It is quite common for cats to present to veterinary clinics with a chronic cough or wheeze. The problem may be constant or just recur from time to time, and can range from mild to severe. Clinically the disease may resemble human asthma, but the term feline asthma can be misleading as there are a number of different possible causes. Here we look at what those underlying causes can be, and the different forms of treatment available to affected cats.

Cats usually present with one or all the following signs:

1.Coughing
2.Wheezing
3.Difficulty breathing

A minority of cases will have the classic human status asthmaticus, rapid onset breathing difficulty due to severe narrowing of the bronchi. Cats tend to be middle aged or older, and Siamese cats may be more prone than other breeds.

The Pathology

Little is known about the underlying causes or exacerbating factors in feline asthma. There may be an element of genetic predisposition. While chronic inhalation of airway irritants, such as smoking, has been shown to cause bronchitis in humans, this has not been studied in detail in cats. Likewise, allergens such as pollen, housedust mites, dander, fungal spores, dust and cat litter could all be implicated theoretically.

To return to the comparison with human asthma, when trying to understand the underlying causes it is important to differentiate between asthma (constriction of the bronchi), chronic bronchitis (oversecretion of mucus with a chronic cough) and COPD (chronic obstructive pulmonary disease). Asthma is reversible bronchial constriction caused by eosinophil cells, whereas COPD is irreversible bronchial constriction involving neutrophil cells.

The Differentials

There are a large number of possible diagnoses when a cat first presents with coughing or breathing difficulty. Here are some of the more important ones:

1. Pulmonary edema. Often due to severe heart disease.
2. Infectious bronchitis. This can be due to bacteria, viruses or parasites.
3. Pleural disease. Filling of the space between the lung and the chest wall with air or an effusion.
4. Cancer. This can be a primary lung tumor or metastatic spread.
5. Potassium bromide induced respiratory disease. A side effect from an anti-epileptic drug.
6. Idiopathic pulmonary fibrosis. Responds poorly to treatment.
7. Pulmonary thromboembolus. Lodging of a clot in a respiratory blood vessel causing sudden onset breathing difficulty.
8. Pulmonary hypertension. Usually secondary to other heart or respiratory disease.

Diagnosis

1. Clinical examination

The first step in the diagnostic protocol is a thorough clinical examination by a veterinarian. This should localize the origin of the disease to the upper airways, lower airways or pleural space. If the cat is found to have pleural disease, a needle may be inserted straight away to remove either air or a sample of the effusion for both diagnosis and short term treatment of the respiratory distress.

2. Radiography

The next test performed is usually thoracic radiography. This is best performed under general anesthetic so there is lee chance for motion blur, though in acute situations this is not possible. This is where the most meaningful information can be gained.

3. Bronchoscopy

Bronchoscopy allows visualization of the larger airways, and assessment for increased mucus and inflammation.

4. Tracheal wash

This involves injecting a small amount of saline into the trachea and immediately withdrawing it, and then examining the cells and debris harvested under a microscope.

5. Bronchoalveolar lavage

This is similar to the technique described above, but the catheter is inserted all the way into a lower airway before the saline is injected and withdrawn. This is therefore a good test for lower airway disease.

6. Lung biopsy

This is an invasive procedure that carries a significant risk to the patient. It is only indicated where diffuse cancer or extensive fibrosis is suspected, or in severe disease that responds poorly to treatment.

Treatment

The aims of treatment are as follows.

1. Eliminate any suspected infectious agents. This may be a sufficiently long course of antibiotics if bacterial infection is suspected, or a wormer such as fenbendazole if lungworm is suspected.

2. Remove or avoid airway irritants. The most obvious one is ensuring the cat has no contact with cigarette smoke, and purchasing dust free cat litter.

3. Removal or avoidance of potential allergens. House dust mite allergy must be excluded by spraying the house with an acaricidal product.

4. Chronic therapy for the underlying condition. For long term treatment of cats with feline asthma, a combination of steroids and bronchodilators are a popular choice. Steroids reduce the inflammation and lower mucus production, and can limit long term consequences such as fibrosis. Bronchodilators are most useful when there is airway spasm. Traditionally, medication has been given orally via tablets, but over the last few years, metered dose inhalers such as the ones used for human asthma have come on the market.

Aerosol therapy has the advantage that the maximum concentration of drug is delivered to the target site. This means that lower overall doses can be used, and the cat is less likely to suffer the negative side effects of steroids. Various inhalers can be used in both cats and dogs, but they tend to be designed for humans. As a result, higher doses are given compared with human medicine, as humans can be instructed to breathe deeply whereas cats will breathe normally at best.

Glucocorticoid drugs (steroids) used in inhalers include Beclometasone, Fluticasone and Budesonide. Beclometasone is cheap, but is rapidly absorbed into the bloodstream when you want it to hang around in the area where it applied. Fluticasone is more expensive, but tends to stay where you want it to. Budesonide is relatively inexpensive and though it is easily absorbed into the bloodstream, it tends to be removed the first time it goes through the liver.

