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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 32803
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Hi there Ive posted before about Tofu, my now 10 month old

Customer Question

Hi there
I've posted before about Tofu, my now 10 month old Burmese. He has just been diagnosed with probable asthma, but his symptoms don't seem to be the ones I've read about so I just wanted a second opinion. Basically, when we got him at 3 months we noticed he was quite a noisy breather. The vet listened to his heart and lungs but wasn't concerned. However, the breathing got worse and by 5/6 months, at times it was very wheezy, and he snored quite a lot at rest. We took him back and then he proceeded to have various investigations - two lots of xrays (the first showed a small shadow on his lung which cleared after antibiotics), scoping and blood tests. He was negative for FIV and FeLV but positive for FCoV. The vet said his airways looked inflamed, and both vets who examined him felt asthma was the likely diagnosis. She prescribed a very mild dose of prednisolone to confirm the diagnosis, which to us didn't seem to make that much difference, but she felt his chest sounded clearer. She doesn't want to medicate for now, so we're monitoring him and trying to remove allergens in the home - we've got dustmite-proof bedding, switched to natural cleaners, and are highly vigilant about vacuuming and dusting! If he gets worse, he'll have an inhaler.
My question, though, is does this really sound like asthma? I do trust my vet but everything i've read online seems to say coughing and hacking are the classic symptoms. Tofu has never done that. He's just very snorty and wheezy at times (at other times not at all) and sneezes a couple of times a day as well. He doesn't seem to have laboured breathing after exertion either - in fact it often seems worst when he's at rest. Aside from the noisy breathing, he's in very good health - loads of energy, very good appetite, weighs 11lbs, likes to play a lot. Could he just have a mild case of asthma and not yet have progressed to the coughing? Or do we need another opinion?
Submitted: 4 years ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 4 years ago.
Aloha! You're speaking with Dr. Michael Salkin
Hi again. We spoke about Sushi last time but the history you provided above is about Tofu yet the history is identical. I'm puzzled.

I'll go ahead and address your questions but do want to hear from you after I post. "Asthma" can be a challenge to identify in our cats. Yes, the classic presentation is a coughing cat who is otherwise normal but as you mentioned the severity of the asthma can vary and confound our diagnosis. There are no formal definitions of feline idiopathic (unknown cause) inflammatory airway diseases, highlighting the fact that these diseases are still poorly understood. The cat is the only animal species that commonly develops a syndrome of asthma similar to that experienced by humans, with eosinophilic airway inflammation, spontaneous bronchoconstriction, and airway remodeling.

Idiopathic, inflammatory bronchial disease is the most common cause of coughing and wheezing in cats. There is no single diagnostic test that is pathognomonic (specificially indicative) for this diagnosis. Diagnosis is made on the basis of collection of diagnostic clues, the results of which can sometimes be inconsistent, and the exclusion of other known causes of lower respiratory disease, mainly parasitic (e.g., lungworm, heartworm) or other infectious causes. In most cases radiography and bronchial wash analysis, together with clinical history and physical examination findings, will give enough information for a working diagnosis. Response to therapy is also a useful indication; most cats with asthma will respond to corticosteroid therapy within 1 week.

Because Tofu (Sushi?) doesn't display the typical symptoms of asthma and you haven't noticed a significant improvement upon prednisolone administration, it would be prudent to have a PCR (DNA-based testing) respiratory panel performed to see which, if any, infectious agents are present. PCR testing is very sensitive and specific for identifying the presence of the feline herpesvirus (FHV-1), calicivirus, H1N1 influenza virus; as well as the bacteria Mycoplsma, Chlamydophila (previously called Chlamydia), and Bordetella bronchiseptica. If no infectious agents can be incriminated in his disorder, a bronchial wash would be my next diagnostic of choice.

I look forward to speaking with you once again. If you'd prefer to speak to another vet because we've already spoken please let me know. I can opt out which will allow other vets to respond to you.
Customer: replied 4 years ago.

Hello Dr Salkin, no, I'm very happy to speak with you - I didn't respond to our previous chat as I wasn't sure you were online. Sorry for the confusion with the name - it is indeed the same cat, but we have changed his name (long and boring story to do with my husband!!) I couldn't remember whether he was still Sushi the last time I talked to you.

The interesting thing is the vet, when she listened to his chest with the stethoscope, DID think his chest sounded better. She only gave 1mg of prednisolone and said she wouldn't expect a dramatic improvement on that (trying to treat conservatively). I must say that while he had that course of treatment I did think that although the wheezing was as bad when he did it, it perhaps wasn't as frequent. But hard to call, really. I understand now there's no 100% test for asthma and that symptoms can emerge in different ways.

I need to check whether the vet did any tests like that. I may have mentioned before they took a swab of some 'gunk' (the vet's words) which came out when they removed the tube. She said it was high in macrophages (?) They didn't do a bronchial wash because they were fairly sure of their diagnosis by then. At the time, they didn't advise treatment, but I noticed him breathe with an open mouth for a few seconds a couple of weeks ago so we took him back and that was when he was put on the prednisolone. I suppose my big worry is that it's something more serious, like lymphoma, although he is otherwise healthy. Also, while I don't want him over-medicated, I don't want to leave the asthma if it should really be treated. I do trust the vet, I am just a little confused as he doesn't seem to have the classic asthma symptoms. Next time we go I will ask about the PCR testing, thank you.

Expert:  Dr. Michael Salkin replied 4 years ago.
Oh good. I'm not going nuts...Yes, the small dose of prednisolone confounded our diagnosis. We don't know if inflammation of asthma, infection, or allergy was addressed. I recall the finding of macrophages but we're primarily concerned with eosinophils when identifying if asthma is present. The concurrent presence of both eosinophils and neutrophils can indicate either chronic asthmatic bronchitis or secondary bacterial infection.

Tofu is too well to be considering lymphoma. Lymphoma is usually represented by mediastinal lymphoid swelling rather than changes in the lungfields in any event. Treatment of asthma remains controversial. Many of us treat as necessary. Many feel that the inflammatory cascade should be pre-emptively treated to avoid wind-up. I'll leave the approach to you and your vet to decide.

You're quite welcome. Please continue our conversation if you wish.