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My cat has had a chronic phlegmy-sounding cough for several

years. He has been...
My cat has had a chronic phlegmy-sounding cough for several years. He has been treated with various antibiotics and Clavamox has been the only one that has been effective. Although the cough clears up after treatment, it always comes back. The longest period of time he has been symptom-free is about nine months, and then the cough returns. We have seen several vets, including experienced vets at Tufts School of Medicine, and everyone remains puzzled. I should also note that with the exception of his initial Xray done years ago when this all started, his Xrays show only a mild "bronchial pattern" and no other abnormalities; that first Xray showed what appeared to be a localized pneumonia. Also, We have two other cats in the home and they have never contracted whatever bacteria seem to causing the infection. I am concerned that he will develop a resistance to the Clavamox over time and nothing else will be available to treat it. I am very concerned and don't know what else to do.
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Answered in 2 hours by:
7/13/2009
Doc Evan
Doc Evan, Board Certified Veterinarian
Category: Cat Veterinary
Satisfied Customers: 1,066
Experience: Veterinarian since 1985. Have worked in both Private Practive and University Veterinary Hospital
Verified
Hello
Can you please answer a few questions for me so I can help you better?
Some of these you may not know, please answer best you can.

1. Do you know if they ever took a sample of fluid from your cats lungs?
2. Has your cat had a fecal test for parasites run recently?
3. Have they thoroughly examined your cats heart to make sure it is working well?
4. How quickly does he respond to the clavamox?
5. Have steroids, prednisolone been tried?
6. Has anyone mentioned chronic bronchitis to you?
7. Has a heartworm test been run on him?
8. Has a sample from your cats lung been cultured?
9. Has aminophylline been tried?
Thanks much..sorry for all the questions.
Doc Evan
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Customer reply replied 8 years ago

Thanks so much for your reply! I greatly appreciate your help.

 

1. Yes, they performed a tracheal wash at one point (when he was symptomatic) but the results were negative. They also found a small nodule on his upper palate which they thought was "necrotic tissue." It was benign.

 

2. I can't remember the last time he had a fecal test for parasites so it has probably been several years. I should note that he is an indoor-only cat, and over the years he has never had any others symptoms-- his appetite, energy levels, activities, etc, have always been completely normal.

 

3. He has never had an echocardiogram (or whatever the appropriate test is) but the various doctors he has seen have never noted any abnormalities during exams. He is currently 6-years-old.

 

4. He generally responds to the Clavamox within 3 days or so, and the cough quickly disappears. I can't remember the exact dosing but it is BID.

 

5. No, steroids have never been prescribed. I'm guessing you ask that because of the chance that his symptoms may be related to asthma? His Xrays have shown a "bronchial pattern" that can be indicative of mild asthma, I've been told, but given that his symptoms respond to the antibiotics the doctors believe that it is bacteria-related.

 

6. I don't recall discussions about chronic bronchitis.

 

7. Yes, he had a heartworm test recently-- earlier this year, I believe. He also takes Heartguard.

 

8. See response #1 above.

 

9. That doesn't sound familiar. I would have to check his records to be sure, though.

 

Thanks again!! Carla (and Cisco)

Wonderful!! Thanks for all the answers.
You sure sound like you could be doing all the tests.
You haven't left me much to work with Smile

Well the three major things we think about in chronic coughing cats are heart disease; chronic bronchitis; and asthma. An usual cause is a lung worm, which can be hard to diagnose.

I anticipate the vets would have noted heart disease and the xrays did not sound consistent with that, so that is less likely. And it happens less frequently than other causes.

Chronic bronchitis and asthma are still left and can go together over time.

Chronic bronchitis is defined as a cough of longterm (several weeks) duration, that may respond intermittently to therapy, but come back again. It consists of a chronic inflammation of the airways and can result in a non-productive (no mucus) chronic cough. Due to the damaged airways, they can be more susceptible to bacterial infection.

Because of a possiblity of lungworm, we sometimes do a trial course of fenbendazole, an antiparasite drug. Often on the bronchial wash, we will see a cell called eosinophils, but it sounds like they did not see this.

At this stage, I would retry a bronchial wash with cytology and culture to see if any change have occured and it should be done during the actual coughing episiodes.
The reason for this is because your cat is having recurring events and we have not found an answer.

Short of that, I would recommend a course of treatment with a bronchodilator, one that is used is theophylline, which is a tablet. This may help decrease lung spasm and allow the airways to rest a little bit. An alternative is there are pediatric masks for astham a type inhalers that can be used for cats.

If there is limited response to the aminophylline, steroids can be used, this really is to help break up the inflammatory cycle.

One could try a course of fenbendazole for potential lungworms, but this is unlikely as your cat is inside most of the time and they get these from snails. If a bronchial wash came back with eosinophils..then I would do this.

