Does my cat have asthma?

Persistent coughing and shortness of breath in humans have become more important over the past year as symptoms of COVID-19 infection are frequently reported. However, not all coughing and wheezing in humans is viral in origin. Human asthma is a lower respiratory disease that can cause coughing, wheezing, shortness of breath, and decreased mobility. These signs occur because asthmatics have overreactive airways that can spontaneously narrow (bronchoconstriction) when exposed to certain substances.

A remarkably similar condition exists in cats. Cat asthma is a lower respiratory disorder characterized by recurring episodes of coughing, wheezing, and shortness of breath. The prevalence of asthma is around 1% of the cat population; However, Siamese cats are predisposed – the prevalence among Siamese is close to 5%. Asthma is a type of allergic bronchitis. It can be difficult to pinpoint exactly what the cat is allergic to, but cat litter dust, used tobacco smoke, mold, pollen, and dust from renovation work have all helped trigger asthma in cats.

Cough against vomiting

Coughs in cats can be difficult to spot for some cat owners. Usually a cat crouches down, stretches its neck, and makes a scratching sound several times. The episodes are usually short and the cat will resume normal behavior after a few minutes.

Many people mistakenly assume that a hairball is to blame. As a feline practitioner, I have heard the misused phrase “cough a hairball” countless times. Hair accumulates in the stomach if swallowed. When it grows large enough, the cat will be induced to vomit. Cough comes from the lungs, not the stomach.

Coughing is a breath sign. When customers tell me their cat is “coughing a hairball,” my job is to distinguish whether the customer is experiencing an attempt to vomit or an attempt to cough. Fortunately, in the age of smartphones, most customers record what they see at home and I can immediately tell whether or not we are experiencing a cough. Other breath signs may also be present, such as B. Difficulty breathing (dyspnea) or rapid breathing rate (tachypnea).

Diagnosis: asthma

There is not a single diagnostic test to get a definitive diagnosis of asthma. A diagnosis is usually made based on clinical symptoms, physical exam results, and chest x-rays. Asthmatic cats often show a lung pattern on x-rays known as “donuts and train tracks”. These represent a collection of inflammatory cells around the airways.

Other tests that can help include a complete blood count and heartworm test. Cats with asthma often (but not always) have high levels of eosinophils, a type of white blood cell that has been linked to allergic or parasitic diseases. Heartworm disease, while rare, has clinical symptoms that overlap with asthma. A positive heartworm test suggests heartworm disease as the cause of the respiratory problems. A negative test increases the likelihood of asthma.

The underlying heart disease can share clinical symptoms with respiratory problems (coughing, wheezing, shortness of breath, increased breathing rate), and it can be difficult to distinguish between the two, especially if the physical exam and chest x-rays are inconclusive. In these cases, a blood test, which measures the level of a hormone called NT-proBNP, which is in the heart, can help. Cats with heart disease have higher circulating levels of this hormone. Cats with respiratory problems should have normal levels of this hormone.

How to treat

Treating cat asthma can be challenging. Asthmatic cats in acute distress (ie, an “asthma attack”) require prompt and accurate assessment and emergency treatment. This includes supplemental oxygen through either a face mask or an oxygen cage. Mild sedation may be needed to reduce the patient’s anxiety. Bronchodilators (drugs that open the airways) should be given by either inhalation or injection.

Many cats are surprisingly tolerant of metered dose inhalers to help keep their asthma under control.

Long-term treatment for cat asthma includes reducing airway inflammation and relieving airway constriction. Many therapies have been studied, but steroids and bronchodilators remain the mainstays of asthma therapy.

The best way to control inflammation is with oral steroid medications such as prednisolone. First, it is given in high doses until clinical symptoms are controlled, and then the dose is reduced. Bronchodilators should be considered in conjunction with steroids, especially if there is wheezing, as this indicates a narrowing of the airways. Bronchodilators should not be used as a stand-alone treatment as they will not work against airway inflammation, which is the main problem in asthmatic cats.

Giving cats oral medication can be a chore, especially in pill form. Most tablets can be made into a flavored liquid, which improves palatability and ease of administration. An alternative to oral medication is to use an inhaler. Metered dose inhalers (MDIs) are commonly used in asthmatic people, which allows a high concentration of drugs to be delivered directly into the lungs. Inhalers designed for humans require the coordination of device activation with a slow, deep inhalation.

This cannot be controlled in children or animals. To get around this, a spacer is added to the MDI. The spacer is a plastic chamber the size of an inner roll of toilet paper. The inhaler fits on one end of the chamber and a specially designed face mask is attached to the other end. To use an MDI on an asthmatic cat, the owner attaches the inhaler to the chamber, squeezes twice to deliver the drug into the chamber, then places the mask over the cat’s face and lets the cat inhale and exhale about ten times . While it is hard to imagine a cat tolerating this, you would be surprised. I’ve had many skeptical cat owners calling me in shock that their cat doesn’t seem to mind, and more than a few have told me that their cat almost seems to like it, as if they know it’s helping them.

Dr. Arnold Plotnick is the founder of Manhattan Cat Specialists, an exclusive veterinary practice for cats in Manhattan’s Upper West Side. He is also the author of the Original Cat Fancy Bible. Dr. Plotnick is a frequent contributor to cat publications and websites, including his own blog, He lives in New York City with his cat Glitter.

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