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Barchilon M, Reinero CR. Breathe easy: inhalational therapy for feline inflammatory airway disease. J Feline Med Surg 2023; 25:1098612X231193054. [PMID: 37675792 PMCID: PMC10812033 DOI: 10.1177/1098612x231193054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PRACTICAL RELEVANCE Feline inflammatory airway diseases, including (but not limited to) asthma, chronic bronchitis and bronchiectasis, are common and incurable disorders. These diseases require lifelong therapy and may result in substantial morbidity and, in some cases, mortality. Goals of therapy include reduction or resolution of clinical signs and the underlying pathologic processes driving those clinical signs. Inhalational therapy has the advantage of topical delivery of drugs to target tissues at higher doses with fewer systemic effects than oral medications. There are multiple options for delivery devices, and proper selection and training on the use of these devices - including acclimation of the cat to the device - can maximize therapeutic efficacy. AIM As inhalational therapy is uncommonly used by many veterinarians and owners, this review article provides a foundation on the selection and use of devices and inhalant medications for specific feline inflammatory airway diseases. Cats present a unique challenge with respect to the use of inhalers, and easy-to-follow steps on acclimating them to the devices are provided. The review also discusses the mechanics of inhalational therapy and helps clarify why certain medications, such as albuterol (salbutamol), fluticasone or budesonide, are chosen for certain diseases. The ultimate aim is that the practitioner should feel more comfortable managing common airway diseases in cats. EVIDENCE BASE In compiling their review, the authors searched the veterinary literature for articles in English that discuss inhalational therapy in cats, and which focus primarily on inhaled glucocorticoids and bronchodilators. While most literature on inhalational therapy in cats is based on experimental feline asthma models, there are some studies demonstrating successful treatment in cats with naturally occurring inflammatory airway disease.
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Affiliation(s)
- Michael Barchilon
- University of Missouri, College of Veterinary Medicine, Columbia, MO 65211, USA
| | - Carol R Reinero
- University of Missouri, College of Veterinary Medicine, Columbia, MO 65211, USA
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Klenk FK, Schulz B. [Inhalation therapy in dogs and cats with chronic lower airway disease - a literature review]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2022; 50:279-292. [PMID: 36067770 DOI: 10.1055/a-1910-3327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chronic respiratory diseases are prevalent medical conditions in dogs and cats requiring lifelong treatment. Mainstay of therapy for chronic inflammatory respiratory diseases are glucocorticoids. Concurrent treatment with bronchodilators may be necessary to control clinical signs sufficiently. Due to the successful use in people as well as subsequent reduction of adverse effects of long-term glucocorticoid therapy, inhalative therapy has become increasingly important in veterinary medicine as well. Primarily spacers or valved holding chambers, in combination with metered dose inhalers, are used in dogs and cats. The technical properties of these devices, as well as their use and maintenance will be described in the following article. Furthermore, the existing literature regarding efficacy of inhalative medications for therapy of chronic inflammatory airway diseases in dogs and cats will be summarized.
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Mueller RS, Nuttall T, Prost C, Schulz B, Bizikova P. Treatment of the feline atopic syndrome - a systematic review. Vet Dermatol 2021; 32:43-e8. [PMID: 33470011 DOI: 10.1111/vde.12933] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Feline allergic skin disease and asthma occur regularly in small animal practice. OBJECTIVES To provide evidence-based recommendations for small animal practitioners on the treatment of feline atopic syndrome (FAS). METHODS AND MATERIALS The authors reviewed the literature available before February 2020, prepared a detailed evidence-based literature review and made recommendations based on the evaluated evidence. RESULTS Sixty-six papers and abstracts were identified describing treatment interventions for FAS and evaluated to establish treatment recommendations. For many treatment options, the papers were retrospective, open studies or case reports. CONCLUSION AND CLINICAL RELEVANCE In this review, there was good evidence for the efficacy of systemic glucocorticoids and ciclosporin, and limited evidence for the efficacy of topical glucocorticoids, oclacitinib and allergen-specific immunotherapy in feline atopic skin syndrome. Evidence pointed to low-to-moderate efficacy for antihistamines, fatty acids and palmitoyl ethanolamide. In feline asthma, there was good evidence for the efficacy of oral and inhaled glucocorticoids, and limited evidence of moderate efficacy for allergen-specific immunotherapy. Evidence supported low-to-moderate efficacy of mesenchymal stem cells, inhaled lidocaine and oclacitinib as treatments for feline asthma. For almost all therapeutic options (with the exception of glucocorticoids and ciclosporin), more randomised controlled trials are needed.
