Veterinary Respiratory Diseases Quiz
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Questions and Answers

What kind of cough is usually associated with lower airway or parenchymal diseases?

  • Productive cough (correct)
  • Terminal retch
  • Paroxysmal cough
  • Non-productive cough

    • Which of the following is NOT commonly associated with upper airway disease?

  • Bronchial collapse
  • Infectious tracheobronchitis
  • Pneumonia (correct)
  • Tracheal collapse

    • What is a potential environmental exposure that could trigger coughing in pets?

  • Stress
  • Exercise
  • Mold
  • All of the above (correct)

    • What is the term for coughing fits that are often induced by cervical palpation?

    <p>Paroxysmal cough (B)</p> Signup and view all the answers

    Which of the following is a common cause of lower respiratory disease in dogs and cats?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the recommended procedure for obtaining a sample for a blind bronchoalveolar lavage (BAL)?

    <p>Perform a sterile intubation, insert a catheter into the lower airway, and aspirate fluid after coupage. (A)</p> Signup and view all the answers

    Which of the following can be determined from a bronchoalveolar lavage (BAL) sample?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the most likely infectious agent causing "Kennel Cough" in dogs?

    <p>Canine Influenza Virus H3N2 (D)</p> Signup and view all the answers

    What is the typical incubation period for Canine Infectious Respiratory Disease Complex (CIRDC)?

    <p>7-10 days (C)</p> Signup and view all the answers

    How is CIRDC typically transmitted?

    <p>All of the above. (D)</p> Signup and view all the answers

    Which of the following pathogens can shed for weeks to months after infection with CIRDC?

    <p>All of the above. (D)</p> Signup and view all the answers

    How long can a dog shed CIRDC pathogens after exposure to the virus?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the typical duration of clinical signs in a dog infected with CIRDC?

    <p>5-7 days (D)</p> Signup and view all the answers

    What is typically characteristic of a productive cough?

    <p>Softer in volume and may be perceived as vomiting (D)</p> Signup and view all the answers

    Which test is considered a first-tier diagnostic test for cough-related diseases?

    <p>Complete Blood Count (B)</p> Signup and view all the answers

    What is the purpose of a Transtracheal Wash (TTW)?

    <p>To evaluate diseases that must involve the airway (D)</p> Signup and view all the answers

    In cats, coughing is considered rare. When it occurs, what should be the approach?

    <p>Pursue aggressive diagnostic evaluation (C)</p> Signup and view all the answers

    What is a common misconception about coughing in cats?

    <p>It is usually associated with a sneeze (A)</p> Signup and view all the answers

    Which of the following drugs can be used to treat pulmonary mycoses? (Select all that apply)

    <p>Amphotericin B (liposomal) (A), Itraconazole (B), Fluconazole (D)</p> Signup and view all the answers

    What is the most likely reason for the prevalence of Feline Asthma & Bronchitis being over-represented in Siamese cats?

    <p>Siamese cats have a genetic predisposition to respiratory infections (B)</p> Signup and view all the answers

    What is the typical time frame for treatment of pulmonary mycoses?

    <p>3-6 months (D)</p> Signup and view all the answers

    Which of the following is a potential side effect of Itraconazole and Fluconazole in treating pulmonary mycoses?

    <p>Hepatotoxicity (B), Blood dyscrasias (C)</p> Signup and view all the answers

    What is the typical pattern observed on thoracic radiographs in a patient with pulmonary mycoses?

    <p>Miliary or nodular pattern (D)</p> Signup and view all the answers

    Which of the following is NOT a hallmark clinical sign of inflammatory airway disease in dogs and cats?

    <p>Nasal discharge (A)</p> Signup and view all the answers

    What is the most common inflammatory cell type found in Canine Chronic Bronchitis?

    <p>Neutrophils (B)</p> Signup and view all the answers

    What is the typical median age for diagnosis of Inflammatory airway disease in dogs and cats?

    <p>4 - 8 years (C)</p> Signup and view all the answers

    What is the typical duration of shedding in cases of CIRDC?

