Cat Asthma: An Interview with Sarah Brandon, DVM

Dr. Sarah Brandon is a practicing Veterinarian and CEO of Canna Companion, where she oversees the research, development, and manufacturing of hemp pet supplements.Dr. Brandon also maintains a small feline only mobile practice in Washington state, focusing on a balanced, holistic approach for her patients which includes nutrition & herbal and essential oil supplementation.It is her belief that the best healthcare plans incorporate the specific needs of the household, rather than only the patient. During the past two decades, researching herbal therapies in clinical practice became her passion, and the experience and data gained was used to launch a line of supplements designed to support a balanced cannabis receptor system.Outside of her professional life, Dr. Brandon enjoys backpacking with her two rescued Belgian Malinois, playing fetch and laser tag with her three youngest cats, or curling up with a good book and one of four senior cats. Other hobbies include birdwatching, listening to Blues & Jazz, and making herbal teas from plants grown in her organic garden.

Check out our other interviews with Dr. Brandon:

• Essential Oils and Cats
• Cat Dental Care
• What Should Cats Really Eat? An Interview about Feline Nutrition
• Feline Asthma
• Vaccines Cats Need

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What causes feline asthma?

Feline asthma is a type of bronchopulmonary disease caused by an allergic reaction to inhaled allergens which results in excess mucus production and narrowing of the airways. Allergens are often the same which cause human asthma and reactions are highly individual. For example, one cat may react negatively to perfume, candles, and essential oils, while another may benefit from essential oils but have an extremely difficult time with wood smoke. It is often exacerbated by dry air, obesity, and history of other cardiopulmonary diseases.

How do you know if your cat has asthma? What are cat asthma symptoms?

A definitive diagnosis is often not possible unless one happens to find high numbers of certain white blood cells on a tracheal wash. This procedure requires full anesthesia and is not 100% -- a negative or normal result does not rule out feline asthma.In general, we diagnose feline asthma based on ruling out other conditions and assessing all laboratory and clinical symptoms together. Blood work to rule out infections and chest radiographs to assess bronchial patterns are considered minimum laboratory tests … and are usually enough when combined with examination findings, to provide a diagnosis of feline asthma.Exam findings range from normal to changes in bronchial sounds and mucous membrane color, depression and dehydration.Symptoms include an episodic hacking cough, usually dry though can be mucoid, which occurs with specific stimuli or times of year. Cats may remove themselves from normal play activities and lay in different positions to ease constricted breathing.In severe cases, symptoms include blue gums (tongue, nose, lips -- anything normally pink can appear blue-tinged), foamy spittle, and even death. Acute and chronic asthma are possible, and some cats only have a single event, while others cough daily for years.

Are there such things as cat asthma inhalers?

Yes and they are surprisingly well tolerated, and like humans, usually work better than oral medications.This video shows a few different types of asthmatic coughing and details administration of a common delivery mechanism, AeroKat. Because we cannot ask cats to hold their breath, allowing the aerosolized medication to sit within airways, they need to have a rebreathing system which keeps the medication in suspension while the cat breathes a few seconds.AeroKat is an adaptation from infant inhalers for the same reasons.

What are cat asthma treatment options?

Like most treatment options, cats respond best to a multimodal approach. Treatment changes based on acute/emergency vs chronic care, age, presence of other health issues, and normal fluctuations of the immune system / disease itself.

