Feline asthma not responding to treatment: what to check

Question

5-year-old domestic shorthair queen with access to a terrace, diagnosed with asthma on clinical signs and radiographs, without bronchoalveolar lavage or parasite testing. After a month on inhaled fluticasone she is still coughing several times a week and has had two crises. The owner reports that the cat resists the mask and pulls away quickly.

What is the most appropriate approach?

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A. Review inhaler technique and compliance, environmental triggers and reconsider the diagnosis (lungworms, heartworm disease) before intensifying treatment

Correct. If the cat does not take several breaths with the mask fitted, she receives hardly any drug. In addition, Aelurostrongylus and feline heartworm disease (HARD) mimic asthma and were not ruled out; steroids do not resolve them.

B. Stop the fluticasone: if she has not responded in a month, the cat is not asthmatic

Lack of response may be due to poor administration or persistent triggers. Withdrawing the steroid without an alternative diagnosis leaves the inflammation untreated.

C. Add a broad-spectrum antibiotic, because unresponsive asthma is usually due to bacterial infection

Secondary bacterial infection is uncommon in feline asthma. Without a lavage culture demonstrating it, antibiotics are not indicated.

D. Double the oral prednisolone dose indefinitely without further investigation

Increasing the steroid without reviewing the diagnosis or technique exposes the cat to adverse effects (diabetes, heart failure in predisposed cats) and may worsen a parasitic infection.

lightbulb Key takeaway

With «refractory» feline asthma, review four points: is the drug being given properly? Are there triggers (dusty litter, smoke, aerosols)? Were lungworms and heartworm ruled out? Is there another disease (heart disease, neoplasia)? To get the cat used to the spacer, use treats and short sessions.

What is the most appropriate approach?

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