    <p>7-14 days (B)</p> Signup and view all the answers

    What is a common clinical sign of CIRDC?

    <p>Harsh, dry cough (A)</p> Signup and view all the answers

    Which antibiotic is commonly used for treating persistent non-productive cough in juvenile dogs?

    <p>Doxycycline (C)</p> Signup and view all the answers

    What should be done for most cases of CIRDC?

    <p>Manage as an outpatient (D)</p> Signup and view all the answers

    What percentage of asymptomatic dogs arriving at U.S. shelters tested positive for Bordetella?

    <p>19.5% (C)</p> Signup and view all the answers

    What is the most common cause of community-acquired pneumonia in dogs?

    <p>Bordetella bronchiseptica (A)</p> Signup and view all the answers

    In cases of severe, progressive, or complicated pneumonia, what is the treatment option?

    <p>Doxycycline or Minocycline (C)</p> Signup and view all the answers

    What should be considered when treating a dog with a persistent cough lasting more than 7 days?

    <p>Looking for underlying complications (D)</p> Signup and view all the answers

    Which of the following is a common treatment option for both bronchitis and asthma?

    <p>Bronchodilators (D)</p> Signup and view all the answers

    What condition is characterized by eosinophilic infiltration of the pulmonary interstitium?

    <p>Eosinophilic bronchopneumopathy (A)</p> Signup and view all the answers

    In terms of treatment goals for airway disease, which of the following is NOT a primary objective?

    <p>Eliminate all environmental triggers (B)</p> Signup and view all the answers

    Which type of therapy is generally less effective for eosinophilic bronchopneumopathy compared to oral steroids?

    <p>Inhaled therapy (C)</p> Signup and view all the answers

    Which treatment aims to break the inflammatory cycle in airway diseases?

    <p>Glucocorticoids (A)</p> Signup and view all the answers

    Which of the following is a potential benefit of using bronchodilators in asthma treatment?

    <p>Stimulate mucociliary clearance (C)</p> Signup and view all the answers

    For achieving treatment goals in airway diseases, monitoring and treatment decisions should ideally be based on:

    <p>Repeated airway washes and cytology (D)</p> Signup and view all the answers

    Which of these breeds is over-represented in cases of eosinophilic bronchopneumopathy?

    <p>Siberian Husky (C)</p> Signup and view all the answers

    Study Notes

    Lower Respiratory Disease 1 & 2

    • Presentation covers lower respiratory disease in dogs and cats
    • Lecturer is Amber Harris, DVM, DACVIM(SAIM), Assistant Professor, LAMS 5333
    • Date of presentation is January 22, 2025

    Outline

    • Brief introduction to coughing (respiratory view)
    • Cough triggers
    • Cough characteristics
    • Diagnostic tests (overview)
    • Common causes of lower respiratory disease in dogs and cats
    • Infectious causes
    • Viral
    • Bacterial
    • Fungal
    • Inflammatory causes
    • Feline asthma
    • Canine chronic bronchitis
    • Eosinophilic bronchopneumopathy

    Coughing

    • A brief overview of coughing within a respiratory context

    Triggers

    • Owner smoking
    • Perfume/cologne
    • Air fresheners
    • Household cleaners
    • Dusty cat litter
    • House construction
    • Stress/exercise
    • Cervical pressure
    • Pollution
    • Mold, pollen, etc.
    • Environmental exposure
    • Boarded/groomed/daycare/dog park
    • Travel history
    • Sick housemates
    • Indoor/outdoor status (cats)
    • Heartworm prevention
    • "Fluffy eats other dogs' poop."
    • Filaroides, Eucoleus???
    • "Rocco travels to Tucson with us every winter."
    • Coccidiomycosis???
    • "Mittens loves to bring us dead birds."
    • Aleurostrongylus???

