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At a glance
About: Coughing (tussis) is a common reflex action which clears the throat and lungs of mucus and foreign irritants.
Causes: Parasites (lungworm, heartworm, roundworm migration), infection (cat flu, bordetella, plague, pneumonia), asthma, allergies, pulmonary edema, hairballs, heart disease, lung tumours, inhalation of irritants, collapsed trachea, upper airway obstruction, brachycephalic syndrome.
Diagnosis: A thorough physical examination and baseline tests. Additional diagnostics will depend on the veterinarian’s index of suspicion but may include x-ray, heartworm tests, fecal analysis, tracheal endoscopy, thoracic fluid analysis, echocardiogram.
Treatment: The goal of treatment is to find, and address the underlying cause.
Coughing (tussis) is a reflex action and serves as a protective measure designed to rid the airways and lungs of particles, inhaled food or water, mucus, irritants, and microbes. It is a symptom of an underlying disorder and not a primary disease in itself.
The purpose of coughing is to prevent noxious materials entering the respiratory system (think about how we cough when we inhale smoke or chemicals), it also helps to get rid of substances from the lungs and respiratory tract which may include mucus, inhaled food or water.
Coughing may be acute (sudden onset), which lasts for one to two weeks, or chronic coughing, which lasts longer than two weeks.
There are several types of cough:
- Dry and hacking
- Dry with a rattle or wheeze
- Wet, producing mucus
- Honking (similar to the sound a goose makes)
The type and frequency of a cough can give your veterinarian a clue as to what the cause may be.
The most common causes of coughing in cats are asthma, pneumonia, heartworm, and lungworm.
- Heartworm – Worm infection of the pulmonary arteries, heart, and lungs. Arrival of the immature worms in the pulmonary arteries causes inflammation and what is termed HARD. Heartworm Associated Respiratory Disease.
- Lungworm – Worm infection of the lungs which causes inflammation.
- Roundworm migration – Migration of roundworms from the bloodstream to the lungs.
- Paralysis ticks – Ixodes holocyclus are ticks found predominantly along the east coast of Australia which injects a neurotoxin into the cat as it feeds. One of the early signs of tick poisoning is coughing due to the onset of paralysis.
Infectious or inflammation:
- Cat flu – An upper respiratory infection caused by a number of viruses including feline herpesvirus, calicivirus, and feline reovirus.
- Fungal infection – Blastomycosis.
- Feline Bordetella – Bacterial cough caused by Bordetella bronchiseptica, it is the same bacteria which causes kennel cough in dogs
- Pneumonia – Infection or inflammation of the lungs which may be bacterial, viral, fungal, parasitic or due to aspiration.
- Pneumonic plague – A bacterial infection caused by Yersinia pestis.
- Tuberculosis – A rare bacterial infection which is of significant importance due to it being zoonotic (transmissible to people).
- Asthma and bronchitis – Tightening of the airways, there are potential triggers for asthma such as cigarette smoke, perfume, household fires, sprays, dust etc.
- Allergies – Airborne allergies such as dust, mould, smoke, pollen, dust mites.
- Pleural effusion – Accumulation of fluid in the pleural cavity, fluid may be blood, chyle, transudate. There are many possible causes of this including cancer, congestive heart failure, liver failure, fluid overload, infection and torn blood vessels.
- Pulmonary edema – Fluid in the lungs.
- Hairballs – Accumulation of hair in the stomach and intestine.
- Heart disease – Not one disease but a number of disorders relating to the heart.
- Lung tumours – Benign or cancerous tumours of the lungs. May have originated in the lungs or spread (metastasized) from another location, metastasized lung tumours are common in cats as the lungs receive blood flow from the rest of the body.
- Congestive heart failure – A life-threatening disorder which occurs when the heart doesn’t pump blood as efficiently as it should. This causes fluid to back up in the lungs and abdomen, while other organs don’t receive enough blood in order to function properly.
- Nasopharyngeal polyps – Benign growths arising from the mucous membranes of the nose.
- Pulmonary embolism – A blockage in the lungs most commonly caused by a blood clot but other blockages may include gas, heartworm, fat globule or tumour.
- Inhalation of foreign body, chemical, or irritants – Such as smoke or bleach.
- GERD (reflux) – A condition in which gastric juices flow back from the stomach and into the esophagus resulting in pain and inflammation. Over time scar tissue can build up leading to a narrowing and tightening of the esophagus.
- Collapsed trachea – The trachea is a rigid tube which carries air from the cat’s mouth and nose to the lungs, collapse can occur when the trachea narrows or collapses.
- Upper airway obstruction – Due to polyps, neoplasia, laryngeal paralysis, or foreign body.
- Brachycephalic syndrome – This disorder is seen most frequently in short-nosed breeds of cats. Their facial structure is as such that the nose and maxilla (jaw) are reduced in length but the soft tissue inside the mouth and neck are normal in structure and size. This mismatch means that the airways are not open as they should be as they are.
As all coughs have an underlying cause, it is common for other symptoms to be present also. These may include:
- Difficulty breathing (dyspnea)
- Increased respiration rate
- Exercise intolerance
- Reluctance to exercise
- Weight loss
A coughing cat is not normal and it is important to see a veterinarian to determine the cause. This is even more urgent if your cat is experiencing difficulty breathing. Breathing difficulty signs include deep or rapid breathing, noisy breathing, shallow breathing and panting. The gums may be pale or blue-tinged, which is a sign of poor oxygenation. All of these symptoms are a medical emergency.
It is easy to confuse sneezing or the gagging and retching associated with hairballs with coughing. If possible, try to get a video recording of your cat coughing to show to your veterinarian.
