Experiences with Bronchoscopy

[DillandAnnie]

I'm wondering if anyone has had their cat undergo a bronchoscopy or a bronchoalveolar lavage (BAL).

My 10-year-old cat has been having rapid, shallow breathing since July or so. Our primary vet and the Internal Medicine specialist we've seen believe it's asthma from the x-rays we've had done. He never really coughs, but his breathing is more rapid than it should be (usually 40-45 breaths per minute) and I hear some wheezing. The radiologist said his heart looks to be in good shape, but we didn't have an EKG or any further testing in regards to his heart.

We tried a round of prednisolone and have been using a steroid inhaler as well as albuterol inhaler as needed. The pred made his breathing better - back down to 30 breaths per minute - but he was still wheezing. The albuterol inhaler didn't seem to help either, so I'm wondering if there is something else going on in addition to his asthma. He's does have supervised outdoor access, although he is on Bravecto Plus for fleas, heartworm, etc.

The specialist said in order to rule out other causes, the next step would be to do a bronchoscopy with BAL. We scheduled one for next week, but I'm scared to go through with it after reading varying things about how risky it is. I assume he's a good candidate for the procedure, otherwise I don't think the vet would schedule it. Aside from the faster breathing and wheezing, he seems healthy and his bloodwork was normal. He's not open mouthed breathing or panting, either. However, it does sound like complications are common with the procedure.

Has anyone here had a cat who's gone through a bronchoscopy? Or have any insight into the procedure? I'm going to call the specialist on Monday to talk about my concerns, but I'm worrying in the meantime. Thanks in advance!

 

[FeebysOwner]

I am sorry no has responded to your post yet. I tried to do a search on this site for previous threads related to bronchoscopies and found very little - what I did find is very, very old.

My only suggestion at this point is to search the internet and read every article you can find in order to develop a list of questions for the specialist. I know you said this is an internal med specialist, but do they have a connection to a vet that specializes in pulmonology?

 

[mrsgreenjeens]

I, too, have searched this site for people whose cats have had this procedures and only found two, and those were 20year old threads, and the posters never came back to say how they went. Most people considering the procedures backed out because of possible complications and/or expense.

I would have a heart to heart with the Vet to make sure you know exactly what to expect and see just how necessary this is.

 

[DillandAnnie]

Thank you both, I appreciate your input. I did a lot of reading over the past couple of days and formed a list of questions for the specialist.

I'm confused as to whether a bronchoalveolar lavage is always done with a bronchoscopy, so I will ask him that. It sounds like the lavage is relatively safe, as long as the proper precautions are taken. Unfortunately, since he did have to be weaned off the pred before the procedure, he's now wheezing more, so that's another concern I'll raise. I'll also talk to him about the complications that could arise and if he's still a good candidate now that his breathing is faster. I appreciate both of your suggestions!

 

[FeebysOwner]

Wish we could provide more help. Please keep us posted, if you want.

 

[DillandAnnie]

Thought I’d post an update in case anyone is looking for information on the topic.

Dillard had the procedure yesterday and was able to come home the same day. We spoke to the specialist about our concerns beforehand and he was very open to them and able to address them. He thought Dillard was a good candidate for the procedure, despite his high respiratory rate. He also said they do the procedure relatively frequently, which made me feel better.

I didn’t look too hard for a pulmonary specialist, but I believe the nearest one is at the university 2 hours away, and didn’t feel like Dillard would do well waiting until an appointment and then driving that far. We’ve seen other specialists at the practice we went to and had been very happy with them, so we had confidence in their expertise and ability to do the procedure.

The vet said he saw a lot of inflammation with the Bronchoscopy and that the lavage brought up a lot of mucus. They also did a PCR test for upper respiratory issues, and heartworm and lungworm tests. We’ll have to wait a few days for the results to come back, but I’m hopeful we can figure out what’s going on, even if it’s just ruling other things out and getting a more definitive asthma diagnosis. I’m glad we had the procedure done and will say while the cost was high, I was actually surprised at how reasonable it seemed. It was less than the MRI he had done a couple of years ago and certainly less cost over the long run than taking him back and forth to the ER and multiple visits to the vet.

I will try to post an update once we hear the test results. Thanks again for helping me think through the best course of action.

 

[fionasmom]

Thank you for letting us know how the procedure turned out. Very glad that it was uneventful and easy for Dillard. Please update as you can.

 

[Blahblahblah]

I know this is an older post, but I'm in this same situation with my cat. Did you get convulsive results from the test?

D DillandAnnie

 

[DillandAnnie]

Apologies in advance for such a long response....

In a way we did, but I never felt satisfied with the results. The IM specialist said the cells from the wash were indicative of chronic bronchitis, not asthma. He said there was no sign of an allergic response, which would point to asthma. Instead, there were predominantly inflammatory cells. However, many vets seem to use the two terms interchangeably, so it caused some confusion for me.

What I took away from the specialist was that Dillard's chronic bronchitis was going to be a constant and progressive issue, but in the end the treatment was very similar as it would have been for asthma. So I did get an answer by doing the procedure, but I'm not sure how much it changed how we treated his condition.

Unfortunately, I never felt satisfied with the diagnosis of chronic bronchitis, mostly because Dillard's symptoms didn't improve very much with treatment. I did end up doing more diagnostics, including testing for fungal diseases and a CT scan. We also treated him for lungworm and got an echocardiogram in the off chance he had heartworms. The only other issue we did find was esophageal dysmotility; he wasn't able to easily swallow dry food.

I'm saddened to say that Dillard passed away on June 23 at the age of 11. He went into respiratory distress and he was suffering from pneumothorax. His lungs were so diseased that my heart dropped when the ER vet showed me the x-ray. We chose not to do a necropsy and I have some regrets about that now as I wonder if there was something else contributing to his respiratory issues, like cancer.

Looking back, I'm not sure if I would've done things differently in terms of the bronchoscopy. I may have started with less invasive diagnostics and worked up to the bronchoscopy, but that may be hindsight talking. Dillard was 10 when these problems began, so part of me chose to go ahead with the procedure because I hoped we'd find out it was something we could cure.

I'm so sorry your cat is going through this. How old are they? If you haven't tried them already, I've found the feline asthma/respiratory groups on Facebook to be a great resource. Also, if you're in the U.S., there's a relatively new clinic out of the University of Missouri called the BREATHE clinic, which I believe opened in November. I had asked my vet to consult with them just before Dillard passed.

I hope you and your cat find some answers. It's so hard to watch them struggle.

 

[Blahblahblah]

Thank you do much for responding, it really means a lot. Fluffy is almost 11, she was diagnosed with asthma 2 and a half years ago, we've been doing Flovent since diagnosed, but she started having attacks multiple times a day starting the end of May. We got an xray done in June and her lungs have gotten worse. She lost part of her lung due to a mucus plug, a small part, but still not great. Since the inhalers aren't working and the xrays aren't the best, our vet suggested a BAL. We have an appointment to see the specialist tomorrow.
I am really torn about the procedure. It seems the couple of people I spoke to it didn't really help in the long run and it's expensive. I guess I will just see what the specialist says tomorrow and make my decision after I get more information. Thank you for replying and I'm sorry you lost your kitty.

 

[fionasmom]

I am very sorry for your loss of Dillard. You were very proactive on his behalf and the fact that you did the bronchoscopy attests to that. I would have done the same thing rather than starting with the less informative procedures.

When a cat passes on, we lock the thread out of respect. If you would like to post a tribute to Dillard in our Crossing the Bridge forum, you are welcome to do so.

Crossing the Bridge