    Non-productive Cough

    • Usually loud, harsh, dry, +/- paroxysmal
    • May be described as a "goose-honk"
    • Often paroxysmal ("coughing fits")
    • Often inducible by cervical palpation
    • Commonly associated with upper airway disease, tracheal or bronchial collapse, or infectious tracheobronchitis (kennel cough)

    Productive Cough

    • Expectoration of sputum
    • Fluid/mucus/debris from lower airways
    • Commonly associated with lower airway or parenchymal diseases (e.g., pneumonia) or inflammatory conditions (e.g., bronchitis/asthma) or edema
    • Typically softer in volume ("huff")
    • Less likely to be paroxysmal
    • May be difficult to appreciate due to sputum swallowing
    • Owner may perceive it as vomiting, while terminal retches are not usually considered productive

    "Huffing" Cough

    • A description of a specific type of cough sound

    Coughing in Cats

    • Less common than in dogs
    • Most common cause, if present, is lower airway disease (asthma)
    • Tracheal disease is less common, while pleural space disease is rare
    • Owners often mistake the cough for a sneeze

    Diagnostics Overview

    • Common "first-tier" tests:
    • Complete Blood Count (CBC)
    • Thoracic radiographs (+/- cervical)
    • Fecal exam (including float, sedimentation, Baermann tests)
    • Heartworm testing
    • Cytology
    • Fine needle aspirate (FNA)
    • Skin lesions/masses, lymph nodes
    • Nasal discharge

    2nd & 3rd Tier Testing

    • Chemistry panel
    • Urinalysis
    • Fungal antigen titers
    • Infectious testing (e.g., Respiratory PCR, titers)
    • Cardiac testing (e.g., electrocardiogram, NT-pro-BNP)
    • Advanced imaging (e.g., fluoroscopy, ultrasound, CT)
    • Bronchoscopy
    • Respiratory sampling
      • Airway (TTW, ETW, BAL)
      • Parenchyma (lung aspirate)

    Transtracheal/Endotracheal Wash

    • Diffuse disease (e.g., bronchitis, asthma)
    • Theory involves pushing sterile fluid into the airway and aspirating out bronchial fluid
    • Patient must be awake or sedated lightly
    • Sterile saline used
    • Saline aspirated; animal must cough
    • A direct method if disease affects the entire airway and in the case where the animal needs to be restrained
    • Different from Bronchoalveolar lavage (BAL)

    Bronchoalveolar Lavage (BAL)

    • Localized or diffuse disease
    • Sampling for deeper lung regions
    • Sterile intubation and anesthesia are required
    • Catheter insertion into lower airway
    • Standard method involves bronchoscopy guidance
    • Blind method omits bronchoscopy
    • Smaller aliquot volume is required
    • May require coupage

    Wash Fluid Diagnostics

    • Cytology (cellular infiltrate?, bacteria, fungi)
    • Infectious testing (bacterial cultures, aerobic and anaerobic, Respiratory PCR (mycoplasma), Mycoplasma, +/- full panel)
    • Reference ranges provided for neutrophils, eosinophils, monocytes, macrophages, and lymphocytes

    Respiratory PCR

    • Oropharyngeal/nasal/conjunctival swab collection
    • Influenza- deep nasal examination
    • Distemper- conjunctival examination
    • Airway wash
    • Immunofluorescent assays (IFA) for organism identification
    • Panels by IDEXX, Antech, Athens lab (comprehensive assays)

    Fungal Specific Diagnostics

    • Cytology and histology (visualizing and classifying fungi)
    • Blastomyces dermatitidis (large, broad-based budding yeast)
    • Histoplasma capsulatum (small, narrow-based budding yeast with halo)
    • Coccidioides immitis/posadasii (double-walled structure)
    • May be difficult/costly to perform
    • Mira Vista urine antigen EIA (detects galactomannan antigen in urine)
    • Used to monitor response to treatment or relapse
    • Coccidioides monitoring via MiraVista canine IgG antibody EIA

    Disease Processes (Infectious)

    • Canine infectious respiratory disease complex (CIRDC) (often referred to as "kennel cough")
    • Pneumonia (bacterial, community-acquired, pulmonary mycoses)

    CIRDC Pathogens

    • Most commonly viral origin
    • Parainfluenza, Adenovirus type-2, Herpesvirus-1, Distemper, Respiratory corona virus, and Pneumovirus
    • Influenza virus
    • "Kennel Cough" is not synonymous with Bordetella infection

