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DrRalston, Veterinarian
Category: Vet
Satisfied Customers: 2205
Experience:  Over twelve years of internal medicine, surgery, and preventive care.
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Hi there After a few months of going back and forth for xrays,

Customer Question

Hi there
After a few months of going back and forth for xrays, blood tests etc, my 9mo Burmese was diagnosed with asthma yesterday. He has had noisy, congested breathing for a while, though no other symptoms. Our vet gave him Prednisolone to take for a week to confirm asthma and also a worming pill as he's started going outside. He had the wormer and a dose of the steroid at midday yesterday and since last night hasn't been himself. He is very sleepy and lethargic, and at lunch today wouldn't eat his favourite food. He's usually very greedy and hyper. Could this be down to the meds? Or could he be sicker than we thought? Thanks.
Submitted: 2 years ago.
Category: Vet
Expert:  DrRalston replied 2 years ago.

Hello, I'm Dr Ralston, thanks for your question.

This is a hard question to answer. It's hard to know how sick your pet may or may not be without seeing it in person. Seeing the xrays are how a diagnosis of asthma is made, and response to therapy (in this case steroids) would not be a bad choice of treatment by your Veterinarian at all. But, really, severity of signs of asthma often correlate directly to those radiographs and how bad they look.

Now, what I have noticed is this. Cats that have asthma often have severe difficulty breathing overtime. They will have "attacks" where they are breathing very deeply and struggling that is true. But there are also long term changes in the lungs that cause them to receive less oxygen over time, and they struggle with this daily.

I have noticed that when starting medications that relieve this inflammation the pet is able to actually breathe easier. This allows them to relax, and even sleep more, especially at first. This is because they are relieved and actually feeling better. They sleep to make up on the loss they have had, and the strain they have encountered. I have experienced this with pets as well with medications like Rimadyl which is a non-steroidal anti-inflammatory drug used to treat pain and inflammation in dogs. Many people tell me that it makes their dogs sleepy. There is absolutely nothing in that medication that would sedate a pet or make them sleepy. But, it does relieve pain which allows them to rest comfortably.

So, I wouldn't be surprised if there are some changes in behavior over the next several days. Typically, they start to come around back to their normal selves after the first 3-4 days of treatment.

I would like to share some more detailed information with you about asthma as well. This is information I have prepared ahead of time that I share with my clients in the exam room. But I want to give this to you here as well, because I think it is very detailed and might also answer some other questions you might have.

As always, if you have questions, please feel free to follow up with me and I will help you.

Below is the information I wish to share with you :


Feline asthma is a type of bronchoconstriction, that makes it difficult to breathe deeply. It probably feels very similar to when people have asthma. People say it feels like a fish out of water, or like pressure in the chest.

The cause is not completely known. However there are several recognized possibilites:

- hypersensitivity / allergies
- environmental pollutants (smoke, air fresheners, candles, incense)
- infectious agents (bacteria, mycoplasma, viruses) that lead to chronic condition and changes
- maybe genetic in some breeds - like Siamese.

What happens is this:

Acute bronchial constriction of the air ways is initiated by the possible causes above. Think of the constriction kind of like a spasm of the trachea/airways. The muscle of the air way contracts, and forces out air. This is a cough. And the cough is usually started by foreign material in the air ways right?
Ok, but the second component is the responsive mucus. The irritation causes mucus to form in the airway, snot. So, you have constricted airways, making it harder to breathe, and they fill with mucus causing even more difficult breathing. In addition, the coughing actually makes the muscle stronger as it works out. It gets larger, and thicker, contributing to the narrowing of the airways.

The signs you see:
-and this is important, difficulty breathing OUT. You can't breathe in either, but then there is so much muscle hypertrophy (growth) and mucus that you can't push out normal air either.
-gagging (mucus)

You may not see signs for a while, and suddenly they are very prevalent.

Secondary complications include:
fever, pneumonia, and emphysema (big pockets of air that form in the lungs as a result of the increased pressure)

Diagnosis is usually made based on:
The physical exam, and the descriptions from the owner.
Auscultation: listening to the lungs. There will be loud wheezing sounds as the air passes through the congested airways
In advanced cases you might hear crackles as air passes through the mucus and makes clicking sounds.

But, x-rays are the best. There is classically a bronchial pattern with interstitial or pulmonary hyperinflation. That might not mean much to you. That's ok. It takes us years of training to recognize it.

This is a really good example of feline asthma on radiograph.
You can see the white "rings" in the lung spaces. These are inflamed airways. The lung should be darker, and more black as it is filled with air. The white is tissue. The airways are often not visible at all on xray, but when they are inflamed they will look like rings and tracks. Clearly visible on this x-ray.

Also, see the large black pockets that are black and towards the left of the x-ray. Those are hyperinflated lung spaces. The pet is gulping air and trying to breathe as hard as possible, hyperinflating those spaces of lung that ARE working.