• Environmental -- in short, remove anything which produces dust, noticeable scent, or smoke. While some can be added later, it’s best to be aggressive during this step.
  • Remove all candles (soy or wax, scented or not)
  • Remove plug-ins (scented or pheromone)
  • Hold off on essential oils …
    • Yes, I know this seems contradictory to comments made previously. Many cats do respond exceptionally well to essential oils, but others respond negatively.
    • While diffused products like OpenAir are good treatment options, I prefer to remove all oils first; add them in with veterinary direction
  • Provide low/no dust litter in an uncovered litter box. Some cats do well with pelleted liters while others need crystal types. Automatic litter boxes are also good options.
  •  If any perfumes are used in the home, make sure to put them on behind a closed bathroom door; leave the door closed when you leave to reduce diffusion of potential allergens in the home.
  • If possible, remove carpets and rugs. Surfaces like tile and laminate flooring, which are easily cleaned of dust and fur, are preferable. Remove what you can and clean the rest at least weekly.
  • Wash cat bedding at least weekly.
  • Pay attention to anything else which triggers your cat’s asthma; remove it as well.
  • Reduce household (human and feline) stress as best as possible.
• Inhaled medications & supplements (Inhaled refers to AeroKat systems rather than nebulization, though the latter is an excellent option for severe patients or those who will not allow masks to be held in place.)
  • Steroidal inhalers: a mainstay of controlling the immune system response in feline asthma, steroids are potent anti-inflammatory drugs. They range greatly in strength and price, and are generally safe. Some cats will develop upper respiratory tract illness secondary to suppressed immune systems and feline herpes viral flares. Rarely cats can exhibit systemic symptoms of steroid administration (increased appetite, increased urination/thirst, poor skin/coat quality, etc.).
  • Bronchodilator inhalers: medications like levalbuterol are suspended in moistened air and cause relaxation of bronchial muscles, opening airways in short time. Typically referred to as ‘rescue inhalers’ they are relatively safe, low cost, and commonly used in cats. Negative effects seen with this class of drugs in oral form are generally absent when inhaled.
  • Essential oils: 1-4 drops of an equal parts blend of copaiba, frankincense and grapefruit, diffused in a room where your cat can come/go freely, is a good choice. These oils are generally well-tolerated and unlikely to trigger any reactions; eucalyptus or evergreen oils are good additions I might add later as needed. They can trigger bronchoconstriction in some mammals, so I avoid them at first.
• Oral medications & supplements
  • Steroids are commonly prescribed to reduce overall inflammation of airways. They are not without risk as systemic steroid administration often creates a host of other issues. That said, most cats who require long term steroid administration typically do not need high doses, limiting negative effects.
  • Bronchodilators help open airways via relaxation of bronchial muscles. Low doses are typically used to avoid negative systemic effects, and these drugs are generally considered well-tolerated.
• Oral antibiotics: it is not uncommon to place feline asthma patients on a course of doxycycline or other antibiotic. Secondary infections are not uncommon, especially when first diagnosed, and they can be present even with a normal systemic white blood cell count.
• Acupuncture & TCVM herbs can help balance the body’s energetic patterns. The patterns which are often found in feline asthma are the same as in humans: Wind Cold, Lung Heat, Lung Yin or Qi Deficiency, & Kidney & Lung Qi Deficiencies.
• Ayurvedic herbs like ashwagandha and curcumin can support the body’s anti-inflammatory efforts, as can full spectrum hemp products. The latter supports the feline endocannabinoid system which aims to resolve all cellular stress, no matter where it’s located.
• Diet is also important as one high in moisture and animal-based protein supports the body’s immune system and overall ability to maintain healthful homeostasis. Such as diet also supports a healthy body weight and can sometimes be tweaked to encourage energetic flow aimed at tonifying Yin and expelling Wind.

If a cat has an asthma attack, what do you do?

Let’s go step by step on this one …Step One: take a deep relaxing breath yourself. If you’re panicked, it will only add to your cat’s stress. Remaining calm helps her remember that you’re going to help, and she can remain calmer as well.Step Two: look at your cat. Is she coughing and annoyed because her play was interrupted, or is bug-eyed and unable to get enough air?Step Three: if the latter, grab her carrier, and your wallet and car keys. Get to your local emergency veterinary hospital immediately. Asthma attacks can and do kill cats; don’t wait as early intervention can save her life.Step Four: let’s presume your cat either has chronic asthma or the first attack is mild, with your cat playing like normal within a minute or two.

• Chronic asthma: get your AeroKat and levalbuterol inhaler. Administer per prescribed directions, which may include administering a steroidal inhaler once the airways are open.
• First time attack or if your cat doesn’t respond as expected to prescribed medications: call your regular veterinarian and schedule a visit.

Step Five: after the attack … let your cat relax wherever she wants. If she responds well to essential oils, get a diffuser going. If not, consider just a plain humidifier, while you see if you can determine a trigger. Make a note on your phone calendar of the trigger, attack itself (dry vs moist cough, duration, mentation, etc.), medications administered, and other pertinent information. This is extremely helpful in determining what preventative and treatments your cat needs moving forward; make sure your veterinarian has copy.

How do you know it’s asthma and now a hairball?

