Feline Asthma
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The goal for asthmatic cats is to decrease inflammation, dilate the airway and diminish mucus production. Medications can be administered orally, inhaled, or intravenously. Some medications can also be made into liquid suspensions or transdermal gels. Commonly prescribed medications include broncodilators, steroids, inhaled steroids, antihistamines, leukotreine receptors, holistic, homeopathic & herbal medications and vitamins.

Links to major online pharmacies can be found here.

Bronchodilators
Albuterol: US Proventil®, US, UK Ventolin®; UK Salbutamol®

Terbutaline: Brethine®, Bricanyl®
Salmeterol: Serevent®
Theophylline: Theo-Dur®, Aminophylline®, Corventil D®


There are two types of bronchodilators used in cats. Sympathomimetics (Albuterol, Terbutaline) primarily used for rapid relief of breathing difficulty, commonly known as revivers and to be used for sudden attacks. Albuterol is an inhaled medication that relaxes the muscle that surrounds feline and human airways, the muscle that can spasm in an asthma attack and cause cough and difficulty breathing. It may be used up to four times daily or as needed for asthmatic cats already on daily steroids and every half hour, for 2-4 hours in a crisis. Terbutaline is in oral, injectable and syrup form and is almost identical to Albuterol, although many owners report the drug makes their cats spacey and/or disorientated. Terbutaline is also available in a child's syrup called Bricanyl® in the UK and Canada. The feline dosage is 2ML twice a day. Can be used three times daily if needed. Salmeterol is a long acting inhaled bronchodilator. It lasts 8-12 hrs in cats. It takes 1-2 hours to take effects and should not be used in a crisis. Side effects can include palpitations and trembling, tachycardia and musculoskeletal twitchiness at the highest doses.

Xanthines (Theophyline). Used for the long-term prevention of breathing difficulty, in oral form. Theophyline when used with Prednisolone has a little understood action of increasing the anti-inflammatory process where others bronchodilators do not. Side effects can include headache and palpitations.

Current research suggests that bronchodilators when used alone may result in quiet progression of asthma and irreversible lung damage. This is because the inflammatory process is allowed to continue while symptoms are masked with the bronchodilators. Bronchodilators do not reduce the inflammation in the lungs. It is better to provide concurrent therapy with steroids. The use of bronchodilators is contraindicated in patients with cardiac disease. so this condition should be ruled out before use of bronchodilators.

Cortricosteroids
Prednisone
Prednisolone
Depo-Medrol


Corticosteroid's work to reduce inflammation and are the most familiar long-term treatment of feline asthma. Steroids are available in many forms including oral, injectable and inhaled. Only oral and injectable steroids are discussed here, inhaled steroids have their own section.

Prednisolone may be administered in oral form or produced by the body from Prednisone which is activated by the patient's liver into Prednisolone. Depo-Medrol is idministered in injection form.

Side Effects
Although felines are considered "steroid resistant", they are still subject to steroid side effects. The side effects of oral and injectable steroids are essentially the same. Both being systemic steroids, you can expect increased thirst, appetite, and urination. Long-term use effects vary among different cats and according to dosage and they include kidney disease, liver disease, pancreatitis, diabetes mellitus, behavioral changes, polyuria, cystitis, and inappropriate urination, stomach or intestinal ulcers, weight gain, altered mood and personality, cataracts, glaucoma, hypertension, osteoporosis, aseptic bone necrosis, increased susceptibility to infections (immunosuppression), peptic ulcer disease, tuberculosis and Cushing’s syndrome.

Injectable steroids do carry more risks than oral because the dose cannot be reduced once it is in the body; you have to wait for its effects to wear off over potentially months. There is also a higher incidence of steroid induced diabetes associated with the long acting depo shot.

It is suggested that steroid doses be given in the evening to tie in with the body’s own production of anti-inflammatory hormones. (Cortisone).

