Inhaled steroids in dogs: fluticasone with a spacer

Question

10-year-old Miniature Schnauzer with chronic bronchitis well controlled on oral prednisolone. Over recent months it has developed polyuria, polydipsia and weight gain, and has just been diagnosed with diabetes mellitus.

Which alternative is most appropriate to keep the bronchitis under control?

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A. Inhaled fluticasone via a spacer and face mask, overlapping it with gradual withdrawal of the prednisolone

Correct. The inhaled steroid acts in the airway with much less systemic absorption, which makes the diabetes easier to control. Its effect takes 1–2 weeks to develop, so it is overlapped with the gradual tapering of the oral steroid.

B. Stop the steroids and keep only daily inhaled salbutamol

Salbutamol is a rescue bronchodilator: it does not treat the inflammation, which is the underlying problem, and bronchoconstriction plays little part in canine bronchitis.

C. Switch to oral dexamethasone, which has no mineralocorticoid effect and so does not affect blood glucose

Hyperglycaemia is a glucocorticoid effect, not a mineralocorticoid one. Dexamethasone is more potent than prednisolone and has the same or a greater diabetogenic effect.

D. Stop the prednisolone abruptly and prescribe doxycycline for a month

Abrupt withdrawal after prolonged treatment may cause iatrogenic hypoadrenocorticism, and there is no evidence of infection to justify an antibiotic.

lightbulb Key takeaway

With inhaled steroids always use a spacer with a well-fitting mask: actuate the inhaler into the chamber and let the dog take 7–10 breaths. Get it used to the device beforehand with treats. They greatly reduce systemic effects, although they do not eliminate them completely.

Which alternative is most appropriate to keep the bronchitis under control?

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