Felis ISSN 2398-2950

Respiratory: disease - clinical investigation

Contributor(s): Brendan Corcoran, Yolanda Martinez Pereira

Introduction

  • Patients with respiratory disease can present with a variety of clinical complaints such as coughing (most common), sneezing Sneezing, other upper airway noises often referred to as reverse sneezing, nasal/ocular discharge Rhinitis, decreased exercise tolerance, abnormal respiratory noise (stridor and stertor), abnormal breathing pattern, breathlessness, increased panting, collapse, acute respiratory distress Acute Respiratory Distress Syndrome (ARDS), dyspnea, cyanosis.
  • Coughing is the most common complaint and can be classified as acute or chronic:
  • Dyspnea is also a common complaint and can be further classified as inspiratory or expiratory:
    • Inspiratory dyspnea indicates a problem of the upper airways: nasal disease, brachycephalic obstructive upper airway syndrome (BUAOS), nasopharyngeal polyps Nasopharyngeal polyp, tracheal collapse, foreign body, neoplasia (rare).
    • Expiratory obstructive dyspnea indicates a problem of the lower airways that leads to obstruction of the normal airflow: lower airway foreign body, neoplasia, feline asthma (bronchoconstriction), bronchitis, extraluminal airway compression (such as neoplasia or fibrosis).
    • Expiratory restrictive dyspnea (shallow, short breathing) indicates a problem of the lower airways that leads to abnormal ventilation and/or perfusion: pleural effusion Pleural effusion, pneumothorax Pneumothorax, diaphragmatic hernia Diaphragm: hernia, pulmonary edema Lung: pulmonary edema, pneumonia, interstitial pulmonary fibrosis, neoplasia, pulmonary hemorrhage/contusion Lung: pulmonary hemorrhage. Includes abdominal conditions that exert pressure over the diaphragm, such as abdominal effusion Peritoneal: effusion, organomegaly Abdominal organomegaly, pregnancy, etc.
  • Abnormal respiratory noises can help in identification of the abnormal anatomical area:
    • Inspiratory stertor usually indicates a nasal problem.
    • Inspiratory stridor is usually associated with problems in the larynx (eg laryngeal paralysis).
    • Reverse sneezing is usually associated with problems in the nasopharynx (eg foreign body).
  • Nasal discharge can be bilateral or unilateral, and the discharge can be serous, hemorrhagic, mucoid, purulent:
    • Unilateral nasal discharge can be associated with foreign body, neoplasia, nasal aspergillosis Aspergillosis.
    • Bilateral nasal discharge is more likely associated with lymphocytic-plasmacytic rhinitis (LPR), aspergillosis, neoplasia Nasal cavity: neoplasia.
  • Cyanosis is characterized by a bluish color on the mucous membranes and is due to a low percentage of saturation of hemoglobin with oxygen (which is an increased amount of the reduced form of hemoglobin) or to the presence of metahemoglobin. In anemic patients, cyanosis may not appear obvious due to the decrease amount of hemoglobin in blood. Cyanosis can be central or peripheral and may be intermittent or persistent. A patient with cyanosis represents a true respiratory emergency.
  • Some respiratory diseases have been described more commonly in some breeds, such as:
  • BUAOS affects brachycephalic breeds (eg Persian cats Persian longhair).
    Follow the diagnostic trees for Dyspnea Dyspnea, Panting Panting, Respiratory distress Respiratory distress, and Abnormal Respiratory Sounds Abnormal respiratory sounds.

History taking

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Physical examination

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Diagnostic tests

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Further Reading

Publications

Refereed papers

Other sources of information

  • Ettinger & Feldman (2010) Textbook of Veterinary Internal Medicine. Elsevier Saunders, 7th edn.
  • Fuentes V L, Johnson L R, Dennis S (2010) BSAVA manual of canine and feline cardiorespiratory medicine. BSAVA.
  • Johnson L R (2010) Clinical canine and feline respiratory medicine. Wiley-Blackwell.
  • Bonagura, Twedt (2009) Kirk's Current Veterinary Therapy XIV. Saunders.
  • Martin M, B Corcoran B (2006) Notes on cardiorespiratory diseases of the dog and cat. Blackwell Publishing.
  • King L G (2004) Textbook of respiratory disease in dogs and cats. Saunders.
  • King A S (1999) The Cardiorespiratory system. Integration of normal and pathological structure and function. Blackwell Science.


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