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Microsoft word - protocol guidelines for using flovent 2004.doc
Treatment Guidelines for Using Inhaled Medication
Flovent™ (fluticasone propionate) and albuterol metered dose inhalers
with the AeroKat™ Feline Aerosol Chamber
2004 Dr. Philip Padrid, RN, DVM
Once a diagnosis of asthma has been determined, the next step is to decide if the clinical signs are mild,
1. Mild symptoms:
In these cases, the symptoms do not affect the way in which the cat conducts its
business (quality of life). In these cases, between “attacks”, the cat eats, drinks, and plays as if nothing is
2. Moderate symptoms:
In these cases, the asthmatic condition sometimes affects the way the cat
conducts its business (e.g., it may tire easily, it may wake up at night coughing). Symptoms are present
on most days and may include in creased effort to breathe and/or daily cough.
3. Severe symptoms:
in these cases, the asthmatic condition is continual and clearly limits the cat’s ability
to conduct its business. These cats are not comfortable at rest, and the symptoms occur for most of each
In summary, to classify cats with asthma, we take the following steps: (1) determine if the signs are intermittent
or daily, and (2) determine the severity of daily symptoms. These two steps are the beginning of a rational
treatment plan. In cats that have sporadic and not daily symptoms, the cause of the sporadic symptoms is from
bronchoconstriction that is acute and non-predictable (spontaneous). In these cases it is usually not necessary to
treat with corticosteroids, neither is it necessary to treat daily. Albuterol alone is an appropriate symptomatic
treatment. For the cat that had been displaying daily symptoms of varying severity and is using inhaled
corticosteroid therapy yet presents the occasional symptom, albuterol is the first choice before increasing the
Treatment of Feline Asthma
Mild Daily Symptoms.
These cats have daily symptoms but in between the coughing and wheezing, they are
generally unaffected by their disorder. For these cats, I prescribe 110 mcg of Flovent™, 1 actuation (puff) twice
daily into the AeroKat™ spacer. [Details of using an MDI (metered dose inhaler) with a spacer are given
below.] I also prescribe albuterol inhaler as needed for those times when symptoms are particularly
troublesome. Because inhaled Flovent™ takes about 7-14 days before its maximum effect is seen, these cats
will likely continue to be symptomatic for an additional week or so. Clients should be supported through this
period and encouraged that their pet is going to begin to improve after the first week of therapy. If the pet is
doing well after two months on the 110 mcg BID (total 220 mcg/day) dose, some patients will continue to do
well after a decrease to 110 mcg once daily.
Moderate Daily Symptoms.
These cats have daily symptoms that have a negative effect on their quality of
life, but their cough, wheeze, or dyspnea is not constant. For these cases, I prescribe 1 actuation of Flovent
110 mcg into the AeroKat™ twice daily. I also prescribe 1 mg/kg of prednisone administered orally twice daily
for 5 days and then once daily for 5 additional days. After 10 days of combined oral and inhaled steroids, the cat
has generally shown great improvement and the oral prednisone can be discontinued without further taper. Oral
prednisone is used in this setting because significant daily symptoms suggest the presence of a more aggressive
inflammatory component that should be more aggressively treated. Albuterol administered as needed. Severe Daily Symptoms.
These cats are symptomatic and uncomfortable at rest and require aggressive early
management. I begin with 2 mg/kg of dexamethasone administered intravenously and inhaled albuterol every
30 minutes for up to 4 hours. This frequency of albuterol treatment generally does not cause side effects or
might cause slight muscle tremor. These cats are also given 40% to 100% oxygen either by nasal cannula or
oxygen cage. Once these patients are stabilized (their symptoms are dramatically improved), they can be
discharged with 1-2 actuations 110 mcg of Flovent™ administered twice daily (total 220 – 440 mcg/day) into
the AeroKat™, and albuterol administered four times daily as needed. Some of these cats with very severe
symptoms may also require intermittent lower doses of oral prednisone or a higher maximum dose of 880
mcg/day Flovent™, but this is tailored for the individual patient.
Using Flovent™ or albuterol with the AeroKat™ Feline Aerosol Chamber
1. Check that the AeroKat™ is free from any obstructions or foreign matter. 2. Insert MDI into back of chamber. Hold and shake for 15 seconds to load the valve inside the MDI. 3. Place mask on cat’s muzzle, making a gentle seal around nose and mouth. 4. Depress and actuate the MDI and count to at least 10 seconds. 5. Repeat steps (shake, depress and count) if prescription warrants.
Corticosteroid accumulation at the mask contact area may cause a benign dermatitis in rare cases. For
prevention, wipe the muzzle with a damp square of paper towel after Flovent™ administration. Candidiasis is
not a concern in the feline. Flovent™ needs to be administered twice a day, with the exception of some mild cases, and has an in vivo half-
life of approximately 8 hrs. The therapeutic range for feline asthma falls between 110 mcg and 880 mcg per
day. Once the lowest therapeutic dose has been achieved and the cat has an extended period of stability, that
dosage should be continued for the life of the patient unless daily symptoms change significantly. What works
for an individual cat is the treatment to maintain.
Flovent™ is a registered trademark of GlaxoSmithKline. AeroKat™ is a registered trademark of Trudell Medical International.
1Padrid, P. Feline Asthma: Diagnosis and Treatment. Veterinary Clinics of North America: Small Animal Practice. Vol. 30, Number
Feline Asthma. Treatment Guidelines for Using Inhaled Medication. 2004 Dr. Philip Padrid, RN, DVM
Contact information: Dr. Philip Padrid. Family Pet Animal Hospital. 1401 West Webster Ave., Chicago,
Illinois, USA 60614 (773) 935-2311 Website: http://www.familypetanimalhospital.com
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