Fritz did not initially begin asthma treatment
with an inhaled drug regimen. Instead, he used a treatment
program from the pages of a veterinarian's conventional diagnostic and
Conventional treatment typically features a corticosteroid
to relieve inflammation, supplemented with a bronchodilator to open
the airways. This is similar to inhaled therapy, but the drugs are
older and more familiar, and they are administered by oral, injected,
or transdermal means.
describe treatments and additional
forget the Glossary
to look up unfamiliar terms.
Oral. Prednisone (prednisolone), in 5 mg tablets,
is perhaps the most common take-home therapy. Prednisone typically is prescribed at 1 mg per kg of cat per day. Since
the drug's effectiveness wears off in several hours, large doses
are spaced out 2 or 3 times a day. Systemic corticosteroids tend
to suppress the cat's immune system, they may interfere with pancreatic
and urinary function, increase appetite, and affect blood
sugar levels. Prednisone is prescribed at as small a dose as
effective to control the inflammation. Cats whose symptoms are
managed by small doses receive as little as one-half tablet
every other day. Note that otherwise healthy cats tend to tolerate
prednisone therapy better than humans do.
Transdermal Gel. (through the skin) Prednisone
is a bitter-tasting compound, so it can be difficult to regularly
pill a cat with it.
Some caregivers have taken their cat's prescription to a compounding
pharmacy, where the drug is prepared in the form of a transdermal
gel. The caregiver will wear a surgical glove and rub a measured
amount of the drug on the cat's ear flap, where it will pass through
the skin and into the cat's bloodstream. However, "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." (Source: Padrid
4/10/03 to FAIM
Compounded Oral. BCP Pharmacy
have developed the original VetChews® in which the raw drug
is compounded into a chewable treat base form. These are available
in meat and fish flavors such as beef, tuna, liver, chicken, and
seafood. Your vet will know of other compounding pharmacies that
may offer similar products.
This not only increases the compliance of the animal
but also makes administering the medication easier for veterinarians
and pet owners. Predisone is notoriously bitter, however, and hard
to hide the flavor no matter
how well it is hidden.
Injection. Another way to get corticosteroids
into the cat is at your veterinarian's office via injection. Common
drugs treatments are a short
acting dexamethasone or long-acting formulation of depo-medrol.
The cat needs visits to the veterinarian as symptoms recur, often
at increasing intervals
as the body develops a tolerance. For
mild asthmatics, this will be once/year at the start of their active
asthma season; for others it is as often as every season, and for
some unlucky cats, every few weeks.
The same concerns about corticosteroids apply. If
the cat tolerates the treatment well, it may be an excellent treatment
decision. It's also an option for people who cannot arrange daily medication
for their cat, or for cats that refuse to tolerate frequent handling (ex:
ferals). The biggest concern is that, once the injection is given,
one is powerless to reduce the dose present in the cat's body --
the only choice is wait for it to wear off. This is one reason oral
prednisone is often preferred.
Terbutaline sulfate (aka Brethine®) and the theodur
family (Theophylline, Aminophylline) are common bronchodilators.
These drugs relax the muscles of the bronchi and bronchioles in
the lungs and allow air to penetrate deeper into tissues.
These drugs are most frequently used to supplement
a corticosteroid. Many vets feel that use of a bronchodilator without
a steroid may "mask the inflammation". To say that another
way, they provide symptomatic relief, while allowing the inflammation
present in the lungs to continue to cause damage. Used as needed,
they can provide quick and effective
Oral. These drugs come in tablet form,
typically a pill or fragment of a pill administered twice a day.
These are helpful when seeing occasional daily symptoms, or to follow
up after hospitalization.
Shots. Quick-acting formulations of these
drugs can be injected, either by the vet or (following your vet's
instruction) at home. Only a trained practitioner should attempt
intravenous or intramuscular injection, but you can be taught how
to inject it subcutaneously. For cats with rapid onset of severe
symptoms, this can be a life saver, giving precious extra minutes
to transport the cat to the emergency room.
Trandsdermal and VetChews®. Bronchodilators
may also be appropriate to compound. See details under Corticosteriods
the main treatment tool
for humans before the development of Metered Dose Inhalers (MDIs) with chambers. It
is a compressor that delivers
a wet solution of a medication
and vaporizes it into the atmopshere
for the patient to breathe.
Currently a portable unit is
being marketed to veterinarians
to sell for take-home asthma
therapy but, in our opinion,
it is not a good choice for
managing this disease.
Budesonide is the only corticosteroid
solution available for nebulizers
and ther is no experience nor
data for vets to know what
strength to prescribe the feline
patient. A nebulized steroid
solution has too large a particle
size to reach their small airways.
Albuterol sulfate may
be nebulized but, again, the
process produces a large particle
size. While these machines may
look impressive because they
produce a "smoke",
what you see cannot be used
since those visible particles
are over 100 microns, and this
is of no long-term benefit to
the cat. Minimal nebulized asthma
medication can get deeply into
the lung. The hazards to
human caregivers who are exposed
to nebulized corticosteroid
or bronchodilator has been well
documented and considered an
occupational hazard in the hospital
setting. If a nebulized solution
is not contained, completely,
in some way for the patient,
anyone close to the patient
will be exposed. Here's a link
for more reading on the hazards
exposure, (such as human respiratory
therapists), to nebulized asthma
medications. Nebulized therapy
will still have its place in
the hospital setting for other
inhaled medications but for
feline asthma, it is a costly
option with no published data
for the cat's safety.
To assist in getting pills into the cat's mouth
you might need to immobilize the cat using the firm-yet-gentle Towel
Treatment. A piller, which has a long syringe-like handle
with a flexible tip where the tablet goes, may also help, ask
your veterinarian where to obtain
them. Some people
swear by them, while others find them unwieldy. Caregiver (and kitty)
compliance is generally a problem
when it comes to giving pills
daily for the life of the cat
and feline asthma is a life
Fritz' experience has been echoed by many who have
shared their cat's medication
history on the Internet discussion
groups and in email to this
site. Initially, he was helped by prednisone, but his waxing and
waning asthma symptoms and sudden onset of severe symptoms made
identifying a effective dose impossible. He also gained three
pounds in four months of therapy.
Fritz needed injections of depo-medrol approximately
every four weeks when he would be rushed to an emergency clinic in
distress. During these visits, many costly procedures were necessary
to bring him back to stability
such as multiple corticosteroid
and bronchodilator injections
(intravenously and intramuscularly),
x-rays, oxygen, blood tests
Fritz tried Aminophylline, which was ineffective
in every form attempted, and Terbutaline, which was effective
in the vet's office (injected IM) and at home (pills and injected
sub-q) but difficult to administer
and slow acting.
For all these reasons, after researching current
new therapies (this was during
March 2001) we were eager to see if he
would get better results on an inhaled
treatment plan. He is now joined by over 10,000 cats who currently
live healthier longer lives
with inhaled medication.
See gallery for video
and photos of
inhaled medications being administered.
and Alternative Medications