May 2015
Peer Reviewed

Sign in to continue reading this article

Not registered? Create an account for free to read full articles on www.cliniciansbrief.com.

To access full articles on www.cliniciansbrief.com, please sign in below.

Busy? Sign in Faster. Sign into www.cliniciansbrief.com with your social media account.

Profile

Feline asthma is an allergic airway inflammatory disease triggered by aero-allergens, resulting in type 1 (IgE-mediated) hypersensitivity reaction and dominated by type 2 T-helper cells.1,2 It affects about 1%–5% of the feline population, with a median age of 4–5 years; Siamese and Havana brown cats are overrepresented.2,3

Hallmark features → Naturally occurring asthma

  • Eosinophilic airway inflammation
  • Mucus hypersecretion
  • Bronchoconstriction
  • Hyperresponsiveness (in response to both allergenic and nonallergenic stimuli)
  • Airway remodeling2,4,5

Inflammation in airways → Can lead to irreversible airway-remodeling damage2,4

  • Controlling inflammation is, therefore, the primary goal of therapy.
  • Despite similarities between human and feline asthma, much about the inflammatory processes that occur in feline asthma remains to be ascertained.6

Primary treatment options → Primary therapeutic approaches include

  • Glucocorticoid (steroidal) therapy: systemic and inhalant
  • Bronchodilator (asthmatic crisis) therapy
  • Supplemental/concomitant therapy

Glucocorticoid (Corticosteroid) Therapy

Glucocorticoids, although nonspecific in their actions, are the mainstays of treatment for feline asthma. Glucocorticoids have potent antiinflammatory effects and are used to suppress airway inflammation and thus slow down or minimize irreversible airway-remodeling damage. Detailed explanation of the pharmacology, mechanisms of action, and resistance of glucocorticoids in the inflammatory process are beyond the scope of this article but can be found in the literature.7,8

General note → Two distinct protocols: systemic (oral, injectable) and aerosol inhalant (metered dose inhaler [MDI])

  • If the patient does not have good response to oral corticosteroids, it may be unlikely that response to inhaled corticosteroids would be better.

Avoid glucocorticoid therapy if possible → In cats with concurrent diabetes mellitus, heart disease, or chronic FHV-1 infection

  • Other contradictions: pancreatitis, GI ulceration (except ulcers secondary to IBD), concurrent administration of NSAIDs9-12
  • Individual cats can vary greatly in their response to the therapeutic and adverse effects of glucocorticoids.
    • There may be qualitative differences between the effects of different glucocorticoids in the same cat.13

Systemic Glucocorticoids

Cats generally tolerate systemic glucocorticoids well and tend to develop fewer adverse effects than do dogs. Nevertheless, long-term, high-dose therapy can lead to cushingoid effects.

Other adverse effects include PU/PD, polyphagia, alopecia, skin atrophy, poor wound healing, bruising, increased susceptibility to infections, weight gain with or without concurrent muscle mass loss, and obesity.6

Caution: Steroid-induced diabetes mellitus may occur, and cats with underlying heart disease may develop heart failure9 (see also Inhalant Glucocorticoids6).

PREDNISOLONE & PREDNISONE

Formulation → Oral, parenteral

Dose → Oral prednisolone/prednisone: 1–2 mg/kg PO q24h or 0.5–1 mg/kg PO q12h for 10–14 days, then taper over next 2–3 months until <0.5 mg/kg q48h (if possible) or taper to lowest effective dose3,6,14-17

Emergency dose → Injectable prednisolone sodium succinate: 15–30 mg/kg IV; repeat q4–6h as needed.18

Key Points

  • Cats do not convert prednisone (a prodrug) to prednisolone (the active compound) very efficiently, although the reason (enzyme, process) remains unknown; therefore, oral prednisolone is preferred over oral prednisone in cats when possible.  
    • If oral prednisone must be used, consider increasing the dose.19-21
  • Of note, prednisolone tablets are not FDA approved for use in cats.
  • When cats with asthma or chronic bronchitis are treated with high-dose oral glucocorticoids, clinical signs may resolve despite persistent lower airway inflammation. 
    • Exercise caution in equating absence of clinical signs with absence of airway inflammation.
    • In cats with subclinical airway inflammation, premature tapering of glucocorticoids based on absence of clinical signs may be detrimental.
    • Current recommendations to taper therapy based on resolution of clinical signs should be reevaluated.14 

DEXAMETHASONE

Formulation → Oral, parenteral

Dose → Oral dexamethasone: 0.1–0.2 mg/kg PO q24h for 10–14 days, then taper over the next 2–3 months until <0.05–0.1 mg/kg q48–72h (if possible)22

