DIAGNOSTIC/MANAGEMENT TREE  h  RESPIRATORY MEDICINE  h  PEER REVIEWED

MANAGING FELINE ASTHMA & CANINE BRONCHITIS

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FELINE ASTHMATIC OR CANINE BRONCHITIS PATIENT PRESENTED

Exacerbation of asthma or bronchitis present with airway constriction causing respiratory distress?

YES NO

E nsure patient can breathe R educe ongoing airway inflammation

h I mmediately dilate airways to
provide respiratory relief
h P rovide injectable steroid and
either inhaled or injectable
bronchodilator (see Types of
Inhaled Medication, next page)
•A  dminister injectable
medications (ie, dexamethasone
[0.1-0.5 mg/kg IM or IV],
terbutaline [0.01 mg/kg IM or
SC]) in clinic 1,2
• I nhaled bronchodilator (ie,
albuterol/salbutamol [1-2 puffs
every 30 minutes for ≤4-5 hours])
may be administered in clinic or
at home by owner. 3 Owners
unable to regain control at home
should bring their pet to the
clinic for veterinary care
h P rovide 10-day, short-term course of systemic steroids 1
•C  ats: prednisolone (1-2 mg/kg every 24 hours)1
•D  ogs: prednisone (0.5-1 mg/kg every 24 hours) 4
h R eview environmental factors and make modifications to reduce potential triggers
h E nsure pet owners understand corticosteroids are considered a mainstay of treatment and
may be administered orally or via injection or inhalation; inhaled forms help limit systemic
absorption (see Adverse Effects of Systemic Steroids, next page)
h O wners already providing inhaled steroids to their pet and who treated exacerbation with
albuterol can continue with inhaled steroid therapy; those currently using other forms may
consider transitioning to inhaled corticosteroids
TRANSITION TO INHALED STEROIDS
h Taper systemic steroids and introduce inhaled steroids
• Fluticasone 3
–C ats and dogs ≤44.1 lb (20 kg): 1 puff (110 µg) every 12 hours
■C ats with more serious disease may require 220 µg every 12 hours
–D ogs >44.1 lb (20 kg): 1 puff (220 µg) every 12 hours
• Fluticasone/salmeterol 5
–C ats and dogs ≤44.1 lb (20 kg): 1 puff (115 µg/21 µg) every 12 hours
–D ogs >44.1 lb (20 kg): 1 puff (230 µg/21 µg) every 12 hours
h Overlap systemic and inhaled therapy for 2 weeks 3
• I nhaled steroids may require 2 weeks to take effect

MAINTAIN DISEASE CONTROL

h U semaintenance therapy to control inflammation and prevent exacerbation

h Continue daily therapy for management of clinical signs
• Fluticasone
–C ats and dogs ≤44.1 lb (20 kg): 1 puff (110 µg) every 12 hours
■C ats with more serious disease may require 220 µg every 12 hours
–Dogs >44.1 lb (20 kg): 1 puff (220 µg) every 12 hours
• Fluticasone/salmeterol
–C ats and dogs ≤44.1 lb (20 kg): 1 puff (115 µg/21 µg) every 12 hours
–D ogs >44.1 lb (20 kg): 1 puff (230 µg/21 µg) every 12 hours
h 
C at owners can administer inhaled bronchodilators during flare-ups secondary to exposure to triggers 6
• Albuterol/salbutamol: 1 to 2 puffs as needed 6
–A lbuterol is a rescue medication and should not be used as monotherapy 2,6
•D ogs have not been shown to experience bronchoconstriction7
–L ittle evidence exists for effectiveness of albuterol therapy to manage canine bronchitis
 DIAGNOSTIC/MANAGEMENT TREE  h  RESPIRATORY MEDICINE  h  PEER REVIEWED
TYPES OF INHALED MEDICATION
h Corticosteroids (eg, fluticasone, mometasone,
budesonide)
• Reduce airway inflammation and mucus
production
• Used for ongoing management of conditions
even in absence of clinical signs
h Bronchodilators
• Open airways by relaxing smooth muscles to
reduce bronchoconstriction
• Not to be used as monotherapy
• Available in short-acting and long-acting
formulations1
–Short-acting formulations (eg, albuterol,
salbutamol)
■ 4- to 6-hour duration
■ Are considered rescue medications; may help
coughing flare-ups and limit need for clinic
visits2
■ A lbuterol is not to be used chronically, as it may
result in worsening of airway inflammation;
corticosteroids are the mainstay for long-term
management and control
–Long-acting formulations (eg, salmeterol)5
■ 1 2-hour duration
h Combination inhalers (eg, fluticasone/salmeterol,
budesonide/formoterol, mometasone/
formoterol)
• Often a combination of inhaled corticosteroids
and long-acting formulations
• Reduce inflammation and relax smooth muscle
• Indicated for disease management, not rescue5
• May be used as a step-up therapy
ADVERSE EFFECTS OF SYSTEMIC STEROIDS1-4,8-11
h Behavioral changes, including aggression
h Lethargy
h Increased thirst and urinary incontinence
h Increased risk for infection (eg, UTI)
h Diabetes mellitus
h Weight gain/obesity
h Vomiting/diarrhea
h Iatrogenic hyperadrenocorticism
h Immunosuppression
References
1. Sharp C. Treatment of feline lower airway disease. Today’s Veterinary Practice. 2014;4(2):28-32.
2. Lee-Fowler T. The asthmatic cat: management guidelines. Today’s Veterinary Practice. 2018.
3. Padrid P. Use of inhaled medications to treat respiratory diseases in dogs and cats. J Am Anim
Hosp Assoc. 2006;42(2):165-169.
4. Carey SA. Current therapy for canine chronic bronchitis. Paper presented at: 2011 ISVMA
Conference; Peoria, Illinois; November 11-13, 2011.
5. Olah G. Which drugs are used to treat feline asthma? Plumb’s Therapeutics Brief.
2015;2(3):18-30.
6. Rozanski E. Aerosol therapy in dogs & cats. Clinician’s Brief. 2013;11(1):32-35.
7. Padrid P. Diagnosis and therapy of canine chronic bronchitis. Paper presented at: 2001 WSAVA
Congress; Vancouver, Canada; August 8-11, 2001.
8. Palermo S, Plumb’s Veterinary Drugs. Prednisone/prednisolone. Veterinary Team Brief.
2017;5(9):33.
9. Carey SA. Feline asthma: a pathophysiologic basis of therapy. https://www.michvma.org/
resources/Documents/MVC/2018%20Proceedings/carey_02.pdf. Published 2011. Accessed
February 12, 2020.
10. Rozanski E. Inhaled corticosteroids & airway disease. Clinician’s Brief. 2014;12(8):29-31.
11. Plumb DC. Prednisolone/prednisone. Plumb’s Veterinary Drugs website. https://www.
plumbsveterinarydrugs.com/#!/monograph/sShl11M9aP. Updated July 2019. Accessed
February 5, 2020.