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Respiratory Medicine

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The purpose of this lecture is to review the management of pyothorax in cats and dogs. Pulmonary infection can result from bacterial, viral, fungal or protozoal infection, however, pyothorax is almost uniformly bacterial. The pleural space has a small amount of fluid normally (~ 5 ml) which serves as lubrication for the pulmonary parenchyma.

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Pneumothorax is defined as free air in the pleural space. Normal intra-pleural pressure is about - 5 cmH20, which means that in order to equilibrate pressures, air from either the atmosphere, or the lung will equilibrate rapidly with the pleural space. Pneumothorax can be further characterized as traumatic, spontaneous and iatrogenic.

Respiratory distress is common and challenging. Cats often compensate well for pulmonary diseases, and some conditions can rapidly fulminate. Dogs are often more "honest" although they can decompensate rapidly as well. It is crucial to balance the equal goals of limiting stress on the patient with respiratory distress, and to work to identify the specific cause of the distress so that appropriate therapy can be provided.

Upper airway diseases/obstruction are relatively common causes of respiratory distress in dogs and cats. However, because lung parenchymal diseases are more frequently observed, upper airway problems may be overlooked. In order to fully appreciate upper airway disease, it is essential to be familiar with the structure, function, and common abnormalities.

Herpesvirus 1 (rhinotracheitis; FHV-1) and calicivirus (FCV) are the most common viral causes of sneezing and nasal discharge in the cat. If oral ulcers are present, calicivirus is most likely. If corneal ulcers are present, herpesvirus 1 is most likely. FHV-1 has now also been associated with chronic stomatitis, facial dermatitis, and endogenous uveitis. Viral rhinitis with or without secondary bacterial infection can be recurrent.

The history of canine influenza virus began with the identification of infections in racing greyhounds, directing research that defined canine influenza virus (CIV), a variant of equine influenza virus with a unique genetic signature capable of being transmitted from dog to dog.

Feline bronchopulmonary disease (FBPD), often referred to as "feline asthma" actually encompasses a group of common, but poorly understood, airway diseases. It is estimated that bronchopulmonary disease affects 1% of the general cat population and > 5% of the Siamese breed. Cats of any age can be affected and there is no clear gender predisposition.

Cats who cannot breathe are the most fragile patients we treat each day. Cats tend to be more compromised on presentation as they hide their breathing issues better from their owners. It is important to balance diagnostic procedures with therapeutic intervention so that these cats can be quickly stabilized and effectively treated.

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If the cat is presented for labored breathing questions should be directed to assist in differentiating upper from lower respiratory disease as some owners perceive stertorous breathing in a cat with upper respiratory disease as a form of labored breathing. This could be misleading to a clinician.