There are times in all of our lives when we just cringe upon entering a situation. We veterinarians pick up a patient chart for the next exam and react internally. If it says “New puppy exam” we smile and gleefully enter the exam room. “Vomiting for 4 days” doesn’t typically bring about a happy response. “Asthmatic cat urinating a lot” makes us want to crawl under a rock. Or, “Diabetic cat now coughing” might also send us running in the opposite direction. “Why”? Well, feline asthma is treated with steroids and steroids can cause insulin resistance. You see our dilemma. Today I’d like to discuss treatment options if your cat has feline asthma.
Feline asthma is a lifelong disease that can be severe or mild, and it typically waxes and wanes over time. Feline asthma is much like human asthma. It’s a hypersensitivity reaction to allergens, dusts, smoke, aerosols, fumes, etc. The clinical presentation of an asthmatic cat is typically a cat who coughs, usually a deep, dry cough. It can then progress to all out respiratory distress as the airways constrict and the cat can’t catch it’s breath. The 3 main treatment options are modifying the environment to eliminate the stimuli, steroids and bronchodilators.
Just a few months ago we ran a series of newsletters about itchy pets and ways that we can avoid or limit steroid use for dogs and cats with food allergies and hay fever. Those of us trying to regulate diabetic patients know that steroids cause insulin resistance, and good glucose regulation is difficult when a pet is on steroids. Steroids can also cause immunosuppression, GI upset, liver or kidney disease, congestive heart failure, and drinking and urinating excessively.
Feline asthma can be even more troubling than food allergy or hay fever because steroids are integral to the treatment of feline asthma. Although we do our best to integrate bronchodilators and environmental avoidance of the triggering agents, steroids break the cycle of airway inflammation in addition to decreasing the allergic response. It is the airway inflammation that causes the clinical signs and results in remodeling of the airways.
The most commonly used bronchodilators for cat asthma are terbutaline, theophylline, aminophylline, and albuterol. Bronchodilators do not control inflammation, so they should never be used as the sole therapy without steroids. Inflammation of the airways causes irreversible changes. Bronchodilators ease respirations and are integral to the treatment of feline asthma. These bronchodilators can come in oral, injectable and inhaled forms. The long-term route of administration for bronchodilators is typically by mouth. Inhaled bronchodilators (ie albuterol) are typically reserved for situations of respiratory distress as they can add to airway inflammation which is the enemy for asthmatic cats. Inhaled bronchodilators shouldn’t be used more than a couple times per week for cats. If a cat is having frequent episodes of asthma, then further investigation for possible infections or altering the steroid dose is indicated.
So if we must use steroids for an asthmatic cats during their episodes, how do we minimize the systemic effects of steroids? We try to avoid long-acting steroid injections because they are more likely to cause the adverse effects. Additionally, with long-term injectable steroids we aren’t able to tailor the dose day to day. Once you give a long-lasting injection it is in the cat until it is metabolized. We can tailor the dose of steroids when given by mouth, so many asthmatic cats are on prednisolone during flare ups. The latest and greatest trend is to use inhaled steroids (ie Flovent) because inhaled steroids result in far fewer systemic effects compared to oral or injectable steroids.
If you are wondering how we get a cat to cooperate with an inhaler, there are several nifty gadgets created to facilitate this issue. They consist of a chamber with a hole fit for the inhaler on one end and a soft rubber kitty face mask on the other end. Since we can’t tell our feline friends to breathe in and out deeply, we fill the chamber then gently hold the mask to the cat’s face while it breathes in the aerosolized medication. The best known of these products is called the AeroKat.
I suspect that there are more asthmatics that end up with diabetes secondary to insulin resistance caused by steroids than diabetic cats who happen to be asthmatic. Nonetheless, if your cat is in either of these categories, speak with your veterinarian about inhalers if you aren’t already using them.
NOTE: Consult your Veterinarian first to make sure my recommendations fit your pet’s special health needs.
