Cat with asthma.
Age: 8-11 years
Misto is a 9-year-old, 15-pound domestic shorthair, house-only cat who lives with me in Dallas, Texas. He developed serious asthma (or some other, similar problem) about 8 months ago. (In retrospect, I think he had very mild asthma (or other problem) for much longer, and I didn't realize it.)
He started a regimen of Prenisolone 5mg plus Flixotide 250mcg administered twice daily with an Aerokat. About 6 weeks ago, we upped the Flixotide to 500mcg, added Ventolin and started giving him that right before the Flixotide to try to get the Flixtotide past the blockage so it could work.
This regimen isn't working. Misto keeps going through a cycle of needing more
Prenisolone than he is supposed to be taking and going into moderate distress when it is tapered off.
He has never had any diagnostics done other than x-rays. The last x-rays were done 6/2/12 and showed more congestion than he had in February. This was when we added the Ventolin and upped the Flixotide to 500mcg.
He is in quite a bit of distress right now. His respiration is ~60, he's wheezing, and he doesn't feel like doing anything. We've given him an extra round of all medicine and then some, and it hasn't had any noticeable effect.
At this point, we don't think he has asthma, but we don't know where to turn to find out what is wrong and what to do about it. We've already changed vets once. We would love to know what you think about the situation, and if you can recommend a vet in the Dallas area with some expertise in feline breathing problems, we'd be extremely grateful.
Dr. Marie replied:
Oh dear. It sounds like Misto is really struggling. What a frustrating case.
I have found that most of my cat patients with asthma respond really well to prednisolone. The ones that do not, usually do well when we add the inhaled medications that you mentioned. It is quite uncommon to have a cat that is still doing this poorly with asthma even though he is on all of these meds.
I don't personally know any vets in the Dallas area, but you may want to consider visiting an internal medicine specialist. Here is a website I found that may be of help:
Do you know if Misto has had a heartworm test? Sometimes, if a cat is being treated for asthma but not responding well, it is because the diagnosis is actually heartworm disease and not asthma. Heartworm is not as common in cats as in dogs, but in Texas, it would definitely be something I would want to test for!
You may want to have some xrays repeated now as well. Sometimes, if there is something significant present, it can take a few months to be visible on xrays. Another thing that may help is to ask your vet if they can send the xrays to a radiologist for their opinion. (It will cost some money to do this, but may be worthwhile). Sometimes it can be extremely difficult to interpret chest xrays. A radiologist may be able to find something different that you could be treating.
There are other tests that can be done such as a bronchiolar lavage which can look for more unusual types of infections and other lung diseases. It's possible, though that you may need to see a specialist (such as the one I linked to above) to have that done.
I hope things are better soon! Please let me know if you have more questions.
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Thanks so much, Dr. Marie! So much helpful info here. Heartworms have been mentioned, but never a test to determine whether Misto has them. A radiologist did look at the last set of x-rays and agreed with the asthma diagnosis, but we weren't charged for the consult, which I thought was odd. VSNT is actually only about 2 miles from our house! We pass by it often, but the sign visible from the street just says "animal cancer center," so I never dreamed they did anything else. Their website looks great, though, and they will probably be our next stop. Thanks a million!