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Affiliation(s)
- Ralf S Mueller
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Tim Nuttall
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Roslin, EH25 9RG, UK
| | | | - Bianka Schulz
- Small Animal Clinic, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - Petra Bizikova
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Abstract
Asthma is an important allergic lower-airway disease in cats affecting approximately 1% to 5% of the pet cat population. New diagnostics are being developed to help better differentiate asthma from other lower-airway diseases and improve monitoring. In addition, new treatments are being developed to help in refractory cases or in those cases in which traditional therapeutics are contraindicated. This article discusses potential pitfalls in the diagnosis of asthma. In addition, current literature investigating new diagnostic tests and therapies for feline asthma is reviewed.
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Affiliation(s)
- Julie E Trzil
- IndyVet Emergency and Specialty Hospital, 5425 Victory Drive, Indianapolis, IN 46203, USA.
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Garrity S, Lee-Fowler T, Reinero C. Feline asthma and heartworm disease: Clinical features, diagnostics and therapeutics. J Feline Med Surg 2019; 21:825-834. [PMID: 31446863 PMCID: PMC10814146 DOI: 10.1177/1098612x18823348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PRACTICAL RELEVANCE For feline practitioners, the cat with a cough or respiratory distress and thoracic radiographs with a bronchial or bronchointerstitial pattern suggests lower airway disease. Two important differentials, allergic asthma and heartworm disease (HWD), have many overlapping clinicopathologic features, but also clear and important differences in terms of cause and disease progression, treatment and prognosis. Notably, asthma is readily treatable and HWD is preventable. CLINICAL SIGNIFICANCE Feline HWD comprises two clinical syndromes: the comparatively recently described heartworm-associated respiratory disease (HARD) and adult HWD. The former is much more common; very few cats with HARD develop adult HWD. In HARD, following death of immature worms, pulmonary lesions may improve over time ('self-cure'). Lesions of adult HWD also improve over time as long as reinfection does not occur; however, with death of adult heartworms, mortality is high, and the prognosis is guarded. In asthma, morbidity is relatively high, but mortality is low, with an overall good to excellent prognosis. DISEASE RECOGNITION Feline asthma is encountered worldwide. In the authors' impression, feline HWD is often under-recognized. AIMS The aim of this review is to assist clinicians in differentiating feline asthma from feline HWD; as such, the emphasis is on distinguishing clinical features, as well as on diagnostics, therapy and prognosis. In differentiating these conditions, clinicians can attempt the goal of properly managing these diseases and can best educate owners on prognosis. EVIDENCE BASE For both feline asthma and feline HWD, the authors have drawn on the available peer-reviewed literature studies involving experimental models as well as spontaneous disease.