I would call this a classic textbook x-ray. You don't always get this in practice.

In some cases a transtracheal wash should be done. This is when the pet is sedated, and closely monitored. A small amount of sterile saline is entered through a tube, and it mixes deep in the air ways. The pet then coughs, and the mixture of mucus and saline is collected and tested to be sure there isn't secondary infection, rare parasitic larvae, bacteria, fungus, even cancer cells that might be mimicking pneumonia.
This isn't usually needed, because the radiographs are often VERY specific and diagnosis can be made off of that alone.

Treatment for asthma:
In cases of sudden asthma, and respiratory distress in a cat, this is an emergency.

Emergency: these cats will need oxygen to help them breathe, rest, and steroids typically to reduce the inflammation as mentioned above. They will remain with oxygen until they are stable. Steroids start with injectable meds and follow up with oral steroids.

BRONCHODILATORS: Theophylline is often give IV in an emergency. This is an older medication that was used more in humans in the past, but still is valuable to us in Vet Med today.
Epinephrine and Atropine might be used in severe cases.

BUT, for LONG TERM, AT HOME STUFF, that you can manage:

Control of the cause if possible helps immensely. Eliminate dust, smoke, powders, any of the aerosolized issues as mentioned above.
Cats should become indoor cats so you can control it easier. Buy a very good vacuum with a HEPA filter, and change the filter in your air/heating
system frequently (once a month) and purchase a high quality one at that.
Fat cats have worse asthma, so a diet is never a bad idea.

Some cats will need to have steroids long term, although it is useful to use the lowest effective dose possible to avoid side effects.

Antibiotics are not usually needed long term, but are worth trying early on in case there is an infection. If culture can't be done, etc, then a choice is often made based on experience and best guess. Your Vet can do that.

Some cats do really well with an inhaler, just like people with asthma.
I'm going to give you some information on that here...
First, I'll give you these links:
Link to Feline Asthma Mostly, just more information for you to read. You can't get enough really.

Fritz the Brave Asthma Cat" target="_blank"> Good tips, hints and information.

Aerosol Chamber This is using an inhaler in cats, and is very helpful.

Flovent is used often in cats. Some will need it daily. Most really do tolerate this very well, and it can almost completely control signs over time.

Hopefully, I have given you some great information that will help you make the best decisions going forward.

Please follow up with any questions you have if I have not answered all your questions. I'm here to help!

Customer: replied 2 years ago.
That is really helpful, thanks! I don't think they saw rings on the xrays but did do a swab and that, plus symptoms, is why they presume asthma. He has never coughed or hacked but has had very noisy snorty breathing, getting slowly worse. Could he have asthma without those acute attacks? Will treatment prevent those? I am a bit concerned he's not eating much - usually he can't get enough food. I suppose he is maturing but he doesn't seem himself.
Expert:  DrRalston replied 2 years ago.
You asked if they can have asthma without the attacks? Yes, absolutely. The signs can vary in severity from cat to cat.

So, eventhough I did say that it is really best to base it on the x-rays, if your cat is not having severe attacks it might be more mild, and better (not worse) than you thought originally?

Treatment does help to partially prevent these episodes, breathing problems, attacks. But it depends on the treatment and the cat. For example, the inhalers, like Flovent, are sometimes used in "event only" situations to stop the attack. BUT, I often have owners that are using the inhalers do one puff (sometimes two puffs depending on the cat) often just once daily. I've had patients do well with that dosing schedule for years with great success and very few episodes.

I treated one cat with long acting steroid only (depomedrol). This is because I couldn't touch the cat. It would try to kill me, and it's owner whenever we did try to touch it. So, about every 30-40 days, the pet would start to wheeze and have troubles breathing. The owner would bring it into the hospital, and I would skillfully inject through the carrier into the muscle while diving backwards and praying, and it would work until the next injection.

Sometimes when it is hard to breathe, it's hard to eat. The steroid will help with that as well over the next several days.

Now, if the breathing noises are not better, and the signs don't improve, and the pet is still acting like he doesn't feel well other considerations should be considered.

I am sure your Vet evaluated the heart as well on the x-ray, but that should be considered as a cause for lethargy and difficulty breathing. Heartworm test if your cat is outside, or you live in an area where this is very common. And one last thing to consider for noisy breathing would be something like a nasopharyngeal polyp. This is a kind of tumor in the back of the throat that can irritate the cat and cause snorting, snoring, gagging, sometimes even sneezing. Not allways the same signs for all cats though. Here I'll give you a good link on that so you know what I am talking about...

(just click here for that) Seems like I have a link for about everything. I need to spend less time online?