While we often confuse hairball vomiting with bronchial coughing, in most cases, they are easily distinguished as expulsion of hairballs involves an abdominal component.Time of year can also help as hairballs are more common end of Spring & Summer while asthma is generally worse during drier months.

Are there cat asthma specialists?

Not asthma specialists per say, but doctors specializing in small animal internal medicine and feline only medicine are as close as the veterinary profession has to feline asthma specialty. Because feline asthma is relatively common, most general practitioners and veterinarians limiting their practice to cats only (non-specialists by education but who only see one species in practice), are comfortable managing feline asthmatic patients. Difficult cases are often referred to specialists; second opinions should be obtained by them when desired.

What are feline asthma triggers?

Anything which their body considers an irritant or allergen, resulting in stimulation of the pulmonary immune system. An easy rule of thumb is if it can trigger human asthma, it can trigger cat asthma. While we don’t think of humans digging around in litter, cat pet parents do so every time they clean their cats litter box. A non-comprehensive list includes: dust of any kind, inhaled dust mites, pollen, smoke, scents, and medications.

Do humidifiers help feline asthma?

Absolutely! We know cold, dry air irritates pulmonary tissues, triggering an increase in asthma attacks during winter. Conversely and likely due to suspension of allergens in moist air, patients who have moderate to severe asthma year-round in the Pacific NW, do well in arid, warmer environments like Southwest region. Generally speaking, diffusing clean water (local municipalities will have public water testing results) during winter is a good idea and may help reduce frequency and duration of asthma attacks.

Reader Questions:

Christy Meyers - "How common is it, what tests do we need to have run, what are the best treatment options? My vet basically told me it's just a waiting game to see if he gets worse"

Common. Exam, blood work, & chest x-rays. In order: environmental changes, nutrition, inhalers, & supplements. In one aspect, your veterinarian is correct; we do not know which treatment is going to work best in what cat. We are left waiting to see how a patient responds to current treatment(s), before we can narrow and institute preventative treatment options. However, serial laboratory results can provide some measure of quantification. For example, patients with initial elevated white cell (WBC) count and abnormal radiographs, may have normal WBCs and improved radiographs in 3 months, indicating that therapy is working. Some patients return to normal and yearly or every 2-year lab results indicate the preventative plan is on track. When combined with your logs/notes regarding any attacks your cat has, the profession has a pretty good idea of how to direct patient care when it comes to feline asthma.

Jenn Rausch- "I have a cat that was diagnosed with Asthma almost 5 years. He was diagnosed from a x-ray of his lungs, there are indicators that they look for in the lungs that determine asthma. Unfortunately he has gotten worse as the years have gone on."

I’m sorry to hear that. If you’ve not done so, consider a second opinion with a specialist and/or holistic doctor. Sometimes a fresh set of eyes can find something helpful.

Some vets prescribe a steroid inhaler, other medication. The steroid inhaler is really expensive. My vet has my Levi on Prednisolone and Terbutaline twice a day and an Albuterol inhaler as needed.

A common and relatively low cost, regimen. You might ask your veterinarian to contact a compounding pharmacy like DiamondBack Drugs, and see if there's a lower cost option for steroidal inhaler. Sometimes changing steroids lowers cost without putting the patient at risk. For example, fluticasone (Flovent) can be more costly than budesonide (Pulmicort), and both work well in cats. While I do not often advocate purchasing drugs from other countries, Canadian pharmacies may offer lower cost options when purchased in bulk (and with your veterinarian’s prescription).

I would never allow a vet to tell me it's a waiting game. It puts more pressure and stress on their heart."

Annette Adler - "My 13-year-old Persian cat Sake was diagnosed with asthma just over a year ago. Since I live in the Sacramento, CA area, we had horrible air quality with the surrounding fires. The tragic Car fire in Paradise, CA Nov 2018 triggered major asthma attacks in her to the point I thought she was going to die.

I am sorry you and Sake had to go through that.

Prior to that, I had only witnessed one slight attack. I happened to be up early when the major attack happened and was able to calm her and make a video for her veterinarian.

Well done! I forgot to mention that above - video is extremely helpful.

I will see if I can find that footage. It is nothing like a hairball. She was bent over with her head low towards the floor and her tongue out as she struggled to breathe. Her vet took an x-ray to confirm and she was put on oral liquid steroids for a short time and we transitioned her to an inhaler which is much safer for long term use as the meds go directly to the lungs.