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Affiliation(s)
- Sarah Garrity
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
| | - Tekla Lee-Fowler
- Department of Clinical Sciences, Auburn University, Auburn, AL, USA
| | - Carol Reinero
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, USA
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Lin CH, Wu HD, Lo PY, Lee JJ, Liu CH. Simultaneous visual inspection for barometric whole-body plethysmography waveforms during pulmonary function testing in client-owned cats. J Feline Med Surg 2016; 18:761-7. [PMID: 26179576 PMCID: PMC11112210 DOI: 10.1177/1098612x15592662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES For the purpose of applying a barometric whole-body plethysmography (BWBP) device as a routine clinical tool in client-owned cats, the objective of this study was to evaluate the methodological importance of simultaneous visual inspection (SVI) of graphic tracing. METHODS To investigate the effect of SVI on the results obtained, 50 client-owned cats were included. Breath-by-breath analysis was conducted with BWBP software, and a commonly used rejection setting was chosen for automatic elimination (AE) of non-breath artefactual waveforms, according to tidal volume (TV), inspiratory and expiratory time, and the difference between inspiratory and expiratory volumes. During 10 mins of data recording, SVI for BWBP waveforms was performed to record manually time periods that were free of any artefacts. The two datasets derived from AE alone (AEA method) and AE plus SVI (SVI-AE method) were compared. The inter-observer effect on the process of SVI was evaluated on six cats. RESULTS There were statistically significant differences (P <0.001) between the AEA and SVI-AE datasets for most BWBP parameters. Bland-Altman analysis of the parameter-enhanced pause (Penh) showed heterogeneous variances, indicating less agreement when the Penh values were large. Intra-individual coefficients of variation of Penh were significantly higher with the AEA method than with the SVI-AE method (61.1% vs 34.7%, respectively; P <0.001). Inter-observer agreement on the SVI process was excellent, and no statistically significant differences between the two observers were found for any BWBP parameters obtained by the SVI-AE method (P >0.05). CONCLUSIONS AND RELEVANCE Visual inspection for BWBP waveforms in real time can reliably identify stable breathing signals in client-owned cats. The obtained results were significantly different when the SVI method was used in addition to AE. In the interpretation of BWBP parameters or comparison of measurements among studies, whether an SVI methodology was applied should be considered.
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Affiliation(s)
- Chung-Hui Lin
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
- Section of Small Animal Internal Medicine, National Taiwan University Veterinary Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Section of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Ying Lo
- Section of Small Animal Internal Medicine, National Taiwan University Veterinary Hospital, Taipei, Taiwan
| | - Jih-Jong Lee
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
- Section of Small Animal Internal Medicine, National Taiwan University Veterinary Hospital, Taipei, Taiwan
- Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Hsuan Liu
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
- Section of Diagnostic Pathology, National Taiwan University Veterinary Hospital, Taipei, Taiwan
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Lin CH, Lee JJ, Liu CH. Functional assessment of expiratory flow pattern in feline lower airway disease. J Feline Med Surg 2014; 16:616-22. [PMID: 24327372 PMCID: PMC11164168 DOI: 10.1177/1098612x13515461] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Feline lower airway disease (FLAD) is a chronic respiratory disease of which there is a lack of information on functional assessment in current veterinary medicine. The purposes of this study were to investigate expiratory pattern and evaluate the diagnostic utility of functional parameters in cats with FLAD. Thirty-three client-owned cats (23 FLAD cats and 10 control cats) were studied. Under quiet tidal breathing, pseudo-tidal breathing flow-volume loop (pTBFVL) was obtained from a barometric whole body plethysmography (BWBP) device. There were significant differences in the shapes of expiratory, but not inspiratory, curves between FLAD and control cats. The incidence of the presence of concave expiratory curve indicating lower airway obstruction was 74% in FLAD cats. To assess the diagnostic utility of pTBFVL indices in cats with FLAD, area under the receiver-operator curve was 0.86 for PEF/EF50 (peak expiratory flow divided by expiratory flow at end expiratory volume plus 50% tidal volume); a cuff-off value of PEF/EF50 >1.51 distinguished normal from FLAD (73.9% sensitivity, 100% specificity). There were no significant differences in traditionally measured BWBP parameters (ie, enhanced pause) between cats with and without FLAD in the present study. In conclusion, underlying change on expiratory flow pattern during natural tidal breathing existed in FLAD cats, and selected pTBFVL indices were useful in discriminating FLAD from normal cats. Tidal breathing pattern depicted by pseudoflow-pseudovolume loops from a BWBP system could be a non-invasive tool for functional assessment in client-owned cats.
