Q: My 14-year-old cat, Tiger, was diagnosed with severe asthma. We have already gone through multiple medications, and nothing has really stabilized it yet. She almost died the other night from a veterinarian prescribing her high doses of cyproheptadine as an appetite stimulant.
She continues to wheeze even though she is on triamcinolone and albuterol. We recently gave her a depo-medrol shot. She barely eats, and she wheezes harder and gags after eating. She breathes through her mouth a lot, and she won’t touch her water. I give her subcutaneous fluids daily. She urinates regularly and has had small bowel movements most days. I plan on giving her flovent as soon as I can get it. Are there any other options to treat my cat’s severe asthma?
A: Wow, this is a very severe case of asthma. I’m surprised that she got so sick from the cyproheptadine. Cyproheptadine is an antihistamine that has the unusual side effect of making many cats hungry, and it can be helpful in overcoming a poor appetite. I don’t know what kind of reaction she had to it, but the only reaction I’ve ever seen is sleepiness (not surprising, for antihistamines). A few years ago, it had been suggested that cyproheptadine might be helpful in asthma treatments for cats, but subsequent studies have shown the drug to be ineffective for this. It is still useful as an appetite stimulant, however.
The cornerstone of treatments for cats with severe asthma is steroid therapy, and your cat is already on a potent steroid (triamcinolone). If steroids alone are not effective, a bronchodilator can be administered as well. You are already doing that with the albuterol. Depo-medrol is another potent, long-lasting steroid, and the fact that she receives triamcinolone and yet has been given additional steroids via injection is worrisome. Cats are fairly resistant to the negative side effects of steroids, however, excessive use of steroids can cause diabetes in cats, and they can cause a disease called Cushing’s disease.
Cats that don’t respond to oral or injectable steroids might respond to inhaled steroids. Inhaled steroids have an advantage in that the drug is delivered directly to the site where the problem is (the lungs). They also have few systemic side effects because the inhaled molecule is not significantly absorbed into the bloodstream. Bronchodilators are also available in inhaled form and may be useful as adjunct therapy. Trudell Medical International makes a feline aerosol chamber called Aerokat that is designed for administering inhaled medications to cats with severe asthma. Good luck with Tiger.
Arnold Plotnick, DVM