Asthma and Bronchitis are chronic conditions that require a lifetime of management
For daily management, a daily solution is needed. While systemic steroids may have an important role in veterinary care, their use should be limited where alternative long-term treatment options exist that are safer for the animal.
Thankfully, inhaled steroids, in the form of metered dose inhalers, are available to treat respiratory diseases in cats, dogs, and horses. They are effective and don’t cause the same adverse side effects, giving you and your clients an alternative and safer option to systemic medications that are often surprisingly easier to use.
See below to learn more about asthma and bronchitis treatment algorithms and dosing guidelines.
Why Prescribe Inhaled Therapy?
- Inhaled medications target the lower airways directly Schulman RL, et al. Investigation of pulmonary deposition of a nebulized radiopharmaceutical agent in awake cats. Am J Vet Res. 2004;65(6):806‐809
- 25x lower concentrations of steroid for same therapeutic effect
- Don’t need to be metabolized – less systemic side effects
- Easier to administer – bonding moments can make it a positive experience
- Safe for long term disease control
Side Effects of Systemic Steroids
- Lethargy/fatigue (no energy to play)
- Change in behavior (such as aggression)
- Suppressed immune system function
- Increased risk of bacterial, fungal, and urinary infections
- Diabetes
- Weight gain / obesity
- Vomiting, diarrhea
- Loss of bladder control
- Poor wound healing
- Cushing’s disease
- Hair loss and skin or coat changes
- Increased blood pressure
- Stomach Ulcers
These side effects may reduce the animal's quality of life and the family relationship.
Pet's who are lethargic or have a change in behavior may be unable or unwilling to play and may no longer seem like the pet owners once knew.
Treatment Path and Dosing Guidelines for Feline Asthma and Canine BronchitisManaging Feline Asthma & Canine Bronchitis. Clinicians Brief. July 2020
1
Stop a
Respiratory Attack
Ensure patient can breathe
- Immediately dilate airways to provide respiratory relief
- Provide injectable steroid and either inhaled or injectable Bronchodilator
- Administer injectable medications in clinic
- Inhaled bronchodilator (i.e. albuterol / salbutamol) may be administered in clinic or at home by owner. Owners unable to regain control at home should bring their pet to the clinic for veterinary care
Medications
Dosing Guideline
Dexamethasone
0.1-0.5 mg/kg IM or IV
Terbutaline
0.01 mg/kg IM or SC in clinic
Albuterol/Salbutamol (SABA LINK)
1-2 puffs every 30 minutes for ≤4-5 hours
2
Reduce Ongoing
Airway Inflammation
Clear the airways
- Provide 10-day, short-term course of systemic steroids
- Review environmental factors and make modifications to reduce potential triggers
- Ensure pet owners understand corticosteroids are considered a mainstay of treatment and may be administered orally or via injection or inhalation; inhaled forms help limit systemic absorption (see Adverse Effects of Systemic Steroids)
- Owners already providing inhaled steroids to their pet and who treated exacerbation with albuterol can continue with inhaled steroid therapy; those currently using other forms may consider transitioning to inhaled corticosteroids
Medications
Dosing Guideline
Cats:
Prednisolone
1-2 mg/kg every 24 hours)
Dogs:
Prednisone
0.5-1 mg/kg every 24 hours
3
Transition
to Inhalers
Wean off of systemic steroids
- Taper systemic steroids and introduce inhaled steroids
- Overlap systemic and inhaled therapy for 2 weeks
- Inhaled steroids may require 2 weeks to take effect
Medications
Dosing Guidelines
Fluticasone
Cats and dogs ≤ 20 kg (44.1 lb)
1 puff (110 μg) every 12 hours
--> Cats with more serious disease may require 220 μg every 12 hours
Dogs > 20 kg (44.1 lb)
1 puff (220 μg) every 12 hours
Fluticasone + salmeterol
Cats and dogs ≤ 20 kg (44.1 lb)
1 puff (115 μg/21 μg) every 12 hours
Dogs >20 kg (44.1 lb)
1 puff (230 μg/21 μg) every 12 hours
4
Maintain Asthma &
Bronchitis Control
Daily Management
- Use maintenance therapy to control inflammation and prevent exacerbation
- Continue daily therapy for management of clinical signs
- Cat owners can administer inhaled bronchodilators during flare-ups secondary to exposure to triggers
- Albuterol is a rescue medication and should not be used as monotherapy
- Dogs have not been shown to experience bronchoconstriction
- Little evidence exists for effectiveness of albuterol therapy to manage canine bronchitis
Medications
Dosing Guidelines
Fluticasone
Cats and dogs ≤ 20 kg (44.1 lb)
1 puff (110 μg) every 12 hours
--> Cats with more serious disease may require 220 μg every 12 hours
Dogs > 20 kg (44.1 lb)
1 puff (220 μg) every 12 hours
Fluticasone + salmeterol
Cats and dogs ≤ 20 kg (44.1 lb)
1 puff (115 μg/21 μg) every 12 hours
Dogs >20 kg (44.1 lb)
1 puff (230 μg/21 μg) every 12 hours
Albuterol or salbutamol(SABA)
1 to 2 puffs as needed
Feline Asthma & Canine Bronchitis
Treatment Algorithm
Peer reviewed treatment algorithm for easy dosing reference.
