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Medications: Inhaled Conventional Other

Overview: Inhaled Medication
Inhaled medications place the drugs directly in the respiratory tissues in need of them, reducing systemic side effects.

Inhaled bronchodilators allow the caregiver to administer medication faster during a respiratory crisis.

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Inhaled Medications

This page describes asthma medications delivered by inhalation. It covers: commonly prescribed inhaled medications, Dr. Philip Padrid's protocol, proper use and maintenance of feline aerosol chambers and metered dose inhalers. See the Treatment Hints page on how to achieve successful acceptance with even the most skeptical of cats (or caregiver!). Other links above cover additional treatment options for feline asthma.

The AeroDawg® is now available. This is a step forward in the treatment of chronic bronchitis in dogs. For more information, contact the folks at AeroKat®.

Get free Adobe Reader® to read the .pdf protocol.

Kathryn Hopper wins the Muse Award. (c) 2005 James Perkins. All rights reserved.
This page was awarded the CWA Muse Medallion in the category of Online Article - Health and General Care

Permission is granted to print for veterinarian and personal purposes, and don't forget to also bring along a printout of the inhaled medications protocol (treatment guidelines). Topics covered in this page include:

  • Inhaled therapy
  • Inhaled medications in detail
  • Aerosol chamber and mask
  • Instructions for use and cleaning

Inhaled Therapy

Asthma, whether in humans or cats, is for the most part manageable but not curable. Inflammation of the lung tissue is reduced with corticosteroids, and for the acute onset of symptoms, restricted airways may be opened with a bronchodilator.

Conventional injection and oral use of these drugs send the medicine to the lungs through the bloodstream and affect tissues throughout the body (systemic). Long-term use of oral or injected steroids increase the risk of feline diabetes and significant behavioral changes in addition to polyuria, cystitis, and inappropriate urination. Excessive weight gain is common which makes the lungs work harder. Cats with these conditions may not be able to continue the most effective conventional methods of asthma treatment, and live limited lives as a result.

A Metered Dose Inhaler (MDI) coupled with an appropriate chamber for cats is the preferred delivery system. Inhaled medications have the main benefit of directing the medicine to the lung tissues. Two medications are used: a corticosteroid, typically Flovent®, to minimize the asthma's ever-present inflammation and a bronchodilator, i.e. Albuterol, to open restricted airways on an as needed basis during times of respiratory distress.

An aerosol chamber designed for a cat's face, the volume of breath, and specific medications results in the most efficient delivery of the drug to the small recesses of the lungs. Most cats quickly to learn to accept the aerosol chamber and mask. See Photos & Video and Treatment Hints (Learning How).

In an article by Tom Ewing in Cat Watch Newsletter, April 2005: Dr. Goldstein, from Cornell University's College of Veterinary Medicine says: "this technique and the device that enables it have been embraced by virtually all veterinarians at large universites and hospitals, and he trusts that inhalant therapy will soon be adopted by all smaller, local clinics in the U.S. and accepted by owners of asthmatic cats nationwide." The news has spread even further because the AeroKat™ is now used in most countries around the world.

Corticosteroid Medication Detail: fluticasone proprionate (Flovent®, Flixotide®)

The inhaled steroid, fluticasone, is a large molecule and does not pass into the bloodstream from the airways. Because of this, it does not cause the side-effects that oral steroids do. The use of inhaled medications using a chamber and spacer was developed by Dr. Philip Padrid. It is equally potent to oral prednisone 1 mg/kg bid. There have been no serious demonstrated side-effects. Many caregivers find inhaled therapy is faster and less invasive than giving oral or injectable medications. Other inhaled corticosteroids have been used with lesser success than the Flovent®. Please note that the dosage number may vary among different countries but they are equivalent - 110 mcg in the US equals 125 mcg in Canada and Europe. Ask your pharmacist or veterinarian for clarification.

The cost of Flovent® may be more per day than conventional therapies, but for moderate to severe asthmatics the improved stability of the cat's health results in far lower vet bills (not to mention less anxiety).

It is vitally important to follow veterinarian instructions when tapering doses of oral corticosteriods.