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Affiliation(s)
- Chung-Hui Lin
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taiwan Section of Small Animal Internal Medicine, National Taiwan University Veterinary Hospital, Taiwan
| | - Jih-Jong Lee
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taiwan Section of Small Animal Internal Medicine, National Taiwan University Veterinary Hospital, Taiwan Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taiwan
| | - Chen-Hsuan Liu
- Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taiwan Graduate Institute of Molecular and Comparative Pathobiology, School of Veterinary Medicine, National Taiwan University, Taiwan Section of Diagnostic Pathology, National Taiwan University Veterinary Hospital, Taiwan
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Abstract
This article provides an overview of recent advances in the diagnosis and treatment of feline asthma. The authors discuss the potential pitfalls in the diagnosis of feline asthma. In addition, current literature investigating new therapies for the treatment of feline asthma is reviewed.
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Affiliation(s)
- Julie E Trzil
- Comparative Internal Medicine Laboratory, Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, 900 East Campus Drive, Columbia, MO 65211, USA
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Allerton FJW, Leemans J, Tual C, Bernaerts F, Kirschvink N, Clercx C. Correlation of bronchoalveolar eosinophilic percentage with airway responsiveness in cats with chronic bronchial disease. J Small Anim Pract 2013; 54:258-64. [DOI: 10.1111/jsap.12070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F. J. W. Allerton
- Department for Clinical Sciences, Faculty of Veterinary Medicine; University of Liege; Liege Belgium
| | - J. Leemans
- Section of Pharmacology, Pharmacotherapy and Toxicology, Department for Functional Sciences, Faculty of Veterinary Medicine; University of Liege; Liege Belgium
| | - C. Tual
- Department for Clinical Sciences, Faculty of Veterinary Medicine; University of Liege; Liege Belgium
| | - F. Bernaerts
- Department for Clinical Sciences, Faculty of Veterinary Medicine; University of Liege; Liege Belgium
| | - N. Kirschvink
- Animal Physiology, Department of Veterinary Medicine, Faculty of Sciences; University of Namur; Namur Belgium
| | - C. Clercx
- Department for Clinical Sciences, Faculty of Veterinary Medicine; University of Liege; Liege Belgium
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A comparison of in vitro relaxant responses to ipratropium bromide, β-adrenoceptor agonists and theophylline in feline bronchial smooth muscle. Vet J 2012; 193:228-33. [DOI: 10.1016/j.tvjl.2011.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 10/18/2011] [Accepted: 10/31/2011] [Indexed: 11/21/2022]
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Leemans J, Kirschvink N, Bernaerts F, Clercx C, Snaps F, Billen F, Gustin P. Salmeterol or doxycycline do not inhibit acute bronchospasm and airway inflammation in cats with experimentally-induced asthma. Vet J 2011; 192:49-56. [PMID: 22136877 DOI: 10.1016/j.tvjl.2011.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 10/14/2011] [Accepted: 11/01/2011] [Indexed: 11/16/2022]
Abstract
The objective of this study was to determine if inhaled salmeterol, a long-acting β(2)-adrenergic agonist, and oral doxycycline, a tetracycline antibiotic displaying matrix metalloproteinase (MMP) inhibitory activity, reduce airway inflammation and obstruction in cats with experimentally-induced asthma. Eight Ascaris suum (AS)-sensitised cats were enrolled in a prospective study in which they underwent four AS-challenges at 1 month intervals. The challenged animals were given no treatment or were treated on 4 consecutive days with either: (1) oral prednisolone (1mg/kg twice daily), (2) inhaled salmeterol (50 μg twice daily), or (3) oral doxycycline (5mg/kg twice daily), according to a randomised cross-over design. Inhibition of allergen-induced early (EAR) and late (LAR) asthmatic reactions were assessed by barometric whole-body plethysmography. Cytology and measurement of MMP-2 and -9 activities were carried out on bronchoalveolar lavage fluid (BALF). Although none of the treatments prevented the EAR, prednisolone treatment inhibited the LAR. Relative to untreated cats, the eosinophil percentage and MMP-2 activity in BALF were significantly reduced following prednisolone treatment (P<0.05). Short-term therapy with either salmeterol or doxycycline had no effect on the EAR or LAR or on airway inflammation. Given the chronic nature of this disease in cats, long-term therapy may be required to produce more favourable functional and clinical outcomes.