Emergency dose → Injectable dexamethasone, dexamethasone sodium phosphate: 0.5–1 mg/kg SC, IV, IM23

  • Can be used in conjunction with β2-agonist for status asthmaticus (acute asthma attack)

Key Points

  • Dexamethasone 2 mg/mL injectable is FDA approved for use in cats, while dexamethasone SP 4 mg/mL injectable and dexamethasone tablets are not.
  • Dexamethasone sodium phosphate usually formulated at concentration of 4 mg/mL (equivalent dexamethasone, 3 mg/mL)
  • It has been suggested that dexamethasone exhibits greater diabetogenic effects than equipotent doses of prednisolone.11

METHYLPREDNISOLONE

Formulation → Oral, parenteral

Dose → Oral methylprednisolone: 0.8–2.2 mg/kg PO q24h or 0.4–1.1 mg/kg PO q12h for 10–14 days, then taper over next 2–3 months until <0.3 mg/kg q48h (if possible) or to lowest effective dose23

Repository dose → Injectable methylprednisolone acetate: 1–5 mg/kg up to 20 mg/cat IM q4–8wk22-24

  • May last as long as 2–6 months

Emergency dose → Injectable methylprednisolone sodium succinate: 4–6 mg/kg IV slowly over 2 minutes q2–3h as needed23

Key Points

  • Methylprednisolone acetate has reportedly led to CHF in cats.
    • May predispose cats to CHF through extracellular hyperglycemia10 but requires further evaluation
  • Iatrogenic hyperadrenocorticism has been reported in a cat following short therapeutic course of methylprednisolone acetate (20 mg SC weekly for 4 weeks).25
  • Some cats with preexisting FHV-1 infection may become symptomatic when treated with methylprednisolone acetate.26
  • Methylprednisolone tablets are FDA approved for use in cats, while methylprednisolone acetate is FDA approved for IM (but not SC) injection. 

Inhalant Glucocorticoids

Inhalant glucocorticoids have demonstrated efficacy in reducing airway inflammation in asthmatic cats and may be an alternative to systemic therapy.27 Inhalants appear to result in fewer endocrinologic and immunologic side effects as compared with oral or injectable steroids. Although inhaled glucocorticoids may be an appealing alternative, their expense could be a deterrent.8

Inhalants are administered by an MDI attached to a spacer device and facemask; see the literature for product information and use.27,28

Clinically effective absorption can be delayed, with optimal clinical effects not realized for days, possibly up to 1–2 weeks.

In moderately affected cats, concurrent administration of prednisolone at 0.5–1 mg/kg PO q12h tapered over 2–3 weeks can allow time for maximum inhalant effect.29,30

Caution: Aerosol inhalant steroids are not recommended for emergency management of status asthmaticus because of delayed effect. Instead, a fast-acting ß2-receptor agonist is recommended (see Bronchodilators).29,30

FLUTICASONE PROPIONATE

Formulation → Aerosol inhalant (MDI)

Dose → Available in 3 strengths: 44 or 50, 110 or 125, and 220 or 250 μg MDI q12–36h as needed23 (see Key Points)

Key Points

  • Most commonly used aerosol inhalant corticosteroid
  • Shows minimal hypothalamic–pituitary–adrenocortical axis (HPAA) suppression in cats.31
  • Available in three strengths per actuation, with the labeling varying by country: 44 or 50 µg, 110 or 125 µg, and 220 or 250 µg23 
    • In the U.S., MDIs are labeled by amount of drug delivered at the mouthpiece; elsewhere, they can be labeled by amount of drug delivered from the valve, which accounts for apparent dose differences.32
  • A recent study has shown that fluticasone propionate doses of 44, 110, and 220 μg q12h are equally efficacious in suppressing eosinophilic airway inflammation in experimental models of feline asthma.31 
    • In contrast, anecdotal responses indicate that 44 µg fluticasone is not always effective clinically, but 110 µg q12h is effective in managing most cats with mild-to-moderate disease; cats with more serious disease require 220 µg q12h.
    • It has been suggested that once-daily dosing is occasionally effective.32

FLUNISOLIDE

Formulation → Aerosol inhalant (MDI)

Dose →  250 μg MDI q12h33

Key Points

  • Because flunisolide suppresses the HPAA, it is not a first-choice inhalant steroid.
    • However, it may have an index superior to systemically administered corticosteroids.  
  • Flunisolide can be tried if other steroids are not available or effective.

