Asthma inhaler (flovent) & heart disease question

Last Thursday, Doodle was diagnosed with asymmetric septal hypertrophy and a lower respiratory disease - (heart disease and asthma)
(He also has diabetes, kidney disease, hypertension, and an adrenal disorder.)
He was sent home with a RX for an emergency albuterol inhaler and an Aerokat.
I thought she had said she didn't want to use oral drugs due to his kidney disease and didn't want to use flovent because it was a steroid and it would make his diabetes more difficult to control - but apparently that was NOT her concern regarding flovent.

I called her back today to tell her I had done some reading and felt comfortable using inhaled steroids despite his diabetes and that I could get flovent without an RX.
But she told me Doodle was "not a candidate for a maintenence inhaler" because of "the level of his heart disease" and the risk of heart failure.
She said that all this was a very delicate balance - esp. with heart disease and renal disease and asthma... and that we would just need to deal with the wheezing and rely on the emergency inhaler.

Are there any other kitties here who have heart disease, renal disease and asthma?
And have others been told this?
I hate not being able to do anything.

 

What a list there! Are you a member of the yahoo group "Feline Asthma Relief"? I bet someone over there would know the answer to your questions!

 

I just joined that group Kelly - thank you.
And Sherry (Sherry and Zoe) is also trying to help find more info.
I've been trying to just search for the info - but maybe I should just post over there...

 

Hi Michelle,

I just posted to Feline Asthma Relief ....I used your words from above, so I didn't mess anything up.....how is Doodle Bug?

 

Thank You Sherry!!
I just saw the post

 

Hi Michelle

I looked at his echo report ... there is heart disease but the numbers don't look bad to me. I was off for the past five days (I have a funny schedule) so I'll print it out and look at other references at work tomorrow ... Regarding the general question re: flovent and heart disease, not specifically Doodle:

It appears to be only cats that have issues with steroids and heart disease. For reasons that aren't clear, systemic steroids can push a cat with otherwise mild/moderate disease into CHF. Flovent is inhaled and acts directly on the respiratory tract. It is very likely to have some very small (negligible) degree of systemic absorption, but not enough so that it is contraindicated in any and all cats with heart disease.

So I'll just be honest with you, I'm a little baffled at the cardio's response. Flovent is unlikely to be absorbed to any measurable degree, the steroid/CHF connection is irregular (it's usually associated with longer acting injectable steroids), and your cat is having actual trouble breathing. Being able to breathe without struggling is important for health reasons and for mental and quality of life reasons. If the albuterol is helping him, I'd suggest that is a good indicator that he has lower airway (lung) disease of some sort, and treatment would be beneficial. It is entirely possible that the cardiologist has some experience which makes her say what she's said -- that is the usual reason when a doctor strongly believes something that is not "textbook." (There is nothing in the medical literature that even hints at a correlation between Flovent treatment and CHF in cats.) But personally, if my cat was having trouble breathing (which he did), he'd be on Flovent (which he is), period. Struggling to breathe is unacceptable to me.

Now you have to do this in light of the fact that the cardio thinks there is a risk to worsen heart disease by which I assume she means there is a risk of inducing CHF. Again personally, my own risk vs. benefit analysis would clearly lead me to treating the breathing problem. I am under the impression -- correct me if I'm wrong -- that Doodle is having frequent wheezing episodes that are affecting his QOL. I guess my point is, if he is having trouble and it is responsive to treatment for lower airway disease (albuterol), then there isn't much choice but to treat it. Now if you can give albuterol and he's good for 4-6 weeks without any symptoms, I'd stick with albuterol. But if you have a cat that needs albuterol for attacks several times a week, or several times a day, he needs primary treatment IMO. The safest of these treatments for cats with heart disease is inhaled steroid (flovent/fluticasone).

Now I'll take a look again at the echo report -- maybe I was confused somewhere. I'll check some references tomorrow. (Nudge me if I dont' write you by Wednesday night. Tomorrow is our late-night-appts so I may not get to it tomorrow.)

Did you order the Flovent already? I'd order it in the meantime, it takes so long to get here and you may have a decision by then.
Take care and keep us posted.