Customer: replied 2 years ago.
You are great! Thank ypu! You even made me laugh with your story of the angry cat,no mean feat as am very worried about my little puss. But you have given me some good other explanations of his sleepiness/appetite loss. The vets initially wanted to rule out cancer , FIP etc so it's been a worrying time. Think they checked for polyps but will check. I hope perhaps his asthma is milder and can be controlled. He is easy going so might take an inhaler. So I suppose I just watch for a day or two and hope he improves? He normally comes galloping if he hears me go into the kitchen, even if he has just eaten. So unusual for him to sniff food and walk away.
Expert:  DrRalston replied 2 years ago.
I would give it a few days, to see if he improves.

If he will not get up or move at all, or seems extremely depressed or unable to move, that is different of course. Take him in right away in that case.

Polyps are hard to check for, it usually requires sedation to look in the back of the throat, and an ear exam. But, in some case a CT or MRI are necessary, and in fact the best way to know for sure. They are costly though maybe 1000-1500 pounds?

So, FIP and cancer are on the list as well for breathing problems for sure. You would often see signs of that on a chest x-ray as well. Sometimes, there are VERY VERY small growths in the lung that do not show up on x-ray. Many of these will respond to prednisone as well, but it takes several days. FIP responds sometimes to prednisone. There is a blood test for that, you might have them run it to be sure if they aren't certain from the x-ray that asthma is the diagnosis.

At any rate, that would be my typical order of trial for asthma:
1. suspicion based on coughing or wheezing cat
2. evaluation of x-rays
3. trial course of steroids
4. if better consider long term steroids and inhalers
5. not better re-evaluate for other causes
- cancers
- polyps
- other lung or throat disease
Customer: replied 2 years ago.
Thanks! They tested for coronavirus antibodies a couple months ago. His titre was high but the vet felt FIP not likely as he is a thriving and slightly overweight kitten - though i am still concerned about it. They felt cancer unlikely based on his age and symptoms. So we are back to asthma as the likely diagnosis. Until the last couple days he has seemed extremely well, but is definitely not himself now and breathing noisier than ever. He is sleping more and eating less though still wating some and playing. The vet said his chest sounded clear with the stethoscope. I suppose other scans are the next step if asthma meds don't help - hopefully they will.
Expert:  DrRalston replied 2 years ago.
Yes. It sounds like we are back to asthma.

They probably discussed this with you already, but I like to talk a lot, so I will too. :)

But, concerning FIP, you can have a high titer and it doesn't mean much actually. It could just mean that the pet was exposed at some point and is producing a reaction to FIP. But, it's when you get that follow up titer 2-4 weeks later, the pet is still sick, and the titer is increasing 2-4 fold, that you know it is a true infection. Doesn't sound like it does it.

Cancer probably not either. It's scary. So, I understand why you are worried. Asthma is not a lot of fun either, but highly treatable. So, that should bring you some relief. From what you have told me, it doesn't sound like cancer to me either. Just something that floats around in the back of Veterinary brains on similar cases.

I hope the meds do help. Please feel free to update me. Even after leaving a rating, you can still contact me by addressing a question " To Dr Ralston" and it will usually find it's way back to me.

This question should remain open for awhile as well, and so you can bookmark it even after leaving a rating in case you have more questions.

I do wish all the best for you and your friend.
DrRalston, Veterinarian
Category: Vet
Satisfied Customers: 2205
Experience: Over twelve years of internal medicine, surgery, and preventive care.
DrRalston and 3 other Vet Specialists are ready to help you
Customer: replied 2 years ago.
Hi Dr Ralston
I just got home and thankfully Tofu seems back to normal - he has eaten all his food and been miaowing for play, even made a hole in my dress by jumping and trying to swing on it. So relieved I don't mind! But I did find a lump of brown stringy stuff on the floor - at first i thought faeces but it didn't have that smell. I think he had vomited it. Could he in fact have had worms that the treatment made him expel??!
Expert:  DrRalston replied 2 years ago.
Glad to hear Tofu is feeling better! That's great. Probably just needed a bit of a rest then.

Not sure what the brown stringy stuff is. Worms are possible, but the more common worms are stringy and white. Roundworms would look like that. Tapeworms occur as well, but you would rarely see a whole worm. Usually, it would just be segments of the worm. And they dry and shrivel, and look kind of like white rice granules.

Interesting. Maybe he had swallowed something too? Wow, that's a weird one.

Well, glad to hear he's doing better at any rate. Great update. I'd like to know how he's doing in 3 days or so as well if you don't mind.

Customer: replied 2 years ago.
He does eat a lot of strings and ribbons. So maybe it was that and the worming pill made him vomit? Anyway he is definitely himself again. Thank you for all the asthma info - will read thoroughly and do everything wecan for Tofu!
Expert:  DrRalston replied 2 years ago.
You bet. I hope it wasn't just an ingestion of ribbon that was making him feel so bad. But, then again, maybe Tofu is feeling better because of the medications working in the lungs?

Best of luck, it's been a pleasure discussing this with you.

Customer: replied 2 years ago.
Thank you so much! I can't see the ratings for service but when they come I will give you an excellent one!
Expert:  DrRalston replied 2 years ago.
Thank you! That alone makes me smile.


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