BECLOMETHASONE DIPROPIONATE

Formulation → Aerosol inhalant (MDI)

Dose →  80–160 μg MDI q12–24h32,34

Key Points

  • Beclomethasone dipropionate is a first-choice inhalant steroid used to treat human asthmatics but has not been well studied in cats.
  • Veterinarians can try it if other steroids are not available or effective.
  • It may have more systemic side effects (eg, HPAA suppression) than does fluticasone. 

Bronchodilator (Asthmatic Crisis) Therapy

Bronchoconstriction is one of the hallmark features of feline asthma, and severe bronchoconstriction can lead to a life-threatening asthmatic crisis. Therefore, short-acting bronchodilators are important therapeutic drugs, particularly for treating cats in asthmatic crisis. 

Usually not indicated for long-term use → Avoid using as monotherapy, as bronchodilators fail to control airway inflammation that exacerbates airway hyperresponsiveness.

If corticosteroid therapy alone fails to control clinical signs → Use bronchodilators symptomatically in combination with corticosteroid therapy.

β2-Receptor Agonists

Short-acting β2-receptor agonists are the drugs of choice for treating status asthmaticus and can be used as an early at-home intervention for asthmatic crisis.

β2-receptor agonists should be used only with careful clinical monitoring in cats with preexisting cardiac disease, hyperthyroidism, hypertension, or history of seizures. 

TERBUTALINE

Formulation → Oral, parenteral (short-acting)

Emergency dose → 0.01 mg/kg SC, IM, IV

  • If beneficial, breathing rate will decrease by ~50% within 10–30 minutes.
  • Can be readministered 30 minutes later at the same dose if minimal effect has been noted
  • A heart rate approaching 240 bpm indicates that the drug has been absorbed.17,23,32

Long-term oral dose → 0.625–1.25 mg/cat PO q8–12h or 0.1–0.2 mg/kg PO q8–12h17,32,35

Key Points

  • Terbutaline is the treatment of choice for acute respiratory difficulty when inhaled albuterol therapy is not possible.
  • Most adverse effects are dose-related and associated with sympathetic stimulation, including
    • Increased heart rate, tremors, CNS excitement (nervousness), dizziness
    • Effects are generally transient and mild and do not require discontinuation of therapy.23
  • Transient hypokalemia has been reported in humans.23

ALBUTEROL SULFATE (USAN) & SALBUTAMOL SULFATE (INN)

Note → Albuterol and salbutamol are the same drug. Albuterol (90 μg/actuation) is the name used in the U.S. as assigned by the U.S. Adopted Names (USAN), and salbutamol (100 μg/actuation) is the name used in the rest of the world as assigned by the World Health Organization (WHO [International Proprietary Name, or INN]).

Formulation → Aerosol inhalant (MDI; short-acting)

Emergency dose → 90 μg (albuterol) or 100 μg (salbutamol) per actuation, ×2 actuations MDI q30min as needed for up to 4–6h23

Key Points

  • Two enantiomers of albuterol (salbutamol) exist.
    • R-albuterol (R-salbutamol) is the pharmacologically active form.
    • S-albuterol (S-salbutamol) is the inactive form and can cause paradoxical inflammation and broncoconstriction.36
  • Avoid long-term use of albuterol (salbutamol); standard formulations are racemic mixtures.  
    • The R-enantiomer formulation is available but very expensive.  
  • Albuterol (salbutamol) may be considered for intermittent, short-term asthma intervention, but its long-term use for feline asthma management may be detrimental.36
  • Clinical effects in humans usually occur within 15 minutes and can last 3–4h.37 
    • Anecdotally, effects are similar in cats.17,32 

SALMETEROL XINAFOATE

Formulation → Aerosol inhalant (long-acting)

Dose → 25 μg for long-term/maintenance use38

Key Points

  • Salmeterol may be given before bedtime to provide bronchodilation throughout the night or given twice daily in more severe cases in which a β2-receptor agonist is beneficial.
  • A large U.S. human trial showed statistically and clinically significant increase in asthma-related deaths in subjects receiving salmeterol.39  
  • Warning
    • Per FDA black label warning for human use, this drug should be used only when nothing else works to control asthma symptoms; its use for the treatment of asthma without a concomitant long-term asthma control medication (eg, inhaled corticosteroid) is contraindicated.
  • Salmeterol–chlorofluorocarbon (CFC) inhalant has been discontinued in the U.S. since 2002 but is still available in the UK.