Bronchodilator drugs used in inhalers include Salbutamol and Salmeterol. Salbutamol is very fast acting and therefore useful in a crisis caused by spasm of the bronchi. However, it only lasts for about 30 minutes and is therefore unsuitable for chronic therapy as frequent dosing is required. Salmeterol on the other hand is longer acting, and lasts for about 12 hours so twice daily dosing is possible. Salmeterol is better for long term control of mild to moderate asthma while Salbutamol is better for relief of acute bronchospasm.

The Seretide Evohaler is useful for cats requiring both steroid and bronchodilator therapy. It contains salbutamol and fluticasone, a combination allowing minimal dosing frequency.

Spacer devices

A spacer device consists of a chamber into which the aerosol drug is released at one end, with a mask at the other end which fits snugly over the cats mouth and nose. Human baby spacer devices (e.g. Babyhaler) can be easily adapted for cats. Alternatively, veterinary spacers specifically designed for cats are now on the market (e.g. Aerokat). The spacer should be held over the cats nose and mouth for about 30 seconds to ensure complete delivery of the drugs. It should be remembered that aerosol steroid therapy can take up to 2 weeks to reach full effect, and if the cat has been on oral steroids previously, these should be phased out slowly during these initial 2 weeks.

Is treatment lifelong?

Generally yes. Doses can often be reduced gradually once clinical remission has been achieved. As with many chronic conditions, complete control might not always be possible and an acceptable quality of life is the main aim of the treatment.

Others are erroneous products of past studies and may seem credible. But in any case, here are the five most common myths about Chlorine in swimming pools and the truth behind them.

Myth #1: Chlorine in pool water has stronger scent the more concentrated it is. Therefore, the water is cleaner.

Truth: Its actually quite the opposite, since the scent is produced by Chlorine bonding with Nitrogen in the water to form chloramines. This is caused by contaminants such as sweat or even urine. In fact, one vital factor in determining the cleanliness of a swimming pool is the absence of chemical scents.

Myth #2: Swimmers Ear is caused by too much Chlorine.
Truth: Swimmers Ear is not caused by irritation due to Chlorine. Its actually caused by a bacterial infection commonly found in unsanitary swimming pools and its primary symptoms include skin rashes, earache and stomach pains.

Myth #3: Chlorine will turn Blonde hair green.
Truth: Yes, getting a dip in a pool for blondes can make their hair green, but not because of Chlorine, since this is commonly caused by high Alkaline content present in most brands of shampoo, coupled with copper and other metal residues present in the pool water. This metal presence is mainly caused by either plumbing or algaecides (they are often copper or silver-based).

Myth #4: Chlorine causes eye irritation.
Truth: As stated beforehand, nitrogenous substances such as urine and sweat combined with Chlorine produce chloramines. Chloramines are substances that could also act as sanitizers, but theyre not as efficient as free chlorine due to the fact that they dont have oxidizing capabilities. Free chlorine has a high level of oxidizing ability which is necessary to kill off bacteria and other microorganisms. Chloramines, on the other hand, cause the eye irritation among swimmers due to the fact that they are not managed properly, unlike the standard free Chlorine.

Myth #5: Chlorine causes Asthma and other Respiratory Diseases.
Truth: Occupational Asthma among professional swimmers isnt caused by free Chlorine. Again, Chloramines found in the water and air (most of the time nitrogen trichloride) induces these respiratory diseases, especially for indoor chlorinated swimming pools. Even people who dont enter the water may develop asthma because of these chloramines.

With all these debunked myths, the main point to consider is this: theres a lot of confusion between Chlorine and Chloramines. To put it in the simplest form possible, Chlorine helps kill bacteria (or oxidize them, so to speak) in pool water. Theyre the most efficient way of keeping the pool sanitized and safe. Chloramines, on the other hand, are unwanted products of Chlorines interaction with organic substances or contaminants, such as sweat and urine. They are detrimental to respiratory health and could be a common indication of an unsanitary swimming pool. In short, knowing the different between these two substances is the key in determining the cleanliness of a swimming pool.

How aromatherapy works.
There are two ways in which is essential oils can be absorbed into the bloodstream.

1) Through the skin
Essential oils are absorbed into the body through the skin, by means of diffusion. As the skin is semi-permeable, the essential oils can be absorbed through the sweat pores and the hair follicle. Being fat soluble, the oil dissolves in sebum, produced by the sebaceous glands and passes into the dermis through the capillary network. They are then carried by the blood and lymphatic system throughout the body. This action is enhanced by massage.
Along with having positive effects on all internal systems, essential oils have amazing qualities to address many external conditions, such as skin imbalances. The therapeutic values of essential oils vary greatly from one oil to the next, while at the same time many share qualities. This is why essential oils are used widely in skincare products. These precious oils are often used to treat rosacea, acne, eczema and psoriasis. A skin condition by definition doesnt need to be present to appreciate the exquisite value of essential oils. They are also valuable additions to skincare products for those with oily skin, sensitive skin, dry skin, mature skin and even normal skin. Essential oils are now commonly found in good skincare products, including cleansers and facial washes, toners, moisturisers and masks.

