Drugs used to treat patients with diseases of the respiratory tract include antibiotics, anti-fungals, anti-inflammatories, bronchodilators, antihistamines, anesthetics and decongestants. Drugs from all of these categories will be discussed during the course of this lecture.

Inhaled bronchodilators and corticosteroids (anti-inflammatories) are available by inhalation to treat dogs and cats with respiratory diseases including rhinitis, laryngitis, bronchitis and allergic lung disease. Both classes of drugs are available as metered dose inhalers (MDI's).

Fluticasone Proprionate (FLOVENT)

The inhaled steroid I use is fluticasone. It comes in three doses (44, 110 and 220 mcg per actuation). I use the 110 dose. This drug has virtually no side effects! Reported problems in people included growth retardation and oral candidiasis, but this has not occurred to my knowledge in more than 100 cats or dogs treated with flovent over the past 4 years. It has the clinical effect of oral prednisone 1mg/kg bid

There are a few potential problems/limitations. First, the drug takes about 7-10 days to reach full effect. Second, the owner may not be aware when the canister is empty.

How to Use

1.  Rx the 110 mcg dose as one puffs into spacer BID.

2.  The dog or cat should breath through mask and spacer for 7-10 second.

3.  If the animal is currently symptomatic and can tolerate short-term prednisone begin 1mg/kg bid oral pred for 5 days concurrent with flovent, then D/C the pred.

4.  Demonstrate how to use the mask/spacer/drug in front of the owner, with their pet.

5.  Have them demonstrate the same technique to you, in the office, with their pet, by themselves. This is a one-person job.

Albuterol (Proventil or Ventolin)

The bronchodilator I use is albuterol. It only comes in one dose. I usually prescribe this drug as needed for cats with intermittent signs of asthma (not daily signs). Potential side effects include musculoskeletal twitchiness, excitability, insomnia, and anorexia.

How to Use

1.  Rx the drug as the generic (albuterol MDI)--two puffs into spacer BID.

2.  Cat should breathe the drug through the mask and spacer for 7-10 seconds.

3.  Positive clinical effect should be seen within 5-10 minutes.

4.  Can be used every ½ hr for 2-4 hrs as needed in crisis.

SUMMARY

Inhaled steroids and bronchodilators are the standard of care to treat humans with asthma. Over the past 4 years we have treated more than 100 steroid-dependent cats and dogs with twice-daily Flovent, and Proventil on an as needed basis. Approximately 80% of these patients no longer use oral prednisone. The methods described above are effective, practical and very safe, and avoid the complications associated with chronic oral steroid use.