FLUTICASONE PROPIONATE–SALMETEROL XINAFOATE COMBINATION

Formulation → Aerosol inhalant (MDI)

Dose → 250 μg fluticasone, 25 μg salmeterol MDI q12–48h32,40

Key Points

  • Combination inhaler products should only be used to treat asthma not controlled by other long-term asthma-control medication (eg, inhaled corticosteroids).

Methylxanthines

Methylxanthines promote airway smooth muscle relaxation and bronchodilation via phosphodiesterase inhibition and adenosine receptor antagonism23,41 and are generally less-effective bronchodilators than are the β2-receptor agonists.17,32,42,43

THEOPHYLLINE

Formulation → Oral

Dose → 4 mg/kg PO q8–12h17,43

  • 20–25 mg/kg PO q24h for extended-release products44

Key Points

  • Extended-release products are no longer available in the U.S.44
  • Generic extended-release theophylline offered from various manufacturers should be avoided because pharmacokinetics vary and are unpredictable.32
  • Clinicians should consider several known drug interactions.23
  • Because of its low therapeutic index and pharmacokinetic characteristics, dosage should be based on lean body mass.17,32,43
  • Because of adverse effects, use theophylline and other methylxanthines cautiously.
    • CNS stimulation/excitement, insomnia, GI disturbances (eg, vomiting, diarrhea), nausea, polyphagia, PU/PD
    • Seizures or cardiac dysrhythmias may occur in severe intoxications.23
  • Therapeutic drug monitoring is advised.23

AMINOPHYLLINE

Formulation → Oral

Dose → 5–6 mg/kg PO q12h32,43

Key Points

  • Aminophylline should rarely be used for treatment of asthma, as other safer, more efficacious bronchodilators are available (eg, β2-receptor agonist).32
  • Side effects are similar to those listed for theophylline. 

Oxygen

When a cat is in respiratory distress, it is appropriate to provide an oxygen-rich environment. However, oxygen supplementation by mask should not be forced if the cat experiences untoward stress. A mild sedative may aid in decreasing anxiety associated with hypoxia.

Patient handling should also be minimized to avoid worsening respiratory distress.32

Methods of supplemental oxygen delivery → flow-by, face mask, Elizabethan collar canopy, nasal catheter, oxygen chamber

Doses45

  • Flow-by: flow rate 6–8 L/min to achieve ~25%–45% FiO2
  • Face mask: flow rate 6–8 L/min to achieve ~35%–55% FiO2
  • Elizabethan collar canopy: flow rate of 2–5 L/min to achieve ~30%–40% FiO2
  • Nasal catheter: flow rate of 100–150 mL/min to achieve ~30%–50% FiO2
  • Oxygen chamber with controlled O2, humidity, and temperature

Antibiotics (Mycoplasma felis)

Mycoplasma felis is a primary pathogen that can mimic or aggravate asthma. The following empirical doses are based on treating upper respiratory M felis infections.

Dose → Medications with efficacy against M felis  

  • Doxycycline: 5 mg/kg PO q12h or 10 mg/kg PO q24h for 2–4 weeks46
  • Marbofloxacin: 2.75–5.5 mg/kg PO q24h for 2–4 weeks23
  • Pradofloxacin: 7.5 mg/kg PO q24h for 7 days23,46
  • Azithromycin: 5–10 mg/kg PO q24h for 2 weeks23 

Key Points

  • Mycoplasma spp are the smallest known prokaryotes, lack a cell wall, and require sterols for growth.
    • They are considered to be normal commensal organisms associated with the mucous membranes of the upper respiratory system in cats.
  • M felis has been suggested to cause lower respiratory tract and pleural cavity disease, acting as a primary pathogen and possibly exacerbating clinical signs in cats with asthma.47-52
  • Tetracycline, fluoroquinolone, and macrolide antimicrobials are most frequently used treatments for respiratory Mycoplasma spp infection in cats.51 

Immunomodulators (Cyclosporine)

In asthmatic patients, immunomodulatory therapy (specifically, cyclosporine) refers to the use of treatment designed to normalize inappropriate responses of the immune system.

Initial cyclosporine dose → 5–7 mg/kg PO q24h23 

  • Doses are empirical and based on those recommended for treating allergic dermatitis in cats.23  
  • Therapeutic drug monitoring, blood trough level in 72 hours53: 300–600 ng/mL
    • Most human medical centers perform cyclosporine assays that can be applied to veterinary patients, providing a faster turnaround time than with veterinary laboratories.