 

Hi Jess
Thank you!
I talked to my regular vet yesterday and she seems to agree with what you are saying. She said she is not aware of any problems with flovent and heart disease - that it would only apply to systemic absorption and that inhaled steroids just didn't fall into that category.
Plus, she said she was under the same impression that I was (and that you are) - that his heart disease is not THAT bad. (she was going to have a second look at his report as well)
We also discussed the quality of life issue and I definitely can't see letting him continue to struggle to breathe comfortably. You can hear him breathing across the room - it's constant... and it sounds like a small ventilator. He's also had a couple of coughing episodes now.
The cardiologist also mentioned to me that cats can build up an immunity to the inhalers and then you have to increase or even change meds -- but this sounds like a longer term issue to me.

My feeling is, at this point, that I just want him to be comfortable and enjoy what time he has left. I'm not expecting to buy him several more years...
so I'm not as concerned about the long term issues.

Another member here was kind enough to share her flovent with us so we'll be getting that in the mail in a day or two. (I'm not naming names in case anyone here has a problem with that and feels the need to complain)
I'm going to go ahead and start him on it. I think it's the only decision I will feel good about.
thank you so much for helping us -- yet again

 

I'm glad Jess dropped by! I think if the flovent helps Doodlebug, your vet doesn't see an issue, Jess didn't so far, then go for it. I couldn't imagine hearing my cat wheeze from across the room and basically have my hands tied to help.

You are da bestest momma-bean!!

 

Michelle I forgot to mention, but you probably saw on the fritz the brave site, you should make sure that there is nothing in your house that is different, that could be triggering an allergic bronchitis. No new cleaners, laundry stuff, no recent carpet cleaning, plants, etc. And also it helps to keep the air in your house as clean as possible i.e. no scents, no incense, scented candles, aerosol anything, powders, check the ceiling fans and vents as these are both dust-blowers if they aren't kept clean. No one smokes in your house, right?

Did your vet try him on an antihistimine? I forget.

Oh also I was wondering, does albuterol help him breathe more clearly for a while?

 

I've been going over everything I can think of.
No one smokes here.
I stopped using perfumes and scented anythings a few years ago when I read how sensitive cats are.
We don't have carpet and I ditched all the plants when we first got Doodle, because he nibbled them and I wasn't sure what was safe and what wasn't .
There's only a few things I can think of:
1. We bought some new furniture a few weeks ago and it outgassed quite a bit. I opened the windows and put an air cleaner in the room after that though.
2. Brielle got a new memory foam mattress - which probably also outgassed a bit as well. (though I didn't really smell that)
3. Abbey was peeing out of the box so I decided to try scoopable clay litter about 2 months ago. They didn't have unscented so I got the scented one. ohmygod_smile Abbey stopped peeing out of the box so I stuck with it. It's way dustier and smellier than the feline pine and swheatscoop they were used to.
---I got rid of that litter the day after his cardio appt. but it hasn't really made much of a difference yet.

I haven't really used the albuterol since the other night because I was concerned it might speed up his heart and I wasn't sure what the heck the cardiologist meant - so I can't honestly say if it works or not. It's weird though, all the youtube videos I saw of cats with asthma are cats coughing - which Doodle isn't really doing. He's mostly just breathing with difficulty and actually sounds congested to me - almost like an URI but without the sneezing and runny nose.
I'm going to try to post a video later.

My vet did give me a prescription for ciproheptadine in hopes that it might have the dual benefit of an antihistamine and an appy stim.
I think it gives him dry mouth because he walks around with his tongue hanging out - he also acts kind of weird and wobbly. He fell off my nightstand twice last night after I gave it to him and he was the same way last time he had it. It makes me worried he's going to hurt himself...
I have a call into my vet about trying a reduced dose.

 

One of the side effects of cyproheptadine is dry mouth. How much are you giving? The standard tablet is 4 mg and a lot vets prescribe 1/2 tablet but for many cats that is too much. Some people use 1/4 or 1/8 of a table.

 

Thanks Larry. (I just realized I misspelled cyproheptadine)
My vet suggested 1/2 to 1 tablet so I gave him 1/2 - thinking I should start on the low side.
But I tried the 1/4 last night and he seemed better with that.
Honestly though I don't really think it's making much change in his appetite and it certainly didn't do anything about his breathing.

Anyway I think you're on the money here, and 1/2 was just too much for him.