Table 8 Conventional and immunomodulatory therapeutic approach to feline asthma

Glucocorticoids

Dexamethasone (0.15–1 mg/kg intramuscular [IM] or IV) is indicated in cats that show signs of acute dyspnea [70, 73].

Oral prednisolone (0.5–1 mg/kg BID) is recommended for the first 7 to 14 days. Once clinical signs are well controlled, the dose can be gradually reduced over 2 to 3 months to once a day.

Inhaled fluticasone (110 mcg BID for 2 to 3 weeks) is an alternative although it is not useful in a crisis because it takes about 10 to 14 days to become effective and, since pets cannot be trained to inhale correctly, administration of aerosolized drugs requires the use of mask.

Injectable methylprednisolone acetate (10–20 mg/cat IM or SC every 4 to 12 weeks) may also be used [70, 73].

Bronchodilators

β2-receptor agonists, such as terbutaline (0.01 mg/kg IM or SC), or albuterol (90 mcg inhaled) to reduce bronchoconstriction and relieve airflow limitation [70, 73].

The most generally used are β2-receptor agonists, namely terbutaline (0.1–0.2 mg/kg PO TID or BID), and less commonly methilxanthine derivates such as theophylline (the recommended dose of sustained-release theophylline in cats is 20 to 25 mg/kg PO SID, and for non-sustained-release theophylline 4 mg/kg TID or BID) [70, 73].

Allergenic-specific immunotherapy

—

Intravenous or subcutaneous allergenic-specific immunotherapy was proved to decrease eosinophilia airway inflammation and is generally associated with minimal side effects [70, 75].

Inhibitors of tyrosine kinase

—

Inhibitors of tyrosine kinase are small molecules that block ATP-binding site of kinases. During a trial model of feline asthma, this therapy has proven to be efficient in reducing airway inflammation [68, 76].

Cyclosporine

—

Cyclosporine inhibits T-cell activation and blocks the development of a Th2 phenotype and the associated Th2-eosinophil interactions. In a feline asthma experimental study, Mitchell et al. (1998) [77] demonstrated that cyclosporine did not inhibit the early phase response to allergen challenge, but it was effective at reducing airway hyperresponsiveness to acetylcholine and airway remodeling [78].