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Asthma in Cats
Asthmatic cat in diabetic remission has corticosteroid problems
Asthma in cats
Feline Asthma
Feline asthma
Feline Asthma
Asthma
Helping Asthma
also see Medication
also see Allergy
also see Respiratory Problems
Asthmatic cat in diabetic remission has corticosteroid problemsQuestion: Dr. Richards,
I have some questions for you , but first I need to give you some
background information on my 11 year-old male cat, Fish.
Ever since he was about one year-old, he has had episodes of
coughing, not necessarily related to physical exertion. I took him to vets
and they said nothing was wrong with him. Eventually, one vet said that he
might be asthmatic and gave him a steroid injection and then started him on
oral steroids. We dosed him with the smallest amount necessary to control
the coughing and that worked well. However, he eventually developed
diabetes, I believe, as a direct result. I have read in the literature that
steroid use can lead to the development of DM in those predisposed to it. We
switched him from the steroid to oral theophylline and put him on a regimen
of PZI with doses ranging from 1-7 units BID. We have a glucometer and do
our own blood sugar checks at home, much better than the stress of the vet
visit. Over the last two and a half years of insulin administration, we have
kept him under control fairly well. Even so, we have experienced some
diabetic complications. Fish developed oral infections and had most of his
teeth extracted and also developed a bone infection in 5 digits on his paws.
We noticed that several claws were growing in very thick, it reminded me of
how fingernails look on an older person with poor circulation. This resulted
in the amputation of the 5 digits (the bone that attaches the claw and the
next one up). Fish has responded remarkably well to both of these procedures
and appears much happier to not have the constant source of pain of the
infected teeth and toes. After the recent procedures, we have continued on
PZI BID until approximately one week ago. I noticed that Fish was quite
lethargic in the midday, about the time the insulin reaches peak effect. We
checked his glucose the next morning before insulin administration and found
his blood sugar level to read 100. Therefore, we held that day's dose and
checked again the next day. His level was 96. Since then, we have not given
him any insulin and our next glucose check came in at 99.
I wanted to ask you two things. First, is it possible for a
diabetic cat to self-regulate to the point of not requiring insulin
injections? And, could they revert back to requiring insulin? Secondly,
Fish's coughing has never been very well-controlled with theophylline and
appears to be getting worse. We give him 25mg QD. Is there a better dose or
a better medication without the side effects of steroids?Thank you for a wonderful website and journal and for your attention to my
questions.
Sincerely, MarcieAnswer: Marcie-
It is not unusual for cats to develop diabetes that requires insulin use and then to have a remission
from the diabetes at a later time. It has usually been a few months in most of the cases we have had
but I do remember one cat whose need for insulin stopped after about two years of treatment. It is a
good idea to carefully monitor these cats because many will eventually need insulin again in the
future, although it may be some time before the need surfaces again.Asthmatic cats that have problems due to corticosteroid administration can be very difficult patients
to help. We have been using cyproheptadine (Periactin Rx), at a dosage of 2mg every 12 hours in
some of our asthmatic cat patients and it seems to help some of them, but not all of them.
Cyproheptadine can cause very noticeable lethargy or depression the first week or so that it is used.
Some cats become so inactive that their owners are reluctant to continue the medication. Most cats
will adjust to the medication and seem to be normal after a couple of weeks, though.Using a corticosteroid via an inhaler is supposed to avoid most of the systemic effects of the
medications and it is possible to use an inhaler successfully. An anesthetic mask, pediatric chamber
or just a toilet paper tube can be used to provide a temporary chamber for the inhaler to be sprayed
into. The mask or tube is held over the cat's mouth and nose for 5 seconds after the pump of the
inhaler to ensure that the cat inhales the medication. This isn't a solution that will work for everyone
but it does help some of our cooperative patients a great deal.For respiratory crises, we have started to dispense terbutaline to use at home. It is an injectable
product and owners must be willing to make the injection but it can provide relief during severe
asthma attacks. The dosage of is 0.01mg/kg of body weight injected subcutaneously. Many cats will
respond well to this medication when they are having asthma attacks and it does give a treatment
option that can be used at home for severe asthma attacks.Dr. Padrid, writing in "Kirk's Current Veterinary Therapy XIII" discusses the use of cyclosporin in
cats that are not responsive to other medications. The major drawbacks of this therapy are the need
to monitor dosage levels through blood tests and the cost of the medication. He recommends
starting at 10mg/kg every 12 hours and then adjusting the dosage based on blood tests for
cyclosporin levels, testing weekly until a stable maintenance dosage is achieved.There are some other medications that are being experimented with for asthma if one of the above
suggestions doesn't work. I can research this more for you if necessary.Mike Richards, DVM
2/7/2001
Question: Hi Dr. Mike,
I am writing to you about my new cat which I adopted about 3 months ago. She
is approx. 2.5 years old and a history of asthma. Her paperwork history is
vague, with just treatments of Prednisone shots that she got approx. every
month. My vet says these just masked the problem. Apparently she never had
X-rays to try to see what cause could be. He is currently trying to get to
the cause of her symptoms by eliminating possible causes, environmental, diet
but it is hard to pin-point.Her symptoms seem mild, just appear to be a stuffy nose to me (no attacks or
anything). Snorty sounds occasionally. No excretion - seems to be way
inside. No runny eyes, they are clear. Acts content & happy, eats well.