2) Through Respiration.
Being Volatile, the Essential Oils quickly and easily become gaseous in nature. These molecules are inhaled and pass through the respiratory system until reaching the alveoli. This is where gaseous exchange takes place. The alveoli are surrounded by a network of capillaries and a membrane of simple epithelial cells. The inhaled essential oil molecules diffuse through this membrane and are transported in tissue fluids. The essential oil molecules can also dissolve in mucous in the inner nasal cavity or be transported to the olfactory nerves by electrochemical message.

Essential oils have three distinct modes of action:
Pharmacological action- the reaction with hormones and enzymes.
Physiological effect – the physical effect on all systems of the body, including its largest organ, the skin.
Psychological effect – how it affects the mind, i.e. sense of well-being, calms the mind.

Purity of Essential Oils
The most common method used to check the purity of essential oils is gas liquid chromatography (GLC). Chromatography is a method of separating substances in a mixture, showing its chemical make-up. A small quantity of essential oil is injected and to a fine, coiled, tubular column and is filled with an absorbent material. The coil has gas flowing through it and is fitted within a temperature- controlled oven. The heat causes the lighter components to be carried along the column more quickly. The time it takes for each component to pass along the column is called retention time. The reading for each batch is compared with an original copy and any variances may indicate that the essential oil has been adulterated. Each essential oil is then given a certificate stating its authenticity and batch number confirming its purity.

Bishops weed is known to be the erect and small shrub comprising with soft fine hairs. The fruit of this particular herb is egg-shaped, greyish and minute in nature. In India this herb is known by the name of ajwain which is derived from the word adarjawan.

The seeds of the herb are used to prepare several valuable carminative and unani medicines. It has numerous healing or curative properties for health ailments such as the seeds of ajwain acts as a stimulant to counteract the affect of spasmodic disorders.

Gastro-intestinal disorders: It acts as an effective medicine for curing various gastro-intestinal disorders such as dysentery, diarrohea, dyspepsia, colic, cholera, indigestion and flatulence. It is advised that 1tsp of ajwain should be taken with rock salt to cure the problem of indigestion.

Respiratory Disorders: For curing respiratory disorders it is advised that the seeds of ajwain should be consumed with buttermilk to cure phlegm. For curing cough caused by influenza it is advised that ajwain seeds should be consumed with clove and salt to have beneficial results.

Common cold: For curing common cold it is advised that 1 tbsp of ajwain crushed seeds should be tied in the cloth and used for inhalation to have the beneficial results.

Migraine: To cure the migraine it is advised the ajwain seeds should be sniffed or smoked to have beneficial results.

Rheumatism: To cure the rheumatic or neuralgic pain it is advised that the oil extracted from the ajwain seeds should be applied thrice a day over the affected area.

Mouth Disorders: To cure various mouth disorders it is advised that the decoction of the seeds prepared with salt should be used for gargle daily to have beneficial results.

Earache: Ajwain proves to be an effective remedy for earache. It is advised that the ear drops prepared by boiling the seeds in 40 ml of milk till gets thicken and later filtered should be administered three times a day. For curing the pain caused in the ear by boils it is advised that 4gms of ajwain seeds should be boiled with 2 garlic cloves in sesame oil till it becomes hot. Later this oil is filtered and used as ear drops twice a day to have beneficial results.

Aphrodisiac: To cure aphrodisiac problem it is advised that the powder prepared by frying ajwain seeds with tamarind kernel seeds in pure ghee should be consumed in the ratio of 1 tsp daily with honey and milk at nighttime to have beneficial results.

Classifying an upper respiratory infection as bronchitis is imprecise. However, studies of bronchitis and upper respiratory infections often use the same symptoms. Cough is the most commonly observed symptom of acute bronchitis. The cough begins within two days of infection in 85 percent of patients. Most patients have a cough for less than two weeks however, 26 percent are still coughing after two weeks, and a few cough for six to eight weeks. When a patient’s cough fits this general pattern, acute bronchitis should be strongly suspected.

Although most physicians consider cough to be necessary to the diagnosis of acute bronchitis, they vary in additional requirements. Other signs and symptoms may include sputum production, dyspnea, wheezing, chest pain, fever, hoarseness, malaise, rhonchi, and rales. Each of these may be present in varying degrees or may be absent altogether. Sputum may be clear, white, yellow, green, or even tinged with blood. Peroxidase released by the leukocytes in sputum causes the color changes; hence, color alone should not be considered indicative of bacterial infection.

Because acute bronchitis is most often caused by a viral infection, usually only symptomatic treatment is required. Treatment can focus on preventing or controlling the cough (antitussive therapy) or on making the cough more effective.

Protrusive therapy is indicated when coughing should be encouraged (e.g., to clear the airways of mucus). Antitussive therapy is indicated if cough is creating significant discomfort and if suppressing the body’s protective mechanism for airway clearance would not delay healing.