How serious is a dog's cough? - DVM
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How serious is a dog's cough?
A review of classifications and treatments


DVM360 MAGAZINE


Second, the presence of a cough that can be induced with tracheal pressure does not indicate that the problem is tracheal or bronchial. Dogs with pulmonary parenchymal abnormalities, such as cardiogenic pulmonary edema, or even normal dogs, will cough with tracheal pressure.

Treatment

Since a cough indicates an underlying respiratory problem, it is important to determine the nature of the problem before deciding on treatment.

With a purposeful cough, the treatment goal is to help eliminate the unwanted material from the respiratory system. Treatments to consider include antibacterials, nebulization and coupage (if bacterial pneumonia), medical management of the underlying cause if present (e.g., megaesophagus) and lung lobectomy if indicated (e.g., foreign body).

Additional diagnostic tests that may help establish the need for specific treatments include transtracheal wash, bronchoscopic examination and bronchoalveolar lavage and computed tomography (CT) or magnetic resonance imaging (MRI) of the thorax. A treatment that is contraindicated is the use of cough suppressants.

With a warning cough, treatment goals are to address the underlying problem before further deterioration and to provide emergent supportive care. Treatments to consider include oxygen supplementation for dyspneic dogs; diuretics in cases of cardiogenic pulmonary edema; crystalloid fluid therapy, plasma transfusion and vitamin K in cases of pulmonary hemorrhage due to anticoagulant rodenticide intoxication; anticoagulants (and possibly plasma transfusions or other therapies based on inciting factor) in cases of PTE; chemotherapy, radiation therapy, and/or surgical therapy for neoplasia; and surgical correction in cases of lung-lobe torsion.

Additional diagnostic tests that may help establish the need for specific treatments may include an echocardiogram and electrocardiogram (if cardiogenic pulmonary edema), prothrombin time (if anticoagulant rodenticide toxicity), platelet count, fibrin degradation products measurement, d-dimer assay, assessment of antithrombin III levels and possibly a lung perfusion scan or pulmonary arterial angiogram (if PTE is suspected) and thoracic ultrasound, CT, and/or MRI and needle aspiration or biopsy of thoracic masses. Contraindicated treatments include cough suppressants and expectorants.

With a nuisance cough, the dominant goal of treatment is comfort. Treatments to consider include cough suppressants (except if a secondary bacterial infection or ventilation problem is present), environmental modification (e.g., air purifier, avoidance of exposure to airborne infectious agents), weight loss if the dog is obese, bronchodilator drugs, and tranquilizers used on an as-needed basis if anxiety appears to play a role in triggering or sustaining the cough.

Additional diagnostic tests that may help establish the need for specific treatments may include transtracheal wash, bronchoscopic examination and bronchoalveolar lavage. A treatment that is contraindicated is the use of expectorants.

Prognosis and outcome

With a purposeful cough, the outcome depends on the ability to eliminate the source. Extraction of a foreign body generally carries a good prognosis, for example, whereas bacterial pneumonia caused by chronic aspiration associated with megaesophagus carries a guarded prognosis due to the high likelihood of recurrence.

More frustrating in terms of exact prognosis is the juvenile dog with pneumonia secondary to suspected viral or primary bacterial causes (e.g., canine distemper, Bordetella, etc.). These young dogs may clear the infection but have persistent regional compromises of local immune function, fostering variable degrees of reinfection. In such cases, the cough may move from purposeful, when pneumonia is present, to nuisance, when pneumonia is absent, and back again, for months or years.

The prognosis associated with a warning cough is directly related to two factors: (1) the speed with which the animal is brought for evaluation and the underlying problem is correctly diagnosed; and (2) the response to treatment for the underlying problem.

For instance, a dog with pulmonary hemorrhage from severe anticoagulant poisoning can have an excellent outcome if treated early and appropriately; the same dog may die if not evaluated and treated rapidly.


Johnny D. Hoskins
Nuisance coughs carry a fair prognosis. When caused by severe, worsening compromise of the airways (e.g., advanced cases of collapsing trachea or bronchial compression from cardiac enlargement), the prognosis is guarded. However, when nuisance coughs are not caused by such disorders, they can be treated on an as-needed basis and are compatible with a good quality of life.

Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with specialities in small animal pediatrics. He can be reached at (225) 955-3252, fax: (214) 242-2200 or e-mail:


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Source: DVM360 MAGAZINE,
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