Considerations for Flovent® are:

  1. The drug takes 7-10 days (sometimes more) to reach full effect
  2. The face mask needs to properly fit to ensure the drug is being inhaled - it should fit snugly around the muzzle including the corners of the mouth. This has been solved by the availability of the AeroKat® Feline Aerosol Chamber.
  3. The caregiver needs to be aware of when the MDI canister is empty. Record keeping of puffs is essential and easily planned with a calendar.

Potential Side-effects:


    There has been concern to vets and caregivers in the possibility of thrush (Candidiasis aka candida), a form of fungus, which is common among human users of Flovent® or other steroidal MDIs. This has not been seen in the feline. The difference in feline and human anatomy is thought to be the reason why cat's oral/nasal cavities do not have the same chemistry in which to provide a medium for the Candidiasis growth.


    Some have noted that in the first few weeks of starting Flovent®, or other inhaled medications, the cat may cough after receiving the medication (puffs). This has been in a minority and seems to disappear after these initial incidents.

Contact Dermatitis/rash

    Rarely, small red or white bumps appear where the mask sits on the muzzle and can be transferred to areas where the cat licks (namely paws and hind-quarters). Cats who presented this clinically have been tested for bacterial and fungal (Microsporum canis) infections. The results were all negative. This is a benign contact dermatitis from the accumulation of the corticosteroid. The main escape route for the corticosteroid is between the mask and the muzzle. Hair may fall out in small patches in these areas, however, no itching or discomfort to the cat has been noted. There is a possibility of infection should the licked areas, without the fur protection, become open.

    To prevent or solve this occurrence, simply wash the face where the mask contacts with a dampened square of paper towel after every treatment. Using a disposable wipe in this manner prevents the possibility of continued contamination from reusing wash-cloth. Keep the AeroKat® clean, particularly the mask.

Long term side effects

    Cats have used Flovent® regularly since 2000 and there have been no reported long term side effects correlated with Flovent® (fluticasone).

Can Flovent® be used after a steroid injection?

"The inhaled steroid, fluticasone, is a large molecule that takes about a week to be fully absorbed into the respiratory mucosa, and because it is so large, does not pass easily into the vascular (blood) system. That is why it doesn't cause side effects, and that is why it takes at least a week to have its peak effect.

"The steroid injection has a variable rise and fall in the blood stream of each cat, each time. The AVERAGE length of time it will have a positive effect in your cat is around three weeks, this is very unpredictable. Most importantly, the inhaled steroid should be given throughout! It, by itself will have no side effects if given while the injected steroid is still circulating, and if you wait until the injected steroid wears off to start the inhaled meds, remember, it will then take another week to get the clinical benefit of the inhaled steroid." Padrid

Corticosteroid Medication Detail: beclomethasone dipropionate (Qvar®)

Qvar® has been used successfully with a few isolated cats; to the best of our knowledge it has not been studied for use in cats at all, unlike Flovent® which has well-documented success. Because Qvar® is also an inhaled corticosteroid, the safety and side-effects issues are similar to Flovent®. There is no protocol available for Qvar®, so your veterinarian will need to use clinical judgment. Follow the same instructions for using Qvar® in the How to Use an MDI with a Feline Aerosol Chamber further down this page in addition to product insert instructions.

Bronchodilator Medication Detail: Albuterol (Proventil®, Ventolin®, Salbutamol)

The bronchodilator albuterol acts more rapidly than the oral or injected terbutaline and is more effective than the theophylline compounds. It can be easily and quickly administered by the caregiver during signs of respiratory distress. It is typically used on an as-needed basis for asthmatic cats already on daily steroids and displaying cough or wheezing. Albuterol is regarded as a safe drug. Side effects may include temporary musculoskeletal twitchiness, elevated heart rate, excitability, insomnia, anorexia, although extremely uncommon.

Bronchodilator Medication Detail: Salmeterol xinafoate (Serevent®)

Salmeterol is a long-acting bronchodilator that takes 15-30 min. to reach effect but will last for 12 hours. It is available in Canada and parts of Europe but no longer in the USA in MDI form. This is not a rescue inhaler. Albuterol is the appropriate medication for respiratory crisis and is noted in the above paragraph. Your veterinarian will be able to advise on the best medication combination. Daily use of any bronchodilator is prescribed with caution since it can mask underlying inflammation that may need to be addressed with a change in corticosteroid prescription.