Types of Inhaled Medication
There are two main types of medication that are prescribed if an animal has been diagnosed with asthma: corticosteroids and/or bronchodilators. These are the same medications used to treat asthma in humans, but require different doses and administration in cats, dogs, and horses.
Short Acting Bronchodilators (SABA)
Bronchodilators are medications used to expand the airways. Short acting bronchodilators are commonly referred to as rescue medications because they act quickly and may be administered during an asthma attack.
- Opens airways by relaxing smooth muscles to reduce bronchoconstriction
- May be used symptomatically to help with coughing flare-ups
- Effects usually only last 4-6 hours
- Does not treat underlying inflammation; inhaled corticosteroids are the mainstay for long-term management and control
Drug Names
Generic Names:
- Albuterol
- Salbutamol
Brand Names:
- Ventolin†
- ProAir†
- Proventil†
Empower your owners!
Inhaled short acting bronchodilators can be used by owners at home to symptomatically manage flare-ups, limiting need for after-hours clinic visits.
Inhaled Corticosteroids (ICS)
Corticosteroids (or glucocorticoids) are anti-inflammatory medications used to treat and manage the underlying causes of asthma and bronchitis.
- Reduces airway inflammation and mucus production
- Used for ongoing management of condition even in the absence of symptoms
Drug Names
Generic Names:
- Fluticasone
- Mometasone
- Budesonide
- Ciclesonide
- Beclomethasone
Brand Names:
- Flovent†
- Flixotide†
- Alvesco†
- Asmanex†
Combination Inhalers (ICS + LABA)
Often a combination of an inhaled corticosteroid (ICS) and a special long-acting bronchodilator (LABA) formulation. LABAs can be slower to take affect, but act over a longer period of time (up to 12 hours).
- Reduces inflammation and relaxes smooth airway muscle
- Indicated for disease management, not rescue
- May be used as step-up therapy
Drug Names
ICS + LABA Combination 1
Generic Names:
- Fluticasone (ICS) + Salmeterol (LABA)
Brand Names:
- Advair†
- Seretide†
- Sirdupla†
- Sereflow†
- Fluticasone Cipla†
ICS + LABA Combination 2
Generic Names:
- Budesonide (ICS) + Formoterol (LABA)
Brand Names:
- Symbicort†
ICS + LABA Combination 3
Generic Names:
- Mometasone (ICS) + Formoterol (LABA)
Brand Names:
- Dulera†
How Trudell Animal Health Chambers help
Our chambers enable the use of inhalers by capturing and holding the metered dose inhaler medication so the patient can breathe it in. Designed specifically for animals by the makers of the leading AeroChamber* brand of spacers for humans, our chambers have special masks, valves, and performance characteristics that help ensure animals get the right dose, while feedback features like the Flow-Vu* inhalation indicator make using the device with any inhaler easy.
Easier for Owners to Administer
Owner Rated Ease of Use
Survey of Pet Owners who have used both oral and inhaled therapies. TMI data on file
Our Chambers help deliver inhaled medications directly to the lungs.
- Vet tested and animal approved
- Provides owners feedback on correct use
- Holds medication longer for better availability
How to use and train:
Specifically designed for animals
Makes every puffy count
Made in Canada(with Canadian and USA parts)
Make Every Puff Count
Our chambers offer greater drug availability for a longer time. Rozanski et al. Impact of Spacer Design on Respiratory Drug Delivery and Potential Cost Implications. ACVIM. 2020 This helps your patients get the right dose while reducing medication waste and helping clients save on their annual respiratory medication costs.
More time means better performance:
- Enables you to puff the inhaler before applying the mask
- Ensures enough time for the 7-10 breaths needed to empty the chamber
- Ensures animals who hold their breath will still get medication
Where to Buy Medications
Metered dose inhalers are available through some veterinary wholesalers for direct purchase. They can also be prescribed out to local or online pharmacies.
USA
Australia
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Canadian Pharmacy World
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Trudell Animal Health chambers are also available through major veterinary wholesalers.