    CIRDC Co-infections

    • Multiple viruses, virus + bacteria
    • Common bacteria:
      • Bordetella bronchiseptica, Mycoplasma spp., Streptococcus equi ss. zooepidemicus
    • Co-infections increase disease severity
    • Virus (X) impairs cilia
    • Bacteria (Y) colonizes & overgrows

    Viruses

    • Enveloped, ssRNA virus (e.g., Parainfluenza)
    • Non-enveloped, dsDNA virus (e.g., Adenovirus type-2)
    • Replicate in upper and lower airways

    Bordetella bronchiseptica

    • Aerobic, Gram-cocccobacillus
    • Highly contagious (Dogs <-> cats; dogs → people)
    • Replicates on ciliated epithelium
    • Virulence factors/toxins: paralyzes cilia, impairs phagocytosis. Invades intracellularly to avoid detection

    Mycoplasma spp.

    • Fastidious bacteria, lacks cell wall
    • Very difficult to culture/isolate
    • Colonizes ciliated and non-ciliated epithelium
    • Lower respiratory tract involvement
    • Purulent bronchitis

    Canine Influenza Virus

    • H3N8, circulated in the Northeast US
    • H3N2, reportable in some areas
    • Mimics kennel cough, often causes mild illness
    • Signs: non-productive/productive cough, nasal/ocular discharge, serous/mucopurulent, fever, lethargy, anorexia

    CIRDC Pathogenesis

    • Source of infection: respiratory secretions & environmental contamination
    • Transmission: close/direct contact, aerosolization, +/- fomites
    • Highly contagious
    • High morbidity, low mortality
    • Incubation period
      • ~7 days post-infection
    • Pathogen shedding
      • Most < 2 weeks
      • Exceptions: weeks to months (Bordetella, Mycoplasma, Distemper, Herpes)
      • Starts as early as 24 hours before clinical signs
      • Can continue after recovery
    • Graphical representations of pathogen shedding and clinical illness timeline

    CIRDC Diagnosis

    • Signalment & history (age, immunocompromised, exposure, vaccination)
    • Clinical signs (Harsh, dry, often non-productive cough; typically inducible, Paroxysmal, usually otherwise healthy)
    • Canine respiratory PCR

    CIRDC Management

    • Most cases are mild, uncomplicated, and self-limiting
    • Resolve within 7 days
    • Manage as outpatient if possible
    • Isolation and supportive care (K-9 influenza)

    Think Before Antibiotics

    • 2019 CIRDC surveillance program (1602 sick dogs)
    • Antibiotic use increased by 25% over 5 years
    • No increase in infection rate or poorer outcomes with antibiotic use
    • Asymptomatic dogs arriving at US shelter (503 dogs)
    • 30% Mycoplasma, 19.5% Bordetella

    Treatment Considerations & Indications

    • Persistent cough (> 7 days)
    • Complicated/progressive disease
    • Juveniles (< 6-8 weeks old)
    • Quality of life negatively impacted by continuous cough

    What to Treat With

    • Persistent cough (> 7 days):
      • Step 1: Anti-inflammatory +/- antitussive
      • Step 2: Doxycycline (5 mg/kg PO q12h for 7-14 days) or Minocycline (5-10 mg/kg q12h)
    • Severe/complicated/progressive: Doxycycline, Minocycline
    • Pneumonia (additional options, including appropriate antibiotic)
    • Juveniles (< 6-8 weeks): Clavamox (15-20 mg/kg PO q12h for 7 d), Doxycycline (caution with pregnant/nursing bitches)

    Prevention

    • DHPP vaccination (Distemper, infectious hepatitis, adenovirus type-1, parainfluenza)
    • +/- influenza vaccination (at-risk individuals)
    • Reduce disease (incidence, severity, shedding)
    • Accidental injection of Bordetella bronchiseptica vaccine
    • Can cause serious, severe injection site reaction
    • Septic hepatitis
    • Death

