Conventional Medications

Fritz did not initially begin asthma treatment with an inhaled drug regimen. Instead, he used a treatment program from the pages of a veterinarian's conventional diagnostic and treatment manual.

Conventional treatment typically features a corticosteroid to relieve inflammation, supplemented with a bronchodilator to open the airways. This is similar to inhaled therapy, but the drugs are older and more familiar, and they are administered by oral, injected, or transdermal means.

Links above describe treatments and additional medications.

Don't forget the Glossary to look up unfamiliar terms.

Corticosteroids

Oral. Prednisone (prednisolone), in 5 mg tablets, is perhaps the most common take-home therapy. Prednisone typically is prescribed at 1 mg per kg of cat per day. Since the drug's effectiveness wears off in several hours, large doses are spaced out 2 or 3 times a day. Systemic corticosteroids tend to suppress the cat's immune system, they may interfere with pancreatic and urinary function, increase appetite, and affect blood sugar levels. Prednisone is prescribed at as small a dose as effective to control the inflammation. Cats whose symptoms are managed by small doses receive as little as one-half tablet every other day. Note that otherwise healthy cats tend to tolerate prednisone therapy better than humans do.

Transdermal Gel. (through the skin) Prednisone is a bitter-tasting compound, so it can be difficult to regularly pill a cat with it. Some caregivers have taken their cat's prescription to a compounding pharmacy, where the drug is prepared in the form of a transdermal gel. The caregiver will wear a surgical glove and rub a measured amount of the drug on the cat's ear flap, where it will pass through the skin and into the cat's bloodstream. However, "there is a significant potential risk in using medications that are compounded into creams to be applied to the skin: there are zero studies on how much, how quickly the drug of interest is actually absorbed. With a disease like hyperthyroidism, we can measure thyroid levels in the blood to tell us if the tapazole cream is effective, But, for other drugs, especially including steroids, there is just no way to know what we are actually giving when we apply a cream or compounded patch." (Source: Padrid 4/10/03 to FAIM Yahoo group)

Compounded Oral. BCP Pharmacy have developed the original VetChews® in which the raw drug is compounded into a chewable treat base form. These are available in meat and fish flavors such as beef, tuna, liver, chicken, and seafood. Your vet will know of other compounding pharmacies that may offer similar products. This not only increases the compliance of the animal but also makes administering the medication easier for veterinarians and pet owners. Predisone is notoriously bitter, however, and hard to hide the flavor no matter how well it is hidden.

Injection. Another way to get corticosteroids into the cat is at your veterinarian's office via injection. Common drugs treatments are a short acting dexamethasone or long-acting formulation of depo-medrol. The cat needs visits to the veterinarian as symptoms recur, often at increasing intervals as the body develops a tolerance. For mild asthmatics, this will be once/year at the start of their active asthma season; for others it is as often as every season, and for some unlucky cats, every few weeks.

The same concerns about corticosteroids apply. If the cat tolerates the treatment well, it may be an excellent treatment decision. It's also an option for people who cannot arrange daily medication for their cat, or for cats that refuse to tolerate frequent handling (ex: ferals). The biggest concern is that, once the injection is given, one is powerless to reduce the dose present in the cat's body -- the only choice is wait for it to wear off. This is one reason oral prednisone is often preferred.

Bronchodilators

Terbutaline sulfate (aka Brethine®) and the theodur family (Theophylline, Aminophylline) are common bronchodilators. These drugs relax the muscles of the bronchi and bronchioles in the lungs and allow air to penetrate deeper into tissues.

These drugs are most frequently used to supplement a corticosteroid. Many vets feel that use of a bronchodilator without a steroid may "mask the inflammation". To say that another way, they provide symptomatic relief, while allowing the inflammation present in the lungs to continue to cause damage. Used as needed, they can provide quick and effective relief.

Oral. These drugs come in tablet form, typically a pill or fragment of a pill administered twice a day. These are helpful when seeing occasional daily symptoms, or to follow up after hospitalization.

Shots. Quick-acting formulations of these drugs can be injected, either by the vet or (following your vet's instruction) at home. Only a trained practitioner should attempt intravenous or intramuscular injection, but you can be taught how to inject it subcutaneously. For cats with rapid onset of severe symptoms, this can be a life saver, giving precious extra minutes to transport the cat to the emergency room.

Trandsdermal and VetChews®. Bronchodilators may also be appropriate to compound. See details under Corticosteriods above.

Nebulization.

Neublizers were the main treatment tool for humans before the development of Metered Dose Inhalers (MDIs) with chambers. It is a compressor that delivers a wet solution of a medication and vaporizes it into the atmopshere for the patient to breathe. Currently a portable unit is being marketed to veterinarians to sell for take-home asthma therapy but, in our opinion, it is not a good choice for managing this disease.

The solution Budesonide is the only corticosteroid solution available for nebulizers and ther is no experience nor data for vets to know what strength to prescribe the feline patient. A nebulized steroid solution has too large a particle size to reach their small airways. Albuterol sulfate may be nebulized but, again, the process produces a large particle size. While these machines may look impressive because they produce a "smoke", what you see cannot be used since those visible particles are over 100 microns, and this is of no long-term benefit to the cat. Minimal nebulized asthma medication can get deeply into the lung. The hazards to human caregivers who are exposed to nebulized corticosteroid or bronchodilator has been well documented and considered an occupational hazard in the hospital setting. If a nebulized solution is not contained, completely, in some way for the patient, anyone close to the patient will be exposed. Here's a link for more reading on the hazards exposure, (such as human respiratory therapists), to nebulized asthma medications. Nebulized therapy will still have its place in the hospital setting for other inhaled medications but for feline asthma, it is a costly option with no published data for the cat's safety.

To assist in getting pills into the cat's mouth (and swallowed), you might need to immobilize the cat using the firm-yet-gentle Towel Treatment. A piller, which has a long syringe-like handle with a flexible tip where the tablet goes, may also help, ask your veterinarian where to obtain them. Some people swear by them, while others find them unwieldy. Caregiver (and kitty) compliance is generally a problem when it comes to giving pills daily for the life of the cat and feline asthma is a life long disease.

Fritz' Notes

Fritz' experience has been echoed by many who have shared their cat's medication history on the Internet discussion groups and in email to this site. Initially, he was helped by prednisone, but his waxing and waning asthma symptoms and sudden onset of severe symptoms made identifying a effective dose impossible. He also gained three pounds in four months of therapy.

Fritz needed injections of depo-medrol approximately every four weeks when he would be rushed to an emergency clinic in distress. During these visits, many costly procedures were necessary to bring him back to stability such as multiple corticosteroid and bronchodilator injections (intravenously and intramuscularly), x-rays, oxygen, blood tests and hospitalization.

Fritz tried Aminophylline, which was ineffective in every form attempted, and Terbutaline, which was effective in the vet's office (injected IM) and at home (pills and injected sub-q) but difficult to administer and slow acting.

For all these reasons, after researching current new therapies (this was during March 2001) we were eager to see if he would get better results on an inhaled treatment plan. He is now joined by over 10,000 cats who currently live healthier longer lives with inhaled medication.

See gallery for video and photos of inhaled medications being administered.

Continue Reading at Other and Alternative Medications