Key Points

  • Cyclosporine can be considered for treating feline asthma in patients with concurrent diseases (eg, diabetes mellitus, severe heart disease) that may contraindicate glucocorticoid therapy.12
  • Cyclosporine treatment does not appear to inhibit early-phase asthmatic response or mast cell degranulation following antigen challenge in sensitized cats.54 
    • However, it reduced airway eosinophilia, airway responsiveness, and histologic changes/airway remodeling in an experimental model of feline asthma.55
  • Cyclosporine is FDA approved for use in cats with atopic dermatitis but not those with asthma.
  • Further studies are needed to validate its use for treating feline asthma.

Additional Therapies

Omega-3 Polyunsaturated Fatty Acids

  • Omega-3 polyunsaturated fatty acids (PUFAs) with antioxidant/luteolin provide antiinflammatory effects by inhibiting key inflammatory signaling pathways.
  • They may have some beneficial effects in reducing airway hyperresponsiveness.2,56

Inhaled Budesonide

  • Inhaled budesonide at 400 μg/cat MDI q12h has been shown to be well tolerated in asthmatic cats, with improvement in clinical signs.
    • However, it may suppress the HPAA in some cats.57

Inhaled Lidocaine

  • Chronic nebulized lidocaine 2% with no preservatives and administered at 2 mg/kg q8h appears to be well tolerated in cats, causing no signs of toxicity.58
  • Lidocaine decreases hyperresponsiveness and improves airway flow, but it does not reduce airway eosinophilia.
    • It is not a suitable monotherapy but may serve as an adjunct to other treatments.2,58

Potential Future Therapies

Allergen-Specific Immunotherapy

  • Has potential to be curative treatment by inducing immunologic tolerance to allergens
  • Has met with some success in treating human asthmatics2,59
  • Abbreviated protocol referred to as rush immunotherapy (RIT) has been shown to successfully reduce airway eosinophilia in experimental feline asthma.2,60
  • Limitations of therapy rest with methods of determining exact (or closely matched) allergens required for inducing immunologic cure.2,61
    • Sensitivity and specificity of intradermal skin testing and serum allergen testing have so far produced unreliable asthma allergen-specific IgE.2,62

Stem Cell Therapy

  • May decrease long-term lung remodeling2,63
  • Tyrosine kinase inhibitor (TKI): masitinib at 50 mg PO q24h64
    • Stem cell factor is associated with proliferation and activation of mast cells and eosinophils; blockage of this factor is possible with TKIs.2,65
    • Side effects (eg, severe proteinuria, neutropenia, GI disturbances) may limit the use of TKIs as treatment for feline asthma.2,56,66

Ipratropium (Anticholinergic)

  • Ipratropium bromide with or without albuterol (inhaled aerosol) is not routinely used in cats at this time, but better potency of this combination may warrant further studies and its possible use in cats in asthmatic crisis.38,67,68
  • Emergency dose of 20 μg/90 μg MDI (ipratropium bromide–albuterol) has been documented.38,68

Precautionary Warning

Avoid/Ineffective Therapies

Several drug classes have been investigated for treating feline asthma because of their benefits in treating human asthma. However, their efficacy in treating feline asthma has been disappointing and, therefore, these drugs are not recommended at this time.

  • Cetirizine (antihistamine)69
  • Cyproheptadine (antiserotonergic and antihistamine)15,69
  • Zafirlukast (antileukotriene)15

CHF = congestive heart failure, FHV-1 = feline herpesvirus type 1, FiO2 = fraction of inspired oxygen, HPAA = hypothalamic–pituitary–adrenal axis, IBD = inflammatory bowel disease, IgE = immunoglobulin E, MDI = metered dose inhaler, PU/PD = polyuria/polydipsia, TKI = tyrosine kinase inhibitor