    Cough Suppresion Points

    • What are you treating? (e.g., collapsing trachea vs pneumonia?)
    • Who are you treating? (patient vs client)
    • Cough is protective mechanism!
    • Contraindicated if productive cough or infectious disease

    Infectious Pneumonias

    • What impaired host defenses? (Congenital defect? Ciliary dyskinesia? Immune compromise: latrogenic, comorbidity? Prolonged recumbency? Sedation/anesthesia? Critical illness? Disease-induced: Bronchitis/asthma, Viral infection, Laryngeal paralysis, Regurgitation)
    • Route of infection (Aspiration? Community acquired? Hematogenous? Cat > Dog? Traumatic/penetrating injury/open wound)
    • Organisms isolated in bacterial pneumonia can include E. coli, Klebsiella, Streptococcus, and Staphylococcus

    Community Acquired Pneumonia

    • Bordetella bronchiseptica (most common CAP in dogs)
    • Important in dogs < 1 year (pups&adults)
    • Age of CAP ~5 months

    Aspiration Pneumonia

    • Most common pneumonia cause in adult dogs
    • Healthy stomach/upper GI poorly colonized by bacteria
    • Initial problem: airway irritation & caustic injury ("pneumonitis")
    • Factors increasing gastric bacteria: antacid use, oral disease, intestinal ileus, enteral feeding
    • History of vomiting/recent anesthesia/common co-morbidities (regurgitation, megaesophagus, laryngeal paralysis, myasthenia gravis).
    • Common isolated organisms (E. coli, Enterococcus, Mycoplasma, Pasteurella, Pseudomonas, and Proteus)
    • Aerobes >> Anaerobes
    • Clinical findings (lethargy, reduced appetite, exercise intolerance, tachypnea/dyspnea, fever, cough, productive/huffing, +/- nasal discharge, +/- crackles)

    Diagnosis of Pneumonia

    • CBC
    • Inflammatory leukogram
    • Thoracic radiographs (3-views)
    • Pulse oximetry/blood gas analysis
    • Airway wash
    • Culture & sensitivity (identifying causative agents for specific treatment)

    Aspiration Pneumonia Location

    • Right middle lung lobe is frequently involved
    • Right cranial lobe/caudal subsegment of left cranial lobe
    • X-ray examples for identifying affected regions.

    Empirical Treatment of Bacterial Pneumonia

    • Uncomplicated (mild) disease
    • Narrow spectrum, single therapy (e.g., Amoxicillin/Amoxicillin clavulanate, Cephalexin, Trimethoprim sulfamethoxazole [TMS], Doxycycline [Bordetella, Mycoplasma], Azithromycin [cats] for ~7-14 days)
    • Complicated/severe disease
      • Broad-spectrum, combination therapy (e.g., Amoxicillin/Clavulanate/Ampicillin Sulbactam, Clindamycin, plus [2nd/3rd gen cephalosporin, Fluoroquinolone, Metronidazole, Amikacin for potentially severe/drug-resistant cases) for ~2-4 weeks
    • Empiric antibiotic selection & Multi-drug resistance (resistance to 3 or more drug classes in ~25% of cases; risk increases with recent antibiotic use)
    • Culture & sensitivity is important
    • Overall survival rate for pneumonia ~85% (Community acquired pneumonia = 96%, Aspiration pneumonia = 83%)
    • Radiographic location correlation with prognosis (more lobes involved = poorer prognosis)

    Fungal Pneumonias

    • Blastomyces dermatitidis
    • Histoplasma capsulatum
    • Coccidioides immitis (Southwest US, esp. Arizona)
    • Cryptococcus neoformans
    • Feline nasal granuloma
    • Clinical findings: not always respiratory-related (typical signs include fever, lethargy, anorexia, weight loss) – Chorioretinitis, uveitis, lameness, bone pain, lymphadenopathy, cutaneous or dermal lesions/nodules are alternative possible findings
    • Work-up includes CBC, chemistry, thoracic radiographs (miliary or nodular pattern, solitary mass/granuloma), urine antigen testing, cytology (airway wash, fine needle aspirate, lymph node, skin lesions/nodules, lung),