She was on Hill's Id for a while because she had constipation problems but
that has cleared & is on Nutro now with good results. Before she came to me
who knows what she ate. Twice she seemed to get uncomfortable with her
breathing & I caught her doing a few small open mouth breaths, that is when I
brought her to the vet & he prescribed her Clavamox & Prednisone tabs to
clear up congestion with good results. (He heard raspiness in her lungs at
this point). He said good thing I brought her in but I almost didn't realize
how bad she got.So here we are again. I brought her back after 2nd round of Antibiotics &
Prednisone and so far so good. Just a little stuffy sounding and vet said to
wait to see how she does again. I am getting tired of bringing her in & not
knowing cause. I agree with vet that it is good to try to get to cause of
symptoms. My questions are could it just be a condition & maybe just get her
on a decongestant at some point?. As far as environmental she is now in a
condo with central/warm air, I have a humidifier (at vets sugg.) & she does
not (will not) go outside. My feeling is diet is not a factor because she
has symptoms no matter the food I give her. Maybe an upper respiratory
thing? Any thoughts would be appreciated. Is Prednisone "bad" in the long
run for cats as I've heard? Please advise...Thanks, Kathy
Answer: Kathy-
The usual signs of asthma in cats include episodes of difficulty breathing
that often occur suddenly, wheezing, decreased ability to exercise and
coughing. This is a disease of the lower airways, so snuffling and
congestion of the upper airways is not a typical sign. However, the
episodes of open mouthed breathing that you saw are a sign of asthma, so it
is possible that there are two conditions --- or that the upper airway
problem caused enough difficulty with nasal breathing that your cat had to
resort to open mouth breathing and asthma is not present.There is no really good way to definitively diagnose asthma. There are
changes on X-rays caused by visible thickening of the airways which can
help in making a diagnosis and if a tracheal wash is done, high numbers of
eosinophils are indicative of asthma ( but can occur in normal cats, too).Upper airway disease is really common in cats, mostly due to recurrent
attacks of herpes virus or damage to upper airway defenses from severe
herpes virus infections as a kitten. Since you don't know much about the
history of your cat, it would be hard to tell for sure which of these
problems was more likely, if herpes virus is the problem. Administration of
corticosteroids can alleviate the symptoms of this problem, even though
they don't do anything to treat the underlying cause. Antibiotics are often
helpful in upper airway disease because secondary bacterial infections are
often present. Antibiotics are less helpful in asthma.Long term use of prednisone in cats can cause problems, including an
increase in the incidence of diabetes, secondary infections, behavioral
changes and increased drinking and urinating. If possible, it is better to
use inhaled versions of corticosteroids, which have fewer secondary side
effects. There is a good article on asthma and use of inhaled medications
in the November 2000 issue of The Clinics of North America by Philip
Padrid, DVM, RN.Your vet's plan to restart the diagnostic process and to work towards a
definite diagnosis is a good one. It may take several efforts to find the
right direction to go in --- whether to worry about upper airway disease,
lower airway disease, general allergies, etc. Just keep working with your
vet until you find a clear direction to go in. Unfortunately, the two most
likely conditions, based solely on their incidence in cats, are herpes
virus and asthma --- and both are chronic problems that will require
maintenance care. But at least if you know what you are dealing with you
can probably find some things you can do at home to minimize visits to your
vet.Hope this helps some.
Mike Richards, DVM
1/3/2001
Question: Dear Dr. Richards,
Due to the fact that I have been trying to find accurate, up-to-date into on Feline Asthma
on the internet & have found it to be a real chore, I was thrilled to find your site with
its accurate info. & possibilities for new treatment modalities i.e. Iain's
suggestions-see Asthma in Cats. Though I feel I have a good, caring vet,
asthma isn't a high priority for her as there aren't many cases. Since I'm
a nurse, I feel anything I can do to "source" new info. for her can be
beneficial for both of us. If you have any good sites on current studies
or recent info. on your vet. continuing education concerning asthma
(feline), I'd be most appreciative in receiving those. Keep up the high
quality of your site; many of us value it! Sincerely, L. S. G.
Answer: L. S. G.
