Canine infectious respiratory disease complex (CIRDC) is common and has clinical signs similar to cold or flu in humans; however, clients often express greater concern for their dog’s illness than they would their own. Clear communication and realistic expectations are essential for effective management and client satisfaction. Clients may be distressed about their dog’s cough and not understand that patience and observation, rather than immediate therapeutic intervention, are key. CIRDC is typically self-limiting, but complications can occur. Concerns about progression or severe disease should thus not be dismissed but instead be contextualized.
This article explores strategies for discussing diagnosis, treatment, and management of patients with CIRDC, including tips for client communication, diagnostic and treatment options, and goals.
Setting Realistic Expectations
Most patients with CIRDC respond well to supportive care and adequate time to recover, but helping clients understand this can be challenging. Although clients may appreciate the lower costs associated with limited testing and treatment, they often expect specific therapies and may react negatively to a do-nothing approach without adequate explanation.
Key Points to Consider
CIRDC is a clinical syndrome caused by a range of pathogens, not a specific disease. Coinfections are common.
Diagnostic testing to identify the underlying cause can be performed but is not routinely recommended for a single instance of disease (vs group situations like kennel outbreaks), as results rarely influence patient care.1
CIRDC is usually self-limiting. Supportive care is typically indicated. Anti-inflammatories, cough suppressants, and antimicrobials should be used only when needed and overuse avoided because of potential adverse effects.
Acknowledging client concerns and conveying a plan is important. Clients are more likely to accept a conservative approach as part of a clear plan, rather than being told to return to the clinic if the condition does not improve.
Clients may push for antibiotics, especially if they are concerned about Bordetella bronchiseptica.
Recheck is not usually needed unless the condition deteriorates or recovery is delayed. Good communication can help ensure the client knows what signs require a follow-up appointment versus when urgent care should be sought.
What a Conversation About Diagnosis May Sound Like
Clinician: Based on Biscuit’s current condition and history of contact with other dogs, he has CIRDC, which you might know as kennel cough. This condition can be caused by different viruses and bacteria, but guidelines do not recommend testing for a specific cause.
Client: Why shouldn’t we test him? Wouldn’t knowing the actual cause tell you what to do? I want to make sure we are doing what we need to do
Clinician: We can’t test for all the possible viruses and bacteria, but even if we did, the results would not change our approach. Similar to a human cold, it is best to treat the signs, rather than the underlying cause.
Communicating Treatment Options & Costs
Clients may want a simple and rapidly effective treatment, but CIRDC can persist for a few days or longer. Coughing can be disruptive and is often the clients main concern, as clients often use cough as the main indicator of their dog’s health. Clients may request antimicrobials for treatment, but cough can persist after the infection has been eliminated, and antimicrobials are not useful if cough is related to postinfection inflammation.
What a Conversation About Treatment May Sound Like
Client: I’m worried about Biscuit’s cough. He can’t sleep because of the coughing and neither can I. What can we do about it?
Clinician: Episodes of coughing can sound bad but are not typically harmful. Cough is one way the body fights disease. Right now, when he coughs, you can see that he’s spitting up phlegm or swallowing when he's done coughing. We want him to be able to expel the phlegm from his lungs. If he develops a dry cough, where he coughs without producing anything, we can give him a cough suppressant.
Client: How long can this go on? Is there anything else we can do?
Clinician: Coughing usually stops in a few days but can go on for weeks. Although coughing can be useful at the start to help clear his lungs, once that’s no longer needed, we want to quiet the cough. Providing warm, moist air by putting him in the bathroom with hot water running in the shower can help clear his lungs and reduce irritation. He should not be allowed outdoors for long periods in cold weather, and activity should be limited. Walks should be short and quiet if it is cold outside.
What a Conversation About Supportive Care May Sound Like
Client: I don’t like not doing anything to treat this. I’m worried Biscuit will get worse, and we will have to come back in a few days. Can’t we give him something?
Clinician: Time is usually the best medicine, but we have options and a treatment plan for him. If he is still bright, alert, and eating well but the cough persists, we can give him medication to decrease inflammation in the lungs. It would better to wait a few more days to see if his lungs will settle on their own because he has not been coughing for long and those medications can make him want to eat and drink more. We have the next steps ready though if the cough persists.
What a Conversation About Antibiotics May Sound Like
Client: Does Biscuit need antibiotics? I don’t want him to get worse.
Clinician: Antibiotics are sometimes used but are not needed in this case. We reach for antibiotics when dogs have more severe disease. Antibiotics can cause complications like vomiting and diarrhea, so we would rather not give them unless absolutely necessary. Biscuit will need antibiotics if he develops pneumonia, which is unlikely but should be monitored for. If he loses his appetite, has less energy, starts breathing harder, or has a worsened cough, we will consider antibiotics. Right now, he is better off without them, and it is easier on him and you because you will not have to administer pills.
What a Conversation About Follow Up May Sound Like
Client: Do we have to come back for another examination?
Clinician: Let’s see how things go. Most likely, this is equivalent to a cold, in which case you would rest for a few days and return to normal activity based on how you feel. It is the same for Biscuit. If he gets worse or is not feeling better within a week, we should see him again. If he starts having trouble breathing, he should be seen right away, either here or at an emergency clinic. Otherwise, we will see him at the next regular wellness visit.
Maintaining Client Engagement
Providing clear information about the approach to treatment is important, so clients can understand the treatment approach and have confidence in the plan. Setting realistic goals for time to resolution and providing a plan helps set expectations. Clients who feel informed and supported are more likely to accept the treatment plan. Clients who do not understand the likely and potential course of disease may become frustrated and disappointed.