My sons cat - little guy

Question
Jessica, you were kind enough to help me with questions I had recently re two Siamese cats which I recently adopted who were termed "special needs". Your advice was very valuable to me and I am hoping that you can answer a few questions in re to Little Guy, my son's cat.

He is a five year old tabby and recently (last month) started to have breathing problems,suddenly he will have a hard time breathing and his back legs will not be steady. My son took him to the vet and he was diagnosed with asthma and put on a bronchial dilator. Two weeks later he had a second attack, was taken back to the vet, and he was put in a machine to help him breath and given a steroid injection. After that, I impressed upon my son, how important it was to go through his house and throughly remove all traces of dust from the rugs and heating vents. He recently moved into a house (last December)and in March, Little Guy started with the asthma problem. Well, I took Little Guy for a week while my son did as much as he could do to remove all dust. When the week was over, on Easter Sunday night,when we were getting ready to bring him back to my son's house, he started with the same breathing problems at my house even though he is taking one pill a day, the dilator. My son's vet has emergency services at night (which are becoming very expensive for my son,(he is a teacher and living on a very limited budget) Well they put the cat on steroids as well as a bronchial dilator. My question is why did he have the attack at my house? Could there be something else wrong with the cat and the symptoms resemble those of an asthma attack? Should we get a second opinion? Although Little Guy is doing better what will happen when he is weaned off the dilator pills and the steroids? Have you had any experience with a feline who developed asthma?

I thank you for your anticipated answer to my questions.

Susan

Answer
Hi, Susan.  I'm glad you found my past advice helpful.  Please feel free to contact me via email, too, if you wish, at redkittycat@hotmail.com.

To keep myself organized (that can be hard sometimes!), I'll paste your questions and answer them below.

Q. My question is why did he have the attack at my house?

A. Asthma in cats is very often related to stress.  Perhaps the stay at your house overwhelmed him.  If you were packing up his stuff to go and getting out his carrier, etc., at the time the asthma attack occurred, he probably was upset by all the commotion and anticipation of the trip.

Additionally, asthma can be brought on by allergies, as you know.  Dust is a big culprit, but surprisingly, human hair and dander can be as allergenic to cats as cat hair can be to humans!  Cats can also be allergic to smoke and just about anything in their environment.  It may have been a coincidence.

Usually, asthma is a chronic condition that can be managed to an extent, but you will never have an asthma-free cat.  Attacks are something that will occur from time to time, for no rhyme or reason, and they have to be treated as needed.

If you're not comfortable with the treatment that's been prescribed, discuss this with the vet.  There is a variety of drugs that can be tried.  The vet shouldn't limit you to just a few.  Perhaps an antihistamine should also be added to combat the allergies that may be triggering his asthma.  And there are now inhalers for cats to treat asthma attacks at home.

Here's a page I had bookmarked for myself for referrence.  I think it will be of some help to you:

http://plaza.ufl.edu/johnsonn/catasthmameds2.htm

Q. Could there be something else wrong with the cat and the symptoms resemble those of an asthma attack?

A. Yes.  Cardiomyopathy, stroke, and congestive heart failure are, unfortunately, rather common in cats.  They cause difficulty breathing, just as they do in people.  I have experience with all three and can tell you that our vets, at first, confused them with respiratory infections.

Another thing that I have experience with is a growth in the lungs or trachea.  Several of my cats have had tumors surrounding the trachea or in the thymus, the wall between the lungs.  These caused periodic breathing problems induced by stress, exertion, or eating.  The symptoms mimicked cardiomyopathy, asthma, and pneumonia so closely, that cancer was only diagnosed in ONE before it was too late.  

The fact that you say his back legs were weak makes me give a second thought to stroke.  It's one of the biggest symptoms.  Of course, any lack of oxygen, including that with asthma attacks, causes weakness, so you shouldn't get worried over it just yet.  But if you continue treatment and it doesn't work adequately, it might be something to consider.

I think the method of diagnosis is very important.  There's room for error when the vet just makes a diagnosis based on physical symptoms or the owner's account of the episode.  Cardiomyopathy, asthma, pneumonia, stroke, and tumors surrounding the lungs may all respond to oxygen, dilators, and steroids, since these treat symptomatically.  They don't address the underlying cause (with the exception of steroids, which are used to prevent inflammation of the tissues with asthma and to inhibit tumor growth in cancer).

Please forgive me if your vet has already run the following diagnostics:

Generally, the best test for asthma is an x-ray of the lungs.  It will detect inflammation of the brochioles.  Typically, the lung area of a cat should be completely black on an x-ray (except for the ribs that will show).  If the vet finds a lacy appearance, or small white spots, he'll know that the bronchioles are inflammed and that there may be mucus present, causing the breathing area to be constricted.

Blood work should be done, too.  A simple complete blood count (CBC) isn't too expensive.  Most times, cats with asthma will have a high white blood cell count (neutrophils and eosinophils, especially).

A bronchial wash (called a Broncho-Alveolar Lavage or BAL) can be taken.  The bronchioles are flushed with saline to wash out some cells for examination.  It can definitively diagnose asthma, but this requires anesthesia.  

Q: Should we get a second opinion?

A: I personally would give the vet one more shot to adjust medications or perform further testing unless you feel he has truly been negligent.  Asthma can be a bit frustrating to treat at first.  Some finagling with medications may be needed.  But the vet should be aggressive about treatment.  When one doesn't work, he needs to try another.

I DO, however, disagree strongly with his not prescribing regular steroids.  I'm not a vet, but I do know that steroids are considered THE treatment for asthma in cats.  If nothing else, he should be on a steroid (usually prednisolone) to PREVENT inflammation, not just treat it.  Dilators, antihistamines, and inhalers are all considered supplemental treatments.  If the vet is intending to wean the cat off of the steroid, I'd seek a second opinion.  The only time I may agree with not using steroid treatment is if a.) the cat was immune supressed, since steroids pose a small risk of trouble healing, or b.) the asthma was found to be accute (due to some exceptional circumstance), not chronic.

Q: Although Little Guy is doing better what will happen when he is weaned off the dilator pills and the steroids?

A: As I mentioned above, I don't think that should ever happen, and I hope your vet agrees.  If he is weaned off, the asthma is likely to rear up again.  Asthmatic cats usually need to be on treatment for life.

Q: Have you had any experience with a feline who developed asthma?

A: I haven't had experience with a cat who had chronic asthma.  I've had one with accute asthma, who had stress-induced attacks.  While emergency treatments are the same (inhalers and injectible dilators), cats with accute asthma don't necessarily need daily treatment like cats with chronic asthma.  He would be given medications prior to stressful events, like vet visits, if we were anticipating them.

I hope things get straightened out!  I've had too many middle of the night emergency visits myself.  They're terrifying and, yes, quite expensive.  Keep your fingers crossed, though. Asthma is considered a treatable condition, and I think you should gain control over it with the right treatment.

Jessica :)