References and author information Show
References
  1. The role of eosinophils in allergic airway inflammation. Walsh ER, Stokes K, August A. Discov Med 9(47):357-362, 2010.
  2. Update on feline asthma. Trzil JE, Reinero CR. Vet Clin North Am Small Anim Pract 44(1):91-105, 2014.
  3. Chronic bronchitis and asthma in cats. Padrid P. In Bonagura JD, Twedt DC (eds). Kirk’s Current Veterinary Therapy XIV—St. Louis: Saunders Elsevier, pp 650-658, 2009.
  4. Airway remodeling in asthma: Therapeutic implications of mechanisms. Homer RJ, Elias JA. Physiology (Bethesda) 20:28-35, 2005.
  5. Mechanisms of remodeling in asthmatic airways. Shifren A, Witt C, Christie C, Castro M. J Allergy (Cairo) Article ID:316049, 2012.
  6. Feline asthma: What’s new and where might clinical practice be heading? Venema CM, Patterson CC. J Feline Med Surg 12(9):681-692, 2010.
  7. How do corticosteroids work in asthma? Barnes PJ, Adcock IM. Ann Intern Med 139(5):359-370, 2003.
  8. Mechanisms of steroid action and resistance in inflammation. Corticosteroids, eosinophils and bronchial epithelial cells: New insights into the resolution of inflammation in asthma. Walsh GM, Sexton DW, Blaylock MG. J Endocrinol 178:37-43, 2003.
  9. Corticosteroid-associated congestive heart failure in 12 cats. Smith SA, Tobias AH, Fine DM, et al. Intern J Appl Res Vet Med 2(3):159-170, 2004.
  10. Hemodynamic effects of methylprednisolone acetate administration in cats. Ployngam T, Tobias AH, Smith SA, et al. Am J Vet Res 67(4):583-587, 2006.
  11. A pilot study comparing the diabetogenic effects of dexamethasone and prednisolone in cats. Lowe AD, Graves TK, Campbell KL, Schaeffer DJ. JAAHA 45(5):215-224, 2009.
  12. Treatment of feline asthma with ciclosporin in a cat with diabetes mellitus and congestive heart failure. Nafe LA, Leach SB. J Feline Med Surg [Dec 19, 2014; Epub ahead of print]
  13. Corticosteroids—Friend or foe? Maddison J. In Proceedings of the 34th World Small Animal Veterinary Congress WSAVA. São Paulo, Brazil, 2009. Accessed via Veterinary Information Network; http://goo.gl/CUecU, 2009.
  14. Subclinical airway inflammation despite high-dose oral corticosteroid therapy in cats with lower airway disease. Cocayne CG, Reinero CR, DeClue AE. J Feline Med Surg 13(8):558-563, 2011.
  15. Effects of drug treatment on inflammation and hyperreactivity of airways and on immune variables in cats with experimentally induced asthma. Reinero CR, Decile KC, Byerly JR, et al. Am J Vet Res 66(7):1121-1127, 2005.
  16. Treatment of feline lower airway disease. Sharp C. Today’s Vet Pract J March/April:28-32, 2014.
  17. Chronic bronchitis and asthma in cats. Padrid PA. In Bonagura JD, Twedt DC (eds): Kirk’s Current Veterinary Therapy XV—St. Louis: Saunders Elsevier, 2014.
  18. Saunders Handbook of Veterinary Drugs: Small and Large Animal, 3rd ed. Papich MG (ed)—St. Louis: Saunders Elsevier, 2011, pp 641-642.
  19. Bioavailability and activity of prednisone and prednisolone in the feline patient. Graham-Mize CA, Rosser EJ. Vet Dermatol 15(s1):7-10, 2004.
  20. Absorption, bioavailability and activity of prednisone and prednisolone in cats. Graham-Mize CA, Rosser EJ, Hauptman J. In Hillier A, Foster AP, Kwochka KW (eds): Advances in Veterinary Dermatology—Ames, IA: Blackwell Publishing, 2005.
  21. Influence of body condition on plasma prednisolone and prednisone concentrations in clinically healthy cats after single oral dose administration. Center SA, Randolph JF, Warner KL, et al. Res Vet Sci 95(1):225-230, 2013.
  22. Lower airway disease. Brainard BM, King LG. In Drobatz KJ, Costello MF (eds): Feline Emergency and Critical Care Medicine—Ames, IA: Blackwell, 2010, pp 137-150.
  23. Plumb’s Veterinary Drug Handbook, 8th ed. Plumb DC (ed)—Ames, IA: Wiley-Blackwell, 2015.
  24. Dermatology. Moriello KA. In Little S (ed): The Cat: Clinical Medicine and Management, 1st ed—St. Louis: Saunders Elsevier, 2012, pp 390.
  25. Iatrogenic hyperadrenocorticism in a cat following a short therapeutic course of methylprednisolone acetate. Ferasin L. J Feline Med Surg 3(2):87-93, 2001.