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Affiliation(s)
- Jérôme Leemans
- Section of Pharmacology, Pharmacotherapy and Toxicology, Department for Functional Sciences B41, Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium.
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Effect of short-term oral and inhaled corticosteroids on airway inflammation and responsiveness in a feline acute asthma model. Vet J 2011; 192:41-8. [PMID: 21354836 DOI: 10.1016/j.tvjl.2011.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 01/17/2011] [Accepted: 01/24/2011] [Indexed: 12/17/2022]
Abstract
The objective of this study was to investigate whether high-dose inhaled fluticasone propionate (FP), alone or in combination with salmeterol (SAL), is as effective as oral prednisolone in reducing airway inflammation and obstruction in cats with experimentally-induced acute asthma. Six cats sensitised to Ascaris suum (AS) were enrolled in a prospective controlled therapeutic trial and underwent four aerosol challenges, at 1-month intervals with AS allergen. The allergen - stimulated animals received four consecutive days treatment with either oral prednisolone at 1mg/kg twice daily, 500 μg of FP inhaled twice daily, or a combination of FP/SAL at 500 μg/50 μg inhaled twice daily, respectively, according to a randomised cross-over design. Treatment-related changes in lung function, airway responsiveness (AR) and bronchoalveolar lavage fluid (BALF) cytology were assessed. Barometric whole-body plethysmography (BWBP) was used for the assessment of respiratory variables and AR. No significant differences in respiratory rate or Penh (an estimate of airflow limitation measured by BWBP) were detected among treatment groups. Allergen-induced airway hyper-responsiveness was significantly inhibited by all three steroid treatments (P<0.05). The mean BALF eosinophil percentage (±SEM) was lower after oral and inhaled corticosteroid treatment and these changes were significant for groups receiving prednisolone and the FP/SAL combination. Findings suggest high-dose FP, particularly in combination with SAL, is effective in ameliorating airway inflammation and hyper-responsiveness in this model of acute feline asthma, and highlight the potential use of these drugs in cats experiencing acute exacerbations of the naturally occurring disease.
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Reinero CR. Advances in the understanding of pathogenesis, and diagnostics and therapeutics for feline allergic asthma. Vet J 2010; 190:28-33. [PMID: 21036078 DOI: 10.1016/j.tvjl.2010.09.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 09/23/2010] [Accepted: 09/23/2010] [Indexed: 11/18/2022]
Abstract
Asthma is a common inflammatory disease of the lower airways and is believed to be of allergic etiology in cats. As little progress has been made in establishing rigorous criteria to differentiate it from other inflammatory lower airway diseases such as chronic bronchitis, descriptions of 'asthma' in the literature have often been inaccurate, grouping this syndrome with other feline airway diseases. With the development of more sensitive and specific diagnostics, it will become easier to distinguish asthma as a disease entity. Pulmonary function testing with bronchoprovocation/bronchodilator responsiveness trials and biomarkers hold particular promise. Discrimination is of critical importance as targeted therapies for the allergic inflammatory cascade are developed and become available for therapeutic trials in pet cats.
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Affiliation(s)
- Carol R Reinero
- Department of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA.
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