My 11-12 y/o female kitty has a corneal ulcer that is treated daily with erythromycin ointment, untreated gingivitis, and mostly controlled asthma through the use of a Flovent inhaler for several years, 2 times a day. Noticing her sudden weight loss, a surge in water consumption, along with frequent urination, blood work confirmed she now has diabetes and was prescribed Prozinc, starting at 1 unit 2x daily. Because of the high out of range bg readings, the vet has steadily increased the dosage over an eight week period, up to a whopping 5 units 2x daily. She is apparently insulin resistent. Her bg readings over the entire time have fluctuated between the 400s and the 700s — waaaay out of range. The vet recently gave a convenia injection as a cautionary measure for her eye and gum issues, also just in case she had a UTI. Still no remarkable change in bg readings. Then we changed to a new bottle of prozinc, just in case the first bottle was just a bad bottle, decreased to 4 units 2x a day; still getting high readings. We are now considering the possible but unlikely effect the Flovent may be having on the insulin resistence; if so, what steps to take next. Or should we change insulin brands to see if we’d get better results? Any hints, tips, or suggestions from your experience? Thanking you in advance…
Is she on canned food only? If not, I’ve seen dramatic drops in blood glucose readings when changing a diabetic cat from dry food to canned low carb food only. You are correct: 4 and 5 units are hefty doses of insulin for a cat.
Flovent is much better than systemic steroids but certainly is still a steroid so of course it can cause insulin resistance. Have you done everything to avoid dusts (home, cat litter, perfumes, air pollutants) that can trigger her asthma? Is she also on a bronchodilator when she flares?
Prozinc is a good insulin for cats. Chat with your vet. Get rid of any dry food if she is on dry food. If she does get dry food now and you change to low carb canned such as Purina DM, anticipate she will need less insulin. Of course you could consider changing to Lantus/glargine. And consider taking her to a vet internal medicine specialist.
Best, Joi
My cat is diabetic, and was diagnosed with asthma 1 week ago. I started an Albuterol inhaler, and flovent inhaler, 1 puff of each, twice daily, on Tuesday Albuterol 10 minutes before flovent. I haven’t seen much of a change. He was diagnosed with diabetes 2 months ago. He is still not regulated. Any advice?
I hope you are feeding a canned low carb diet. That will help to regulate your kitty’s diabetes. Good job getting the inhaled steroid rather than systemic steroid! Are you testing the blood glucose at home? That’s key to regulate a dog diabetic pet. And it sounds like you need to have a recheck with your veterinarian.
I have a diabetic cat and she is severely asthmatic as well. She is on an inhaler that she gets every 12 hours. She is also on insulin. The asthma is getting worse? Where would I go from here to treat the asthma. My regular vet said she would have to stop treating the diabetes to treat the asthma. Is this recommended. I feel my cat is suffering!
I think you may have misunderstood what your vet said about “stop treating the diabetes”. She probably meant that the diabetes would likely get worse when using steroids. Asthma is an inflammatory disease, an allergy. Unfortunately, for cats we must use some steroids to control the asthma. We try to use Flovent over systemic steroids if possible. You can get a chamber (most common brand is Aerokat) to puff the Flovent into. Most of my patients with asthma get their Flovent from Canada as it is less expensive there than in the USA.
The unfortunate part of steroids is that it will make the diabetes more difficult to control. Are you doing home glucose monitoring? I hope so. You will likely need to if she adds steroids. I’ve long recommended the Alphatrak pet glucose meter.
You have no choice but to treat the asthma, just know that steroids will make her diabetes harder to regulate.
If you didn’t confuse what your vet said (and she feels she must stop treating the diabetes to treat the asthma… I seriously doubt she meant this) then you should seek a second opinion. Most larger cities have internal medicine specialists who treat tough situations such as this.
Best,
Joi
My cat is diabetic and has been diagnosed recently with asthma. I believe what set it off was a new bed I bought her that perhaps the material on it caused her to have an asthma attack. She is on flovent daily and I used the aerokat chamber to administer. The issue I’m having now is the cat is having a reaction on her face, both sides, where the mask goes and now she is itching the area causing cuts that keep healing and reopening. The mask is latex free but it all started when I started using the mask and flovent. I dont know what to do. I also wipe her face off after she inhales to get rid of any medication residue. Any ideas???
Great job starting with an inhaled steroid rather than a systemic steroid. Asthma unfortunately does require steroid use for cat, so by inhaling it where it is needed will affect the diabetes (and body in general) less than an oral or injectable steroid.
Now, the question is whether the dermatitis is infection (such as yeast or bacterial) versus just inflammation or allergy. Have your vet do a skin cytology (super easy… we vets do it all the time) to see if there is infection. Your vet might clip the fur, send medicated cleansing wipes or a cream based on the cytology results.
I suggest you chat with your vet about a salve or cream for the area of dermatitis.
Best,
Joi