  26. Effect of ciclosporin and methylprednisolone acetate on cats previously infected with feline herpesvirus. Lappin MR, Roycroft LM. J Feline Med Surg 17(4):353-358, 2015.
  27. Use of inhaled medications to treat respiratory diseases in dogs and cats. Padrid P. JAAHA 42(2):165-169, 2006.
  28. Aerokat Feline Aerosol Chamber, Trudell Medical Internation, London, Ontario, Canada, http://trudellmed.com/animal-health/aerokat; accessed April 2015.
  29. Feline asthma: Diagnosis and treatment. Padrid P. Vet Clin North Am Small Anim Pract 30(6):1279-1293, 2000.
  30. Inhaled fluticasone reduces bronchial responsiveness and airway inflammation in cats with mild chronic bronchitis. Kirschvink N, Leemans J, Delvaux F, et al. J Feline Med Surg 8(1):45-54, 2006.
  31. Effects of fluticasone propionate dosage in an experimental model of feline asthma. Cohn LA, DeClue AE, Cohen RL, Reinero CR. J Feline Med Surg 12(2):91-96, 2010.
  32. Lower respiratory tract diseases: Asthma and chronic bronchitis. Baral RM. In Little S (ed): The Cat: Clinical Medicine and Management, 1st ed—St. Louis: Saunders Elsevier, 2012, pp 866-875.
  33. Inhaled flunisolide suppresses the hypothalamic-pituitary-adrenocortical axis, but has minimal systemic immune effects in healthy cats. Reinero CR, Brownlee L, Decile KC, et al. JVIM 20(1):57-64, 2006.
  34. North American Companion Animal Formulary, 10th ed. Kuehn NF (ed)—Port Huron, MI: North American Compendiums, 2013.
  35. Terbutaline pharmacokinetics in cats (abstract). McKiernan BC, Dye JA, Powell M, et al. JVIM 5:122, 1991.
  36. Enantiomer-specific effects of albuterol on airway inflammation in healthy and asthmatic cats. Reinero CR, Delgado C, Spinka C, et al. Int Arch Allergy Immunol 150:43-50, 2009.
  37. A comparison of the bronchodilating effects of a beta-2 adrenergic agent (albuterol) and an anticholinergic agent (ipratropium bromide), given by aerosol alone or in sequence. Easton PA, Jadue C, Dhingra S, et al. N Engl J Med 315(12):735-739, 1986.
  38. A pilot study comparing the antispasmodic effects of inhaled salmeterol, salbutamol and ipratropium bromide using different aerosol devices on muscarinic bronchoconstriction in healthy cats. Leemans J, Kirschvink N, Bernaerts F, et al. Vet J 180(2):236-245, 2009.
  39. SMART Study Group. The Salmeterol Multicenter Asthma Research Trial: A comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Nelson HS, Weiss ST, Bleecker ER, et al. Chest 129:15-26, 2006.
  40. Effect of short-term oral and inhaled corticosteroids on airway inflammation and responsiveness in a feline acute asthma model. Leemans J, Kirschvink N, Clercx C, et al. Vet J 192(1):41-48, 2012.
  41. Methylxanthines in asthma. Tilley SL. Handb Exp Pharmacol 200:439-456, 2011.
  42. Management of asthma and chronic airflow limitation. Are methylxanthines obsolete? Lam A. Newhouse MT. Chest 98(1):44-52, 1990.
  43. Asthma. Padrid PA. In August JR (ed): Consultations in Feline Internal Medicine, 6th ed—St. Louis: Saunders Elsevier, 2010, pp 447-457.
  44. Plumb’s Veterinary Drug Handbook, 7th ed. Plumb DC (ed)—Ames, IA: Wiley-Blackwell, 2011.
  45. The thoracic cavity. Baral RM. In Little S (ed): The Cat: Clinical Medicine and Management, 1st ed—St. Louis: Saunders Elsevier, 2012, p 898.
  46. Efficacy of pradofloxacin in cats with feline upper respiratory tract disease due to Chlamydophila felis or Mycoplasma infections. Hartmann AD, Helps CR, Lappin MR, et al. JVIM 22(1):44-52, 2008.
  47. Prevalence of mycoplasmal and ureaplasmal recovery from tracheobronchial lavages and of mycoplasmal recovery from pharyngeal swab specimens in cats with or without pulmonary disease. Randolph JF, Moise NS, Scarlett JM, et al. Am J Vet Res 54(6):897-900, 1993.
  48. Mycoplasma respiratory infections in small animals: 17 cases (1988-1999). Chandler JC, Lappin MR. JAAHA 38(2):111-119, 2002.
  49. A retrospective analysis of feline bronchoalveolar lavage cytology and microbiology (1995-2000). Foster SF, Martin P, Braddock JA, Malik R. J Feline Med Surg 6(3):189-198, 2004.
  50. Mycoplasma species in cats with lower airway disease: Improved detection and species identification using a polymerase chain reaction assay. Reed N, Simpson K, Ayling R, et al. J Feline Med Surg 14(12):833-840, 2012.