The veterinarian will perform a physical examination of the cat and listen to the heart and lungs as well as obtain a medical history.
- How long symptoms have been present?
- Do they occur after an event (such as exercise) or at a particular time of the day or year?
- Does the cough sound wet or dry?
- How is the cat between coughing episodes?
- Any other symptoms you have noticed?
- Does the cat receive regular heartworm preventative?
- Is the cat regularly treated for common parasitic worms?
- Does the cat go outside, and if so, does it hunt?
The type of cough and other presenting symptoms (if any) may be indicative of the cause. Three such examples below:
- A cough which is accompanied by sneezing and nasal discharge may suggest cat flu.
- Coughing accompanied by wheezing may suggest asthma.
- A honking cough is seen in cats with a collapsed trachea.
- Biochemical profile, complete blood count, and urinalysis. These baseline tests can evaluate for signs of infection or inflammation as well as rule out a systemic cause.
- Chest x-ray which may determine the presence of asthma, pleural effusion (a collection of fluid inside the chest cavity around the lung) and heartworm disease.
- Heartworm antibody and antigen tests.
- Fecal analysis and/or flotation which may detect the presence of pulmonary parasites. Repeat fecal examinations (at least three) may be required due to the intermittent shedding of lung parasites.
- Tracheal endoscopy to evaluate the trachea. Biopsies and phlegm may be removed for testing.
- Thoracic fluid analysis where pleural effusion is present.
- Echocardiogram – An ultrasound to evaluate the size and shape of the heart and vessels as well as to look for heartworms in antigen-positive cats.
It is important to identify the cause of the coughing and treatment depends on the underlying cause but may include:
There are no medications which have been approved for use in cats with heartworm. Treatment is aimed at supportive such as bronchodilators to assist with breathing. In severe cases, the veterinarian may decide to give medications to kill the heartworm, this comes with risks though and should only be used as a last resort.
Avoidance of the trigger if possible, corticosteroids to relieve symptoms and hyposensitisation (allergy shots) may be of help in some cases.
Treatment depends on the type of heart disease your cat has, but may include medications to improve the function of the heart, diuretics to remove fluid, which can accumulate in cats with congestive heart failure, ACE inhibitors to relax blood vessels and lower blood pressure, surgical repair, low salt diet, keeping your cat in a stress-free environment.
Supportive care such as fluids to treat dehydration and nutritional support. Antibiotics may be prescribed to treat secondary bacterial infections.
Lungworm and roundworm
These worms are easily treated with worming medications as well as supportive care, where necessary.
Asthma and bronchitis
Steroids to reduce inflammation (either oral or inhalant form) and bronchodilators to open up the airways.
Thoracentesis to remove fluid from the pleural cavity, surgery may be necessary to treat the unresponsive cases.
Bulk up the diet with bran, pumpkin or lubricants can help the cat pass a hairball more easily. There are also special hairball diets available from your veterinarian.
Surgical removal of the polyps.
Antibiotics are prescribed to treat Bordetella. There is also a vaccine available now.
Removal of the ticks, if paralysis has occurred aggressive treatment will be necessary. Oxygen to assist with breathing, antiserum in counteracting the poison, your cat will have to spend several days at the veterinarian recovering. This is a life-threatening condition.
Blood-thinning medications as well as drugs to break down the embolism. Supportive care such as oxygen therapy will also be necessary.
Where possible, treat the underlying cause if it can be established and prevent further damage to the esophagus with antacid medications to inhibit the production of stomach acid. Cats with a severely damaged esophagus may require a stomach tube. Unfortunately, this is not a long-term solution.
Congestive heart failure
Managing the medical cause as well as relieving symptoms such as oxygen therapy, thoracentesis, diuretics to assist with fluid removal via the urine, vasodilators to open up the vessels.
Antibiotics to treat bacterial infection and supportive care including oxygen therapy, fluids to treat dehydration and cage rest.
Careful weight reduction, cough suppressants, corticosteroids to relieve inflammation and bronchodilators to open up the airways.
In most cases due to the seriousness of this disease as well as the risk of infecting people, euthanasia is usually recommended.
Upper airway obstruction
Immediate care to stabilise the cat may include oxygen therapy, keeping your cat as stress-free as possible as stress can exacerbate the problem, short-acting corticosteroids to decrease inflammation and fluid therapy. Surgery to remove the obstruction,
Finding and treating the cause where possible and supportive care such as removing fluid from the pleural cavity (thoracentesis) and oxygen therapy.
Supportive care such as non-steroidal anti-inflammatory medications, corticosteroids, and oxygen therapy. These aren’t curative but can help relieve symptoms. Surgery to shorten the soft palate will be necessary to cure the disorder.
Can I give my cat cough medicine to treat a cough?
No, cats are not small humans, they have a different metabolism to us because they lack the necessary liver enzymes to process the active ingredients in cough medicines such as codeine, paracetamol and pseudoephedrine. All of which can cause death if administered to cats.
Only give your cat medications prescribed by your veterinarian.
Never administer human cough medications to cats as these are extremely toxic to cats.
Follow the veterinarian’s instructions and administer medications as prescribed.
Try to keep your cat in an environment which is as stress and toxin free as possible to avoid triggers, which can irritate the airways, these include:
- Don’t smoke around your cat, second-hand smoke is a known carcinogen for both cats and people as well as a major trigger for cats with airway disorders.
- Avoid using wood or coal burning fires.
- Avoid using synthetic chemicals, where possible, switch to natural household cleaning products such as white vinegar and bicarbonate of soda.
- Weight loss for overweight cats, in a slow and controlled manner, this must be supervised by the veterinarian.
- Switch to a dust-free cat litter.
- Avoid household sprays such as spray-on deodorants and hairspray.