I am not sure if this is on our site, or not. Dr. Phillip Padrid wrote an
article in a Capsule Report a couple of years ago advocating the use of
cyproheptadine (Periactin Rx) for asthma. He was using 2mg per cat given
twice a day. I have not seen other literature references to this but it is
probably pretty safe since Periactin is used a lot as an appetite stimulant
in cats.At a continuing education seminar that I attended the speaker said that a
lot of cases of suspected asthma may be heartworm disease. Cats apparently
react very strongly to the early stages of heartworm disease and can arrest
or suppress the growth of the heartworms but develop severe respiratory
disease in the effort, in some cases. This might be worth considering. But
again, there are no other references that I am aware of supporting this
theory.We have had a couple of cases where we suspected asthma where we were able
to find lungworm eggs in stool samples (they are not always present when
this disease is affecting a cat). Both cats responded well to the
administration of ivermectin. There have been some case reports of
ivermectin reactions in cats being treated for ear mites, including some
reported deaths, so it is important to be reasonably sure that lungworms
are a potential problem before using this treatment. I am not sure if there
are other treatments. Our two patients did fine and the coughing cleared up
quickly after treatment.We see enough cases where we do not find any other discernible cause that I
feel that asthma by itself is not especially uncommon in cats. We have had
the best luck treating with corticosteroids like prednisone, so far.Veterinary Medicine magazine had a review article on feline asthma in
September of 1990 that had some good information on diagnosis of this
condition. If your vet subscribes to this journal, and saves it, he or she
might still have this issue.Recently, the use of antibiotics like azithromycin (Zithromax, Rx), which
seem to work well against chronic upper respiratory bacterial infections,
has been helpful in our practice in clearing up a couple of chronic
sneezing/coughing kitties. It has definitely not been the answer for all
cats but it would be worth considering if the response to prednisone isn't
sufficient.Hope this helps some.
Mike Richards, DVM
10/27/99
Question: I came across your pages on feline asthma through a Web search. You might be
interested in my experience.I've got a 13 year old Tonkinese who has been diagnosed with asthma (largely based
on no other positive diagnosis and good response to prednisone). Since I was concerned
at the long term effects of systemic steroid treatment (I have already had one diabetic cat,
through acromegaly of all things), I persuaded my vet to prescribe a Becotide 50
inhaler (50 ug beclomethasone per "puff"). Also, the prednisone wasn't very effective
at the low doses which would have been "safe" for long term oral treatment.Each puff is delivered into a 500 ml plastic bottle held over the cat's muzzle (muzzle sized
hole at one end, and smaller inhaler nozzle hole at the other end). The bottle is held over
his muzzle for about 90 seconds. Needless to say, this treatment was only considered 'cause
the cat is very easy to handle and is not distressed by the process.When his asthma is bad I give him 1 puff morning and night, sometimes 2 in the morning
and 1 at night. This treatment is extremely effective, being almost as effective as the oral
prednisone but without the systemic risks.For treatment of the occasional acute attack my vet proposed Boehringer Ingelheim
Ventipulmin Syrup (clenbuterol hydrochloride 25 ug/ml), 0.2 - 0.4 ml BID max dosage.
This certainly seems to help his acute attacks, but is only used perhaps once or twice a week.This overall regime has been used for about 14 months, and the cat is in excellent health.
NB - while not a vet, I have an honours degree in Physiology and Biochemistry, and I'm l
ucky to have a vet who is happy to involve me in the treatment decisions.Iain
Answer: Iain-
We have used the inhalers for dogs with allergic bronchitis but have never
tried this in a cat. Your method of administration is interesting. One of the
best things about providing information online is learning new ideas from
people who write to us. It is always good to have alternative suggestions
for difficult situations such as asthma in cats.Mike Richards, DVM
Dear Dr Richards,
Firstly I want to congratulate you on your excellent site, I am no computer buff, but I am interested
in Internet through my youngest Son, Johny (13) who really loves internet /computer. He helped
design my web site, hopefully be ready sometime this month. I am currently rather busy with relocation
of my Vet Clinic. My Clinic is situated next door to the University of Western Australia Campus, in
Perth, Western Australia. Although the Clinic was started 21 years ago it is still a very small Clinic.