How to Use a Metered Dose Inhaler with Feline Aerosol Chamber:

  1. Remove cap from MDI.
  2. Look for foreign objects and ensure all components are intact.
  3. Insert inhaler (MDI) into back and shake for 15 seconds.*
  4. Apply mask to face of cat. If you cat experiences anxiety, speak to your veterinarian.
  5. Depress inhaler and hold mask in place for at least 5 breaths (approx. 10 seconds).
  6. Wait 5-10 seconds before repeating steps 3-5 if prescribed.
  7. Keep written record track of each puff used or note date to discard according to your prescribed dosage. Never use it for more than the guaranteed number of actuations listed on the side.

*Shaking the canister is vital in order to load the internal mechanism for effective aerosol delivery. Must be shaken before each actuation.
To obtain the AeroKat® Feline Aerosol Chamber, go to the AeroKat®  website.

Aerosol Chamber and Mask

The chamber and mask eliminates the need to coordinate MDI actuation and inhalation. It:

  • Allows MDIs to be used in cats
  • Decreases the velocity of aerosol particles
  • Facilitates the evaporation of propellant producing "respirable" particles in the 1-5 micron range
  • Decreases the local side effects such as medication taste, cough, and the cold freon effect
  • Reduces systemic drug side effects
  • Provides superior benefit to nebulized therapy at a greatly reduced cost

Thousands of cats worldwide have been using AeroKat®, a feline aerosol chamber, with great success. Dr. Philip Padrid worked in conjunction with the medical device designer to evaluate its effectiveness in clinical trials.  

To view a sampling of cats currently using Inhaled Medication Therapy for control of asthma, see the AeroKat Testimonials page.

Cleaning a Feline Aerosol Chamber and Mask

  1. Remove back piece from chamber (where the MDI fits in).
  2. Soak all parts for 15 min. in luke warm water with liquid detergent. Agitate gently, do NOT rinse.
  3. Rinse all parts in clean water.
  4. Shake out excess water. Do not rub dry.
  5. Let air dry in vertical position.
  6. Replace back piece and mask when unit is completely dry and ready for use.

Clean the Feline Aerosol Chamber as above prior to first use and then weekly or when obviously dirty.

The white film which accumulates inside a chamber is normal. It is a surfactant - a fatty acid (oleic acid) added to a MDI formula to keep the respirable particles separated and prevent them from attaching to each other, thus allowing the smaller particles to be available for the cat to breathe in.

Cleaning the Metered Dose Inhaler (MDI)

These instructions are intended for human patients who have direct mouth contact with the MDI canister. When inserted in a spacer, there is less concern for contamination. Use your and your vet's best judgment to determine the cleaning schedule. In addition, ignore any rumors about the "float test" to determine amount of medication inside, this is inaccurate and can damage the canister.

  1. The inhaler should be cleaned at least once a week.
  2. Pull the metal canister out of the plastic casing of the inhaler and remove the mouthpiece cover.
  3. Rinse the plastic casing and mouthpiece cover in warm water. A mild detergent may be added to the water. Then rinse thoroughly with clean water before drying. DO NOT PUT THE METAL CANISTER INTO WATER.
  4. Leave the casing and mouthpiece to dry in a warm place. Avoid excessive heat.
  5. Replace the canister and mouthpiece cover.
  6. After cleaning, release one puff into the air to make sure that the inhaler works. (Source: GlaxoSmithKline)

Continue Reading with Conventional Medications

© 2001-2008 Kathryn Hopper & James Perkins. All rights reserved. Permission is granted to print portions of this website for personal and veterinary reference only. Disclaimer: All material on Fritzthebrave.com is provided for educational purposes only. It is not a substitute for professional veterinary care. Consult your cat's veterinarian regarding all aspects of your cat's health. Fritzthebrave.com provides links to other organizations as a community service and is not responsible for the information, services, or products they provide.

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