    Pulmonary Mycoses treatment

    • Itraconazole (5 - 10 mg/kg q24h PO)
    • Fluconazole (5 - 10 mg/kg q12h PO)
    • Amphotericin B (liposomal)
    • Minimum 3-6 months
    • Potential for worsening prior to improvement
    • Potential need for intensive supportive care, oxygen

    Inflammatory Airway Disease

    • Feline asthma & bronchitis
      • Prevalence ~1 - 5%
      • Siamese cats over-represented
      • Eosinophilic inflammation
    • Canine chronic bronchitis
      • Exact prevalence unknown
      • Considered "moderately common"
      • Co-morbid diseases often present
      • Neutrophilic inflammation
    • Often diagnosed in middle age (median age ~4-8 y)

    Pathophysiology

    • Likely multi-factorial.
    • Prior single respiratory insult, or repeated injury?
    • Chronic irritant exposure?
    • Culmination of multiple minor insults over time?

    Clinical signs of inflammatory airway disease

    • Chronic cough (starts as non-productive)
    • Tachypnea at rest
    • Expiratory dyspnea (prolonged expiration/expiratory push)
    • Exercise intolerance
    • Problem with cats: Signs may only be intermittent and not seem severe, including acute respiratory distress. (Emergent presentation Cats >> Dogs)
    • Airflow limitation, positive intra-thoracic pressure on expiration, and air trapping are implicated in wheezing

    Bronchiolar Disease

    • Characterized by airway narrowing.
    • Possible structural changes (eg. thickened walls) affecting gas exchange
    • Classic findings in radiographs include “donuts” and “tram lines”.

    Airway Reactivity

    • Chronic bronchitis: little to no spontaneous bronchoconstriction (static narrowing)
    • Feline asthma: reversible spontaneous bronchoconstriction (dynamic narrowing)

    Work-Up for Inflammatory Airway Diseases

    • Physical exam, including listening for/presence of wheezes
    • CBC
    • Evidence of inflammation (eosinophilia?)
    • Thoracic radiographs
    • Infectious screening (e.g., heartworm, fecal float/sedimentation, fecal Baermann, respiratory PCR)
    • Airway wash and cytology

    "Classic" Asthma Radiographs

    • Broncho-interstitial pattern
    • Pulmonary hyperinflation
    • Right middle lobe atelectasis ("flattened/caudadly displaced diaphragm")
    • Rib fractures?

    End-Stage Airway Disease

    • Common conditions: Pulmonary fibrosis, Airway remodeling (Bronchomalacia/Bronchiectasis); Pulmonary hypertension, and Cor pulmonale

    Treatment Goals

    • Resolve clinical signs (resolved cough/resolved inflammation)
    • Prevent remodeling (Bronchiectasis, Pulmonary Fibrosis, Pulmonary Hypertension, Cor pulmonale)
    • Decisions based on repeated airway washes and cytology

    Eosinophilic Bronchopneumopathy

    • Typically idiopathic
    • Eosinophilic infiltration of pulmonary interstitium and on airway washes
    • Over-representative breeds: Rottweiler, Husky, Malamutes.
    • Varied radiographic findings (localized... diffuse... multi-focal; Interstitial... alveolar... nodular... mass-like)
    • Oral steroids (1.0-2.0 mg/kg/d) are a treatment option
    • Often responsive to inhaled therapy if initially unresponsive.

    Case Study (5y FS Chow mix)

    • Chief complaint: chronic cough
    • 4 weeks post-prednisolone treatment
    • Bronchial lavage (cytology/cellular differential)
      • Mixed (predominantly eosinophilic, mildly suppurative) inflammation.

    Questions to [email protected]

    • Specific questions regarding case study.

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    Lower Respiratory Disease 1 & 2 Past Paper PDF

    Description

    Test your knowledge on respiratory diseases in dogs and cats with this comprehensive quiz. Explore topics like coughing types, environmental triggers, and common pathogens associated with lower and upper airway diseases. Perfect for veterinary students and professionals alike.

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