We have moved to a new location at the Highway just 600 metres from our original location. This
move should have been done fifteen years ago. But better late than never.The reason why I want to write to you is about Cat Asthma. As I mentioned, being next to a
University where Medical School is available, I have a lot of Medical Practitioners as Clients
or Medical Research Scientists. If I remember correctly, I was once told by a Research Professor
of Asthma/ Respiratory System, that he uses a lot of Cats for his research because Cats DO NOT
suffer ASTHMA. So , have you heard about this? If this is so, than your and many other Vets statements
on Cats asthma can be 'unfortunate'.I will ask this Client again when I see him, he also owns a Vineyard down South of Western
Australia. May be the wine?Anyway, since he told me about it 10 years ago I never mentioned or claim 'an asthma' attack
again in Cats. My clinic is about 60 % Cats practice. But as I said it is a small clinic.Best regards, Sudjar
Dear Sudjar,
Thank you for you kind assessment of our site. When I was in veterinary school there was a lot of
argument over whether cats could have allergies since they did not seem to have a functional IgE
system. There still seems to be some controversy over this but I think it is generally recognized now
that cats do have allergic disorders. But that line of logic may have also led to the conclusion that
asthma did not exist in cats. According to recent work by Drs. Dye and McKeirnan, published
in the Journal of Veterinary Internal Medicine (10:385, 1996) and repeated in Dr. Morgan's book
"Handbook of Small Animal Practice, 3rd. edition) there is demonstratable hyperactive airway
disease in cats, which fits the definition of asthma. Other supporting evidence has been published
previously, based on things such as radiographic interpretation and arterial blood gas analysis in
affected cats.One other problem I have struggled with in the past over these sorts of issues is the discrepancy that
appears to exist between the way veterinarians use a descriptive term such as asthma or actinic
keratitis and the way that human physicians define the terms. I think that sometimes it would be
a lot better if we kept in closer communication with our physician counterparts!Hope this helps to clear up the use of the asthma description. If you don't have it, Dr. Morgan's
book is a very valuable resource and worth considering adding to any practice library.Sorry for the long delay in replying to you.
Sincerely,
Mike Richards, DVM
Q: Our Cat, Shadow, is under a vet's care. She sufferes from athsma, and gets "steroid" shots
on a regular basis. We question what effect this is having on her overall health. She is 12 years
old, and is in good health and physical condition.She has been receiving these shots for about six years, and gets one about every three to four months.
At the onset she received a shot about every six to eight months, but the frequency has obviously
increased. We have been cautioned about her getting them too frequently, but have been unable
to get more specific information. We then let her go for as much as another month after she develops
her coughing and wheezing, before taking her in for another shot. Besides shots, we have also tried
an oral medication, which did not seem to provide any relief whatsoever.Please tell us as much as you know, since we are considering euthanasia, as we don't want her to
suffer a worsening condition.A: Asthma is fairly common in cats. Recently we have seen two cases that we thought were asthma
based on clinical signs and X-rays that turned out to be
1) a case of heartworm disease and
2) a case of lungworm infestation. We discovered the lungworm problem completely by accident
on a fecal examination for another problem. We check for heartworms frequently here due to
our location near the Chesapeake Bay.Asthma usually responds well to cortisone injections. Cats are much more resistant to the side effects
of corticosteroids than dogs and humans. We have used cortisone injections as often as once every 3
to 4 weeks for several years in a number of cats without significant side effects. We have seen one or
two cats that we think may have developed diabetes in part due to long term corticosteroid use.When euthanasia is the alternative, I see no reason at all to worry over possible long term side effects
of corticosteroids. In most cases, you won't see problems and in the cats in which diabetes or other
complications do occur euthanasia at a later date seems a lot better than euthanasia sooner ---
at least to me!If you can maintain a schedule of using long acting cortisone injections at intervals of greater than one
injection per month, I doubt you will see serious side effects, based on our experience using these
injections in a cat. It is always worth reviewing the history and considering a re-evaluation of the
problem in any chronic disease when the treatment seems less effective than it has in the past.
Sometimes, the progression of a disease will point to another problem. You might want to talk
to your vet about rechecking Shadow, just to put everyone's mind at ease about the diagnosis
and long term treatment.Mike Richards, DVM
Q: Dear Dr. Richards, I recently read about studies detailing the positive effects of using
a negative ion charger around people with asthma. Do you think that a negative ion charger
would be of help with feline asthma? My cat (7 y.o.) was on steroids for his asthma and
developed diabetes from the steroids. I am hesitant to use any steroids at all to help his
asthma and am seeking alternative medical treatments that will not interfere with his insulin
needs. Currently, I give him 1/4 tab of Theo-Dur when his coughing begins, but I do not
administer the medication on a regular basis. We have also bought an air purifier in the
hopes of alleviating some of his allergic symptoms and we have all windows closed to
prevent allergens from entering the house. Any advice you may be able to offer regarding
the negative ion charger or any other treatments would be greatly appreciated.
Thank you in advance for your time, MonicaA: Monica- I have not seen any research on the use of negative ionizers for cats with
asthma but these fall in the "unlikely to hurt" category so I can't see any reason not to
try one if you want to.Other antihistamines may be helpful if theophylline (TheoDur Rx) doesn't work well enough.
There are a lot of possible choices in antihistamines and sometimes it just takes some
experimentation to see which one will work best.Mike Richards, DVM
Last edited 09/23/02
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