These are some suggestions as how I would approach.. Since this is ongoing, you may need to try several different strategies for diagnosis and treatment.

A lot here. Let me know if you need clarification or have more questions.
Evan Keller
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Customer reply replied 8 years ago

Very helpful! I will definitely discuss your thoughts/ suggestions with our vet. Just one more question if you don't mind-- are chronic bronchitis and/ or asthma associated with a phlegmy-sounding cough? His cough has never produced mucus but it definitely sounds like he is trying to cough something up. Also, the cough sounds more like it's along his throat (as opposed to in his lungs), although years ago he had one Xray that showed what looked like a localized pneumonia. When symptomatic he also "gurgles" a bit, which can be heard from time to time, and which seems to interfere with his ability to purr (i.e., it seems like purring can sometimes trigger a cough). Does that change your impressions at all? Thanks again.

Chronic bronchitis can very well be associated with a phlegmy sounding cough as it is associated with mucous plugs in the airways...these typically dont get coughed up though. They just hang out in the lower airways.

Asthma would be more of a wheeze..and genreally not so phlegmy sounding. This amy also account for some gurgliness (made up that word).

One thing the vets should check for is a collapsing trachea..we see this in dogs, but it would be very unusual in cats, so we don't think of it often. This is where the treachea is a bit weak and narrows down causing irritation and cough..it can lead to chronic bronchitis too. An xray when they are coughing can help show this.

Hope this helps.
Evan
Doc Evan
Doc Evan, Board Certified Veterinarian
Category: Cat Veterinary
Satisfied Customers: 1,066
Experience: Veterinarian since 1985. Have worked in both Private Practive and University Veterinary Hospital
Verified
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Customer reply replied 8 years ago

Hi Dr. Keller, I received a copy of the cytology report based on the sample obtained from the tracheal wash, and I was wondering if it would help guide your impressions at all? These are the results:

 

The sample contains a moderate amount of mucus with a moderately increased cellularity, consisting almost entirely of neutrophils. A few clusters of deeply basophilic epithelial cells were also found. Some of the neutrophils appear slightly to moderately degenerate. Small numbers of neutrophils contain variably sized, irregularly shaped, metachromatci inclusions suggestive of celluar debris or immunoglobulins. An etiological agent is not apparent.

 

Also, after you mentioned the association between eosinophils and that parasite, I think I remember hearing that one of his blood tests revealed a slight elevation in eosinophils-- could that also suggest the lungworm, or not so much?

 

Both of my vets (local and at Tufts) are out this week so I thought I'd try to do some research before bringing Cisco for an appointment. I really appreciate your help. This situation has been very frustrating and worrisome.

 

Carla

Hi
Thanks for sharing this.
The neutrophils and mucus can be consistent with the chronic bronchitis.
The eosinophils the blood is consistent with a parasite (such as lungworms), but we would expect to see eosinophils in the lungs too, which are not reported in your cat. Sometimes, we see eosinophils just from allergic responses too. This should be repeated to see if it is consistent or has chagned in anyway. If the high eosinophils are still there, it could be worthwhile to try a treatment of fenbendazole (or other wormer), it won't hurt and may help a problem we are not identifying.
Good luck!
Evan
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Customer reply replied 8 years ago

Hi Dr. Keller,

 

I just thought I'd write to give you an update on Cisco, my kitty with the mysterious phlegmy-sounding cough. Almost immediately after his last round of antibiotics his cough returned, which was especially concerning, since he usually experiences a longer period of remission between episodes. I vet tech I spoke with during his opthalmology visit -- yes, he has an eye issue too -- suggested trying holistic medicines, which I had never considered. I started doing some research and found a company that sells many different holistic remedies for both pets and humans -- Pet Alive -- and decided to try one of their products which they claimed both cured and prevented bacterial respiratory infections. I did some research on the company online, to ensure that their products were safe, and started giving Cisco the "medicine."

 

Believe it or not, it worked!! It seems like a miracle. After YEARS of repeated rounds of all types of antibiotics, Xrays, and other tests, his coughing decreased significantly, and ultimately disappeared! At first I was giving him the product regularly, as directed, but once the cough improved I started giving it to him less often, and then not at all. He will occasionally begin to cough, so I start giving him doses again, and again it improves. It's amazing. I still can't believe it.

 

I realize that we still don't know the cause of the coughing, which is a concern, but I'd rather treat the cough with a holistic medicine than put him through endless tests and rounds of antibiotics, running the risk that he will eventually (if he hasn't already) develop immunity to them. I'm so relieved about it, I can't express it enough.

 

Anyway, just thought I'd share that with you.

 

Carla

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Doc Evan
Doc Evan
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Category: Cat Veterinary
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