of Hawaii, 2010, verchawaii.com/assets/PDFs/Tracheal_Wash_and_Bronchoscopy.pdf.

18. Byers, Christopher G, and Nishi Dhupa. “Feline Bronchial Asthma: Treatment.” Vetfolio, Compendium , June 2005, vetfolio-vetstreet.s3.amazonaws.com/mmah/e0/851d9448f34096b5d002b5bae51db2/filePV_27_06_426.pdf.

19. Pierson, Lisa A. “Feeding Your Cat: Know the Basics of Feline Nutrition.” Cat Info, Nov. 2016, catinfo.org/#Feline_Asthma.

20. Byers, Christopher G, and Nishi Dhupa. “Feline Bronchial Asthma: Treatment.” Vetfolio, Compendium , June 2005, vetfolio-vetstreet.s3.amazonaws.com/mmah/e0/851d9448f34096b5d002b5bae51db2/filePV_27_06_426.pdf.

21. Reinero CR. Advances in the understanding of pathogenesis, and diagnostics and therapeutics for feline allergic asthma. Vet J. 2011;190(1):28-33. doi: 10.1016/j.tvjl.2010.09.022.

22. Reinero CR, Delgado C, Spinka C, DeClue AE, Dhand R. Enantiomer-specific effects of albuterol on airway inflammation in healthy and asthmatic cats. Int Arch Allergy Immunol. 2009;150(1):43-50. doi: 10.1159/000210379.

23. Reinero CR, Decile KC, Byerly JR, et al. Effects of drug treatment on inflammation and hyperreactivity of airways and on immune variables in cats with experimentally induced asthma. Am J Vet Res. 2005;66(7):1121-1127.

24. Schooley EK, McGee Turner JB, Jiji RD, Spinka CM, Reinero CR. Effects of cyproheptadine and cetirizine on eosinophilic airway inflammation in cats with experimentally induced asthma. Am J Vet Res. 2007;68(11):1265-1271. doi: 10.2460/ajvr.68.11.1265.

25. Louise, Debbie De. “How Holistic Treatments Help Cats With Asthma and Allergies.” Catster, 31 Aug. 2016, www.catster.com/lifestyle/cat-health-holistic-treatments-asthma-allergies.

26. King, Ingrid. “Natural Remedies for Feline Asthma.” The Conscious Cat, 30 May 2012, consciouscat.net/2012/01/30/natural-remedies-for-feline-asthma/.

27. Lowe, Derek. “N-Acetyl Cysteine: A Warning Shot.” Science Translational Medicine, In the Pipeline, 4 Oct. 2019, blogs.sciencemag.org/pipeline/archives/2019/10/04/n-acetyl-cysteine-a-warning-shot.

28. Bardot, JD. “Homeopathic Treatment for Feline Asthma in Cats.” The JB Bardot Archives, www.jbbardot.com/homeopathic-treatment-for-feline-asthma-in-cats/?fbclid=IwAR0ufI-H5QGzm-YuqLSd-zUPfWviSUn9cdPWp8TrM_veH4v-q1FAVQcdD4M.

29. Li, Meng et al. “Acupuncture for asthma: Protocol for a systematic review.” Medicine vol. 96,26 (2017): e7296. doi:10.1097/MD.0000000000007296

30. Wei Y, Dong M, Zhang H, et al. Acupuncture Attenuated Inflammation and Inhibited Th17 and Treg Activity in Experimental Asthma. Evid Based Complement Alternat Med. 2015;2015:340126. doi:10.1155/2015/340126

31. Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study. Joos S, Schott C, Zou H, Daniel V, Martin EJ Altern Complement Med. 2000 Dec; 6(6):519-25.

32. Park, Hee Sun et al. “Attenuation of allergic airway inflammation and hyperresponsiveness in a murine model of asthma by silver nanoparticles.” International journal of nanomedicine vol. 5 505-15. 9 Aug. 2010, doi:10.2147/ijn.s11664

33. Vachon, Louis, et al. “Single-Dose Effect of Marihuana Smoke - Bronchial Dynamics and Respiratory-Center Sensitivity in Normal Subjects: NEJM.” New England Journal of Medicine, 10 May 1973, www.nejm.org/doi/full/10.1056/NEJM197305102881902.

34. Pletcher MJ, Vittinghoff E, Kalhan R, et al. Association Between Marijuana Exposure and Pulmonary Function Over 20 Years. JAMA. 2012;307(2):173–181. doi:10.1001/jama.2011.1961

35. Hofmann D, Hecker M, Völp A. Efficacy of dry extract of ivy leaves in children with bronchial asthma--a review of randomized controlled trials. Phytomedicine. 2003;10(2-3):213-220. doi:10.1078/094471103321659979

36. Goldman, Rena. “5 Fast Facts About English Ivy.” Healthline, Healthline Media, 31 Oct. 2016, www.healthline.com/health/5-fast-facts-english-ivy#side-effects.

37. Ullman, Dana. “A Homeopathic Perspective on Asthma.” Homeopathic.com, 27 Feb. 2018, homeopathic.com/a-homeopathic-perspective-on-asthma/.