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.

  Treatment Path

  Dosing Guidelines

  Types of Inhalers

  Where to Buy

  How to Use Inhalers

 

cat using AeroKat

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

inhaled versus systemic cat

 

Side Effects of Systemic Steroids

“The goal of oral steroid treatment is to find the lowest dose possible and use it for the shortest period of time.”
Icon of syringe and 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

Medications for Step 1 Stop a Respiratory Attack


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

Medications for Step 2 Gain Airway Control


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

Medications for Step 3 Transition to Inhaled Steroids


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

Medications for Step 4 Daily Management


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.

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FOR EMERGENCIES

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

Where to buy

Illustration of a vet holding a cat

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.

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FOR LONG-TERM MANAGEMENT

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

Where to buy

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

 

Where to buy

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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

Owner rated ease of use

Survey of Pet Owners who have used both oral and inhaled therapies. TMI data on file

Woman using AeroDawg* chamber with her pet.

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

Easy to Give ISFM

How to use and train:

Cat transparent          dog transparent          horse transparent

Counseling Tools and Videos

cat paw prints

Exclusive Flow-Vu* indicatorAeroKat* chamber

icon: paw printSpecifically designed for animals
Icon: Lung with medicationMakes every puffy count
Icon: maple leafMade 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

Graph: comparison of drug delivery and cost by chamber

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.

 

$120

Australia

Inhousepharmacy.vu

$120

Discount Code (Save $10)
Canadian Pharmacy World

vet10
** The links to online pharmacies are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or support of the drug product or content of those sites. Drug prices are monthly costs for 120ug(125ug) Flovent† HFA. Get 10.00 off for any purchase of inhaler product, onetime use only at canadianpharmacyworld.com (see their site for full details) ALWAYS consult and follow the instructions of your veterinarian before giving your animal any medication! Only use inhalers as prescribed by your veterinarian.

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Trudell Animal Health chambers are also available through major veterinary wholesalers.

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