Inhaled Steroids
Fluticasone proprionate: US Flovent®, UK Flixotide®
Beclomethasone: Qvar®, Becotide®

Check out the pictures of Frankie and Keisha receiving their inhaled medications

Inhaled steroids usually do not get past the first few layers of cells in the lungs, though a tiny amount escapes into the system, therefore significantly reducing the likelihood of side effects associated with the oral route. They only affect the lungs while oral or injectable steroids are systemic and therefore affect the whole body. For this reason, there are far fewer side effects of inhaled steroids than oral or injectable steroids. There can be minor side effects such as throat irritation, voice loss, gag reaction and stomach upset from the swallowed medication.

Inhaled Steroids can be administered through a spacer or through the new AeroKat.

The final Flovent® treatment protocol for the AeroKat has not been officially published by Dr. Padrid. In the meantime, he suggestions the following protocol (pdf) to get a feline started on inhaled steroids.

Antihistamines/Antiserotonins
The only antihistamine that is useful in feline asthma treatment is Cyproheptadine: Periactin®. This is because the antihistamine portion of Cyproheptadine is not the useful portion for asthmatic cats. It is the anti-serotonin portion that helps. Serotonin is involved in feline asthma, but histamine is not, the standard dose for the asthmatic cat is 2mg twice daily however, many owners report their cats are extremely spaced out on this dose and should this hyper-sensitive reaction occur, it is worth trying the drug at a half or quarter of this dose, before deciding to discontinue. The drug also acts as an appetite stimulant and is commonly prescribed for non-asthmatics for this purpose.

Leukotreine Receptors
This class of drugs include Zafirlukast: Accolate® and Montelukast: Singulair®. A very few patients are using these drugs however; studies would suggest they have not been shown to have a widespread use in feline asthma and more trials and data are needed.

The drug was being used by some specialists at a University veterinary hospital in the UK with reported success at doses of 5mg twice daily. The drug has a reputation of being tough on the liver so initial treatment needs to be monitored very carefully and any changes in behaviour whatsoever should be assessed by a vet. Some cats are unable to tolerate these doses and in those cases, it may be worthwhile to experiment with lower doses. Some animals were able to get away with as little as 2.5mg every other day.

Holistic, Homeopathic & Herbal Medications
Many pet owners opt for alternative therapies, particularly if the disease is mild or if they feel a product is beneficial, alongside the conventional meds. In this regard, we recommend that you employ a homeopathic or alternative medicine vet, preferably by a referral from your vet, or another person who has used their services. It is always very tempting to try some of the remedies available, especially with so many products claiming miracle cures however, while there is no doubt some therapies can be useful in some cases, certain herbal remedies for example can interfere with conventional medicines so these treatments are best left to the professionals although of course, many feline asthma members will share their own experiences which should help with your evaluation.

Vitamins
Many people choose to use vitamins for their pets to help boost the immune system and support the respiratory system generally. This can be particularly beneficial with the elderly patient where the immune system is already flagging. The vitamins listed below are suggestions only, drawn from list members who use them daily but again, vitamins can do harm as well as good so we therefore recommend that you discuss their use with your vet prior to treatment.

This list is a reference guide to assist with the chronically sick and elderly pets. A healthy cat or a cat with mild or well controlled asthma should not require any specifically targeted therapy and should receive all the nutrients required from a good balanced diet. There are also many multivitamin and mineral supplements available for pets as well as immune support supplements and these should be adequate in most cases. Please discuss with your vet.

Vitamin C - Ester C is recommended, as this is gentler on the stomach -250mg daily. The vitamin is well known for accelerating the healing of damaged tissue and for its role in maintaining healthy immune and circulatory systems, strong bones and teeth. There are also reports that it may minimize the risk of cancer. Cats do naturally produce a little vitamin C but with the chronically sick, a supplement is worthwhile.

Vitamin E - this should be the natural vitamin E, (look for d-alpha tocopherol) - 50 IU (international units) is a suitable dosage rate. This vitamin helps to fight infection and disease. It is an anti oxidant and helps preserve the activity of vitamin a and fatty acids in food. Wheatgerm oil is a good source and promotes a good glossy coat.

Cod Liver Oil - 300mg capsule, one week in every four or twice weekly. Apart from its effect in helping to prevent and treat the symptoms of arthritis, and in helping to maintain a healthy skin and coat, the vitamins a and d in cod liver oil assist in the function and maintenance of eyesight, tooth formation, nervous tissue, bones and joints. Vitamin a is also an antioxidant and combats the effects of chemicals and pollutants. Due to the vitamin a content of cod liver oil, the dosage rate should never be exceeded, for in excessive amounts, vitamin a, which is stored by the liver, can cause damage to bones and joints.