  51. Feline respiratory disease: What is the role of Mycoplasma species? Lee-Fowler T. J Feline Med Surg 16(7):563-571, 2014.
  52. Detection of feline Mycoplasma species in cats with feline asthma and chronic bronchitis. Schulz BS, Richter P, Weber K, et al. J Feline Med Surg 16(12):943-949, 2014.
  53. Disposition of cyclosporine after intravenous and multi-dose oral administration in cats. Mehl ML, Kyles AE, Craigmill AL, et al. J Vet Pharmacol Ther 26(5):349-354, 2003.
  54. Differential effects of cyclosporine A after acute antigen challenge in sensitized cats in vivo and ex vivo. Mitchell RW, Cozzi P, Ndukwu IM, et al. Br J Pharmacol 123(6):1198-1204, 1998.
  55. Cyclosporin A inhibits airway reactivity and remodeling after chronic antigen challenge in cats. Padrid PA, Cozzi, P, Leff AR. Am J Respir Crit Care Med 154(6 Pt 1):1812-1818, 1996.
  56. Prophylactic effects of omega-3 polyunsaturated fatty acids and luteolin on airway hyperresponsiveness and inflammation in cats with experimentally-induced asthma. Leemans J, Cambier C, Chandler T, et al. Vet J 184(1):111-114, 2010.
  57. Inhaled budesonide therapy in cats with naturally occurring chronic bronchial disease (feline asthma and chronic bronchitis). Galler A, Shibly S, Bilek A, Hirt RA. J Small Anim Pract 54(10):531-536, 2013.
  58. Nebulized lidocaine blunts airway hyper-responsiveness in experimental feline asthma. Nafe LA, Guntur VP, Dodam JR, et al. J Feline Med Surg 15(8):712-716, 2013.
  59. Role of immunotherapy in the treatment of allergic asthma. Yukselen A, Kendirli SG. World J Clin Cases 2(12):859-865, 2014.
  60. Rush immunotherapy in an experimental model of feline allergic asthma. Reinero CR, Byerly JR, Berghaus RD, et al. Vet Immunol Immunopathol 110(1-2):141-153, 2006.
  61. Beneficial cross-protection of allergen-specific immunotherapy on airway eosinophilia using unrelated or a partial repertoire of allergen(s) implicated in experimental feline asthma. Reinero C, Lee-Fowler T, Chang CH, et al. Vet J 192(3):412-416, 2012.
  62. Comparison of intradermal skin testing (IDST) and serum allergen-specific IgE determination in an experimental model of feline asthma. Lee-Fowler TM, Cohn LA, DeClue AE, et al. Vet Immunol Immunopathol 132(1):46-52, 2009.
  63. Long-term evaluation of mesenchymal stem cell therapy in a feline model of chronic allergic asthma. Trzil JE, Masseau I, Webb TL, et al. Clin Exp Allergy 44(12):1546-1557, 2014.
  64. The tyrosine kinase inhibitor masitinib blunts airway inflammation and improves associated lung mechanics in a feline model of chronic allergic asthma. Lee-Fowler TM, Guntur V, Dodam J, et al. Int Arch Allergy Immunol 158(4):369-374, 2012.
  65. The potential use of tyrosine kinase inhibitors in severe asthma. Guntur VP, Reinero CR. Curr Opin Allergy Clin Immunol 12(1):68-75, 2012.
  66. Safety of masitinib mesylate in healthy cats. Daly M, Sheppard S, Cohen N, et al. JVIM 25(2):297-302, 2011.
  67. The use of ipratropium bromide for the management of acute asthma exacerbation in adults and children: A systematic review. Aaron SD. J Asthma 38(7):521-530, 2001.
  68. A comparison of in vitro relaxant responses to ipratropium bromide, β-adrenoceptor agonists and theophylline in feline bronchial smooth muscle. Leemans J, Kirschvink N, Gustin P. Vet J 193(1):228-233, 2012.
  69. Effects of cyproheptadine and cetirizine on eosinophilic airway inflammation in cats with experimentally induced asthma. Schooley EK, McGee Turner JB, Jiji RD, et al. Am J Vet Res 68(11):1265-1271, 2007.
Author

Glenn A. Olah

DVM, PhD, DABVP (Feline) Albuquerque Cat Clinic

Glenn A. Olah, DVM, PhD, DABVP (Feline), is an associate veterinarian at the Albuquerque Cat Clinic in New Mexico and president of Winn Feline Foundation, a nonprofit organization devoted to funding feline health research and feline education. His interests include all aspects of feline clinical medicine, in particular geriatric medicine. He received his PhD in biophysics from Rice University and DVM from Oklahoma State University.

Material from Clinician’s Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

Up Next