Veterinary care should include diagnostic tests and subsequent treatment recommendations. Diagnostic tests are needed to recognize bronchopneumonia and exclude other diseases.
A complete medical history and thorough physical examination should be performed by your veterinarian. Clinical signs, radiography and a hemogram are usually sufficient to make a presumptive diagnosis of bacteria pneumonia. Airway cytology and culture can confirm the diagnosis. Radiography (chest x-rays) can often check for increased lung density (lung consolidation). Lung changes may differ with bacterial versus fungal, viral or parasitic infections.
A complete blood count (CBC) may indicate signs of infection with an elevated white blood cell count and an increased number of immature cells (increased band count). The magnitude of change is not consistently related to the extent of infection. Overwhelming bacterial pneumonia may cause a low neutrophil cell count.
A tracheal wash is a procedure in which a fluid sample from the trachea is analyzed. This test is also called a trans-tracheal wash (TTW). Fluid samples can be obtained by placing a small needle into the trachea in a lightly sedated patient. Transtracheal or endotracheal aspiration cytology determines infection based on the examination of the cells present. Bronchoalveolar lavage is a test in which fluid samples of the bronchus and alveolar (lung tissue) is obtained.
Further diagnostic testing may be needed to diagnosis a concurrent condition or eliminate other causes of similar symptoms (such as heart disease). These tests may include:
Bronchoscopy, which consists of placing a small flexible fiberoptic tube into the airway. This test may establish the diagnosis and rule out other diseases such as inflammatory disease, lungworms, fungal infections and neoplasia.
Biochemistry tests (serum blood tests) may be recommended to determine general health and check for secondary conditions.
Checking arterial blood gases is a method to determine oxygen levels. This sensitive test verifies the presence of significant lung disease. Many veterinary hospitals do not have the equipment to run this test but blood can be analyzed easily at a local human hospital.
Blood cultures may be useful to determine bacteria levels present in the blood.
Fine needle lung aspiration, using a fine needle or instrument to evacuate fluid or tissue by suction
Fecal (stool) examination may be necessary to evaluate for evidence of parasites and aid in diagnosis of lungworms
Conditions that are predisposed to bronchopneumonia may be evident from the history, physical and neurological examinations or may require additional studies such as a barium swallow to identify swallowing disorders and bronchoscopy to identify a bronchial foreign body. Caution: further aspiration may worsen pneumonia
Treatment of bronchopneumonia is usually individualized based on the severity of your pet's condition, the cause, secondary diseases or conditions and other factors that must be analyzed by your veterinarian.
Pneumonia can be a severe and progressive condition that causes difficulty breathing. Severely ill pets with a fever, not eating, lethargic and/or difficulty breathing may require hospitalization with oxygen, intravenous fluids and antibiotics and supportive care.
Mildly affected pets that are well hydrated and eating properly may be treated as an outpatient with frequent follow-ups to monitor the progression of the infection.
Treatment of bronchopneumonia may include the following:
Keep your pet well hydrated and warm. Fluid therapy is often required to prevent dehydration, which can cause thickening of respiratory secretions.
Coupage (clapping on the chest to mobilize/loosen secretions) is recommended 4 to 6 times daily. Once the patient feels better, brief walks (followed by coupage) help to mobilize tracheobronchial secretions.
Airway humidification may assist in expectoration (productive coughing) of secretions.
Expectorants like guaifenesin are of uncertain value and are not typically prescribed.
Bronchodilator therapy is not of proven effectiveness but may reverse irritative bronchoconstriction and strengthen respiratory muscle effort in pets having difficulty breathing.
Antibiotics should be prescribed for at least three weeks; duration of therapy may be longer pending clinical results and radiographs. Antibiotic choice should be based on culture and sensitivity (obtained by transtracheal washing) or on likelihood of empiric success and with consideration of current or prior antibiotic therapy. Antibiotics recommended may include cephalexin(Keflex®; Keflin®; Kefzol®), sulfadiazine-trimethoprim (Bactrim®; Septra®), enrofloxacin (Baytril®), amoxicillin-clavulanic acid (Clavamox®), tetracycline (mature dogs), chloramphenicol or cefadroxil. In life-threatening blood contamination (sepsis), the combination of intravenous cephalothin or ampicillin plus enrofloxacin should be considered. Newer generation cephalosporins (e.g. moxalactam) are very expensive and usually reserved for resistant infections.
Bronchodilator drugs include xanthine derivatives and beta adrenergic (sympathomimetic) agonists. Bronchodilators also may increase the vigor of contraction of the respiratory muscles, which may be useful in dogs with dyspnea. Theophylline and its various salts are most commonly chosen. Some dogs cannot tolerate the adverse effects of xanthines, which include anxiety, restlessness, tachycardia (abnormally rapid heart rate), polyuria (frequent urination) and emesis (vomiting).
Cough suppressants are inadvisable.
Humidified oxygen should be administered to dyspneic, severely cyanotic or hypoxemia pets.
Management of bacterial pyothorax (pus in the cavity around the lungs) requires thoracostomy tube drainage and antibiotics. Since anaerobic organisms are commonly involved in pyothorax, treatment with alone or in combination with sulfadiazine-trimethoprim or clindamycin is recommended.
Encourage appetite with good quality food.