This is an excellent and common protocol after diagnosis.

I was traveling a lot at that time for a new job so ended up leaving my job as they were not flexible for "cat care". So we transitioned Sake to Fluticasone (Flixotide) dosed 2 x daily via an inhaler (AeroKat) allowing for about 10 breaths per dose. It is the same medication a human would use but just delivered through the special AeroKat inhaler. US costs for these meds are $250-300 per inhaler, so unless you have pet medical insurance, it is very expensive. Our Vets assistant taught us how to use it and offered that since her mother's cat is also on this regimen, I might consider buying from outside of the US, specifically Fiji, which we did at a fraction of the cost, $120.00 for 4 inhalers. Each Inhaler lasts about 2 months for my cat. My cat has been very receptive to the inhaler, for the most part, because it makes her feel better. Sadly, she was diagnosed with a huge liver tumor almost 2 months ago. They tried to resect in but it involved all 6 lobes of her liver so we are trying to keep her comfortable and let her tell us when it is time to let her go. We are heart-broken.

I am very sorry to hear this news and hope you are able to heal soon.

My question for your interview with your expert would be "can asthma inhalers cause liver tumors in cats or otherwise compromise their overall health".

I have never heard of such as the drugs and carriers within inhalers are relatively safe, causing non-life threatening issues at worst. This presumes the product is unadulterated and as advertised.

I just found the timing of her liver tumor to be possibly related. She is actually has had more frequent asthma attacks since being diagnosed with the liver tumor, even though we still give her the inhaler 2x day.

I tend to agree and think it most likely something carried in the smoke was a carcinogen. Cats are very sensitive to such compounds as their livers cannot process them. We cannot know if that supposition is true, but I think airborne carcinogen more likely related to her liver failure, than her asthma medication.

I think the tumor has become so large that it is pressing on the other organs making breathing more difficult.

Yes, it would have. Poor kid 🙁

Also, when there are fires in N. CA., the poor air quality can seep into the house, thus impacting her. It is all heartbreaking as she is our everything. I will see if I can find the video of her asthma attack but would appreciate any insight from the group, even though it is too late for my Sake kitty."

Cynthia Cronkhite - "I’d like to know if there’s a good way for non-veterinarians to distinguish between hairball symptoms, asthma and a cough. Thank you."

Watch for an abdominal component; it’s only present with hairballs, even if the hairball is swallowed rather than expelled. Anything else should be investigated by your veterinarian.

Amy Ratcliffe - "My Beverly Leslie was diagnosed with asthma earlier this year. The vet prescribed an inhaler (yes, that's right -- and they have a little apparatus that makes it easy to administer the puff of air) for everyday use (one puff a day) to control it and an emergency inhaler if he has an attack. He has only had two attacks since I've had him. He is 13 and I have had him for about 4 years. My question for the vet is whether it really does much good to administer the daily inhaler. He doesn't like it (it involves holding a plastic piece up around his nose and mouth and releasing the puff of medicine), so I'm not sure how much of the medicine he's getting because he pulls away. It's also a bit expensive, which I don't mind if it really is doing some good for him."

Fantastic response to therapy 🙂 Check with his veterinarian first, but in cases like this, I usually start phasing out the inhaler. Sometimes we can eliminate it completely, other times, we can reduce frequency to every 3 days. The goal is to use the lowest effective dose which allows for asthma management … no/little coughing, normal play/grooming/appetite, normal lab work. This is where environmental and dietary changes can really set the feline body up for success.

Angie Alexander Burdette - "My cat passed from an asthma attack out of the blue. We had no idea she had asthma at all. What symptoms or how would we have known to look for this? It was devastating.”

I am so sorry - what a horrible thing to go through. While rare, some asthma patients do die from their first attack, having a severe response to some unknown allergen. If she had never coughed, played normally, ate/drank well, and had a normal yearly physical exam, then I cannot see how you could prevent such an attack. These are the main areas which alert us that something is wrong with our beloved kitties.

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Check out our other interviews with Dr. Brandon:

• Essential Oils and Cats
• Cat Dental Care
• What Should Cats Really Eat? An Interview about Feline Nutrition
• Feline Asthma
• Vaccines Cats Need