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Respiratory Distress: Diagnosis & Treatment at a Glance

Stacey Leach, DVM, & Deborah Fine, DVM, MS, Diplomate ACVIM (Cardiology)

Respiratory Medicine

|February 2011|Peer Reviewed

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Upper Airway Obstruction

  • Clinical Signs: Inspiratory dyspnea, stridor
  • Differentials: Laryngeal paralysis, extrathoracic tracheal collapse, compressive masses, foreign bodies, brachycephalic syndrome

Lower Airway Obstruction

  • Clinical Signs: Expiratory dyspnea with auscultable expiratory wheezes
  • Differentials: Bronchoconstriction/spasms, bronchial wall inflammation (feline asthma, chronic bronchitis), intraluminal exudative/mucoid debris, intrathoracic tracheal collapse & bronchomalacia, bronchial compression secondary to left atrial enlargement

Thoracic Wall Disorders

  • Clinical Signs: Paradoxical respiration with the affected area of the thorax collapsing inward on inspiration & forced outward on expiration
  • Differentials: Flail chest, “sucking” chest wounds

Pleural Space Disorders

  • Clinical Signs: Rapid, shallow breathing patterns with inspiratory distress
  • Differentials: Pleural effusion, pneumothorax

Pulmonary Parenchymal Disorders

  • Clinical Signs: Inspiratory & expiratory difficulty; presence of heart murmurs, gallops, or arrhythmias may suggest underlying heart disease
  • Differentials: Pneumonia, edema (cardiogenic or noncardiogenic), pulmonary contusions, interstitial lung disease, neoplastic or fungal infiltration

Pulmonary Vascular Disorders

  • Clinical Signs: Hemoptysis, coughing, dyspnea, syncope; split heart sounds possible if concurrent pulmonary hypertension
  • Differentials: Pulmonary thrombo-embolism, heartworm disease

Severe Abdominal Distension

  • Clinical Signs: Inspiratory distress typically characterized by slow, exaggerated pattern
  • Differentials: Ascites, gastric dilatation-volvulus, organomegaly, pregnancy


Upper Airway Obstruction

  • Sedation with acepromazine (eg, 0.025–0.2 mg/kg IV or IM) or butorphanol (eg, 0.1–0.4 mg/kg IV or IM)
  • Intubation, tracheostomy, etc if patent airway cannot be maintained
  • Glucocorticoids (eg, dexamethasone, 0.1–0.25 mg/kg IV) to reduce laryngeal & pharyngeal inflammation & edema
  • Active cooling for hyperthermic patients

Lower Airway Obstruction

  • Bronchodilators (eg, terbutaline, 0.01 mg/kg IM) to relieve bronchospasm
  • Glucocorticoids (eg, dexamethasone, 0.1–0.25 mg/kg IV or IM) for acute asthma in cats

Thoracic Wall Disorders

  • Parenteral opioids in combination with local anesthetics; NSAIDs may be used if no contraindications
  • Stabilization of flail segment to improve ventilation & facilitate evaluation & treatment; can impede inspiratory effort
  • Intermittent thoracocentesis to relieve concurrent pneumo/hemothorax

Pulmonary Parenchymal Disorders

  • Empirical therapy in extremely unstable patients
  • Thoracic radiographs for definitive diagnosis and treatment
  • Broad-spectrum antibiotics (eg, ampicillin, 22 mg/kg IV Q 8 H; enrofloxacin, 10–20 mg/kg IV Q 24 H for dogs & 5 mg/kg IV Q 24 H for cats), if pneumonia suspected
  • Loop diuretic (furosemide, initially 2–6 mg/kg IV or IM) at repeated dosing intervals for cardiogenic pulmonary edema 
  • Supportive care, oxygen supplementation, and mechanical ventilation for noncardiogenic pulmonary edema

Pulmonary Vascular Disorders

  • Anticoagulants, antiplatelet medications, thrombolytics
  • Bronchodilators (eg, theophylline, 10 mg/kg PO Q 12 H)
  • Pulmonary arterial vasodilators (eg, sildenafil, 1 mg/kg PO Q 8–12 H; pimobendan, 0.25 mg/kg PO Q 8–12 H) for concurrent pulmonary hypertension

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