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Challenging Respiratory Diseases
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Pulmonary Infiltrates with Eosinophilia
Eosinophilic lung disease in the dog, otherwise referred to as pulmonary infiltrates with eosinophilia (PIE) or eosinophilic bronchopneumopathy (EBP), is a poorly understood entity. Heartworm disease and lung parasitism are recognized causes of PIE and larval migration of parasites can also lead to PIE, however the etiology of PIE in most dogs remains unknown. It is likely that PIE is due to a hypersensitivity reaction. However, inciting antigens are rarely recognized and treatment involves prolonged therapy with glucocorticoids.
Dogs with PIE are usually young, ranging from <1 year to 8 years of age. Owner complaints generally include an unrelenting cough, many dogs are short of breath, and some dogs have nasal discharge also. Some dogs appear systemically ill on physical examination, with fever, depression, and anorexia. Auscultation usually reveals increased bronchial or adventitious lung sounds, and tracheal palpation results in a moist productive cough.
Leukocytosis and eosinophilia are common, and parasitism must be ruled out in these dogs by performing heartworm tests and fecal analysis. Radiographs usually show alveolar infiltrates and bronchiectasis. Airway examination may reveal yellow-green tinged mucus (indicative of eosinophils) in some dogs, although in others, only marked hyperemia is noted. Normal dogs have <5% eosinophils on a differential count of bronchoalveolar lavage fluid while dogs with PIE can have up to 90% eosinophils.
Treatment for PIE relies on therapy with prednisolone or prednisone, often at 1-2 mg/kg PO BID initially. If signs diminish in the first 10-14 days, a gradual decrease in corticosteroid dose and lengthening of the dosing interval are recommended. Long-term treatment (4-6 months) should be considered in these dogs because of the tendency for relapses to occur if drugs are tapered too quickly. For dogs that are poorly tolerant of oral steroids, inhaled steroids (fluticasone propionate) can be used with a facemask and spacing chamber. Antibiotics are not necessary unless concurrent bacterial infection is documented.
Bronchiectasis
Bronchiectasis is characterized by irreversible dilatation of the bronchi and is often accompanied by suppurative airway secretions. It can result from poorly controlled inflammatory or infectious lung disease, foreign body pneumonia or smoke inhalation. Animals that have bronchiectasis as part of the syndrome of primary ciliary dyskinesia are young on presentation, however, animals with acquired disease are middle aged to older. Cocker Spaniels seem predisposed to this disorder.
Definitive diagnosis of bronchiectasis is difficult in veterinary medicine. A history of recurrent pneumonia should raise suspicion for the disorder, however early radiographic lesions are subtle. Computed tomography can document enlargement of bronchial diameter in comparison to the adjacent pulmonary artery along with thickening of the airway wall. Bronchoscopy allows documentation of bronchiectasis as an increase in airway space and thinning of airway bifurcations.
During bronchoscopy, lavage samples should be collected for cytology and cultures for aerobic and anaerobic bacteria, as well as Mycoplasma. Cytology is generally characterized by a high proportion of non-degenerate or degenerate neutrophils. Bacterial cultures in dogs with bronchiectasis have not been evaluated, although it is presumed that deep-seated pulmonary infection is present. Six weeks to six months of broad-spectrum antibiotics may be required to aid resolution of pulmonary inflammation. In severe cases, life-long antibiotics should be considered. Focal bronchiectasis may be amenable to surgical resection of affected lung lobes. [...]
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