Evening Primrose Oil - 500mg capsule daily. This has long been used to help promote a healthy skin and coat however; more recently, studies have shown it can have an anti-inflammatory effect. The oil contains not only the essential fatty acid, linoleic acid, but also the important substance gamma linolenic acid or gla. In the body, linoleic acid must be converted into gla before it can produce prostaglandins. These important hormone like substances enable the body to control and regulate a variety of such functions as cell growth and regeneration, muscle action, and healthy circulation. The conversion of linoleic acid to gla can be disrupted by modern food preparation, vitamin and mineral deficiency as well as metabolic disorders such as diabetes, viral infection, hormonal changes and aging. It is debatable how much anti-inflammatory action this oil may have when given to cats, because in one study, doses of 7000mg daily were used in dogs before any anti inflammatory action was observed. Although the dosage rate is not dangerous as such, it is unlikely that this amount of oil would be tolerated by the average kitty stomach!

Co Enzyme Q 10 - 10mg-30mg daily. This is a natural vitamin like substance that is essential for the release of energy from all cells in the body. The substance occurs naturally in foods and although the body can make CoQ10 from food, the ability to do this declines with age. It is an antioxidant and antioxidant nutrients are able to quench free radicals before they can damage cells or tissues. Recent studies have also shown it may help with heart disease. There are now veterinary products on the market, which your vet can provide if appropriate.

L Lysine - 500mg-1000mg once daily. This is one of the essential amino acids, the building blocks for protein, which is needed for normal growth and development in the body. Some owners have found this supplement useful where a viral element to their cats disease is suspected (Herpes) and symptoms such as excessive tearing and general signs of a viral flare up are said to improve with its use.

Vitamin B Complex - pediatric dose once daily. The B group of vitamins are vital to the feline and have many functions in the body, including that of helping to fight disease. The vitamins are water soluble (with the exception of B12, where small amounts are stored by the liver) are therefore need to be replenished daily. Vitamin B12 is stocked by all vets in injection form and is often prescribed to promote appetite, and help with anemia where a deficiency of vitamin B12 is the suspected cause.

Cranberry - Various doses, available in capsule and powder forms. Cranberry supplements can be used as a natural way to ward off urinary tract infection where this is a persistent problem. It willalso help with cystitis and bladder problems generally.

Probiotic Digestive Aids - many available, containing friendly bacteria essential for healthy gut flora. Particularly useful following antibiotic therapy to restore gut flora and in studies, it was shown that patients given a probiotic during antibiotic therapy recovered faster. The theory is that that probiotic contains billions of good bacteria and more than the antibiotic can destroy.

Liquid Medications
Some medications, including prednisone, can be made into a liquid suspension in chicken, liver, beef or tuna flavors. These can be made at a compounding pharmacy.

Transdermal Gels
Some medications, including prednisone, can be made into a transdermal gel. it comes in pre measured syringes and you put on a rubber/vinyl glove and squeeze a dose onto your finger and rub it into the flap of the cat’s ear. These can be made at a compounding pharmacy.

From Dr. Padrid on Transdermal Gels
I wanted to remind us all that there is a significant potential risk in using medications that are compounded into creams to be applied to the skin: there are zero studies on how much, how quickly the drug of interest is actually absorbed. With a disease like hyperthyroidism, we can measure thyroid levels in the blood to tell us if the tapazole cream is effective, But, for other drugs, especially including steroids, there is just no way to know what we are actually giving when we apply a cream or compounded patch etc.

A recent pharmacologic study using steroids on the skin (inside flap of the ear) on the theory that they will be absorbed and therefore as useful as oral steroids, for kitties that are difficult to pill. First, remember, if it works, it carries the same side effects as pills. More importantly, the study demonstrated that even at 10 times the oral dose applied to the skin, no steroid could be detected in the blood stream after topical application.

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Each cat is an individual and what works for one may not work for another. Please do not undertake any treatment regimen without the assistance of a veterinarian.


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