Prescribing Inhaled Therapy
Asthma and Bronchitis are chronic conditions that require a lifetime of management
The Advantages of Inhaled Therapy for Chronic Respiratory Diseases
Asthma and Bronchitis are chronic conditions that require a lifetime of management.
For daily management, a daily solution is needed. While systemic steroids may have an important role in veterinary care, their use should be limited where alternative long-term treatment options exist that are safer for the animal.
Thankfully, inhaled steroids, in the form of metered dose inhalers, are available to treat respiratory diseases in cats, dogs, and horses. They are effective and don't cause the same adverse side effects, giving you and your clients an alternative and safer option to systemic medications that are often surprisingly easier to use.
See below to learn more about asthma and bronchitis treatment algorithms and dosing guidelines.
Why Prescribe Inhaled Therapy?
- Inhaled medications target the lower airways directly
- 25x lower concentrations of steroid for same therapeutic effect
- Don't need to be metabolized – less systemic side effects
- Easier to administer – bonding moments can make it a positive experience
- Safe for long term disease control
Treatment Path
Treatment Path and Dosing Guidelines for Feline Asthma and Canine Bronchitis
Ensure patient can breathe
- Immediately dilate airways to provide respiratory relief
- Provide injectable steroid and either inhaled or injectable Bronchodilator
- Administer injectable medications in clinic
- Inhaled bronchodilator (i.e. albuterol / salbutamol) may be administered in clinic or at home by owner. Owners unable to regain control at home should bring their pet to the clinic for veterinary care
Medication
Dosing Guideline
| Medication | Cats & Dogs ≤ 20 kg (44.1 lb) | Dogs > 20 kg (44.1 lb) |
|---|---|---|
| Dexamethasone | 0.1-0.5 mg/kg IM or IV | 0.1-0.5 mg/kg IM or IV |
| Terbutaline | 0.01 mg/kg IM or SC in clinic | 0.01 mg/kg IM or SC in clinic |
| Albuterol/Salbutamol | 1-2 puffs every 30 minutes for ≤ 4-5 hours | 1-2 puffs every 30 minutes for ≤ 4-5 hours |
Notes
Owners unable to regain control at home should bring their pet to the clinic for veterinary care
*Cats with more serious disease may require 220 μg every 12 hours
Clear the airways
Provide 10-day, short-term course of systemic steroids
Medication
Dosing Guideline
| Medication | Cats | Dogs |
|---|---|---|
| Prednisolone | 1-2 mg/kg (every 24 hours) | - |
| Prednisone | - | 0.5-1 mg/kg (every 24 hours) |
Notes
- Review environmental factors and make modifications to reduce potential triggers
- Ensure pet owners understand corticosteroids are considered a mainstay of treatment and may be administered orally or via injection or inhalation; inhaled forms help limit systemic absorption (see Adverse Effects of Systemic Steroids)
- Owners already providing inhaled steroids to their pet and who treated exacerbation with albuterol can continue with inhaled steroid therapy; those currently using other forms may consider transitioning to inhaled corticosteroids
Wean off of systemic steroids
- Taper systemic steroids and introduce inhaled steroids
- Overlap systemic and inhaled therapy for 2 weeks
Medication
Dosing Guideline
| Medication | Cats & Dogs ≤ 20 kg (44.1 lb) | Dogs > 20 kg (44.1 lb) |
|---|---|---|
| Fluticasone | 1 puff (110 μg) every 12 hours | 1 puff (115 μg/21 μg) every 12 hours |
| Fluticasone + salmeterol | 1 puff (220 μg) every 12 hours | 1 puff (230 μg/21 μg) every 12 hours |
Notes
Inhaled steroids may require 2 weeks to take effect
*Cats with more serious disease may require 220 μg every 12 hours
Daily Management
- Use maintenance therapy to control inflammation and prevent exacerbation
- Continue daily therapy for management of clinical signs
- Cat owners can administer inhaled bronchodilators during flare-ups secondary to exposure to triggers
Medication
Dosing Guideline
| Medication | Cats & Dogs ≤ 20 kg (44.1 lb) | Dogs > 20 kg (44.1 lb) |
|---|---|---|
| Fluticasone | 1 puff (110 μg) every 12 hours | 1 puff (220 μg) every 12 hours |
| Fluticasone + salmeterol | 1 puff (115 μg/21 μg) every 12 hours | 1 puff (230 μg/21 μg) every 12 hours |
| Albuterol or salbutamol (SABA) | 1 to 2 puffs as needed (cats) | - |
Notes
- Albuterol is a rescue medication and should not be used as monotherapy
- Dogs have not been shown to experience bronchoconstriction
- Little evidence exists for effectiveness of albuterol therapy to manage canine bronchitis
*Cats with more serious disease may require 220 μg every 12 hours
Types of Inhaled Medication
Treatment for emergencies or long-term management
Asthma in animals is treated with corticosteroids and bronchodilators, similar to human treatments but with different doses and administration for cats, dogs, and horses.
Emergency Management
Bronchodilators are medications used to expand the airways. Short acting bronchodilators are commonly referred to as rescue medications because they act quickly and may be administered during an asthma attack.
- Opens airways by relaxing smooth muscles to reduce bronchoconstriction
- May be used symptomatically to help with coughing flare-ups
- Effects usually only last 4-6 hours
- Does not treat underlying inflammation; inhaled corticosteroids are the mainstay for long-term management and control
Drug Names
- Albuterol
- Salbutamol
- Ventolin
- ProAir
- Proventil
Long-Term Management
Corticosteroids (or glucocorticoids) are anti-inflammatory medications used to treat and manage the underlying causes of asthma and bronchitis.
- Reduces airway inflammation and mucus production
- Used for ongoing management of condition even in the absence of symptoms
Drug Names
- Fluticasone
- Flovent†
- Flixotide†
- Alvesco†
Often a combination of an inhaled corticosteroid (ICS) and a special long-acting bronchodilator (LABA) formulation. LABAs can be slower to take affect, but act over a longer period of time (up to 12 hours).
- Reduces inflammation and relaxes smooth airway muscle
- Indicated for disease management, not rescue
- May be used as step-up therapy
Drug Names
- Advair†
- Seretide†
- Sirdupla†
- Sereflow†
- Fluticasone Cipla†
- Symbicort†
- Dulera†
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