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| Bordetella BronchiSeptica & CanIne Influenza VIRus (H3n8) Today's Veterinary Practice July/August 2014 36 tvpjournal.com tracheobronchitis or suspected tra- cheitis secondary to frequent cough- ing. Ensure the patient has no evi- dence of pneumonia and is otherwise systemically healthy before interven- ing with these therapies. Most patients with CIRDC do not require these therapies, and I do not recommend using oral/inhaled corti- costeroids or cough suppressants in patients with moderate to severe B bronchiseptica infection or CIV, espe- cially if pneumonia has developed. Cough suppressants, in particular, are contraindicated in patients with bron- chopneumonia, as suppression of cough can prevent clearance of bacteria, wors- en disease, and/or delay recovery. Bronchodilators Methylxanthines (eg, theophylline, aminophylline) and beta-2 agonists are bronchodilators that prevent bronchospasm. There is evidence that methylxanthines improve ventilation and diaphragmatic contractility in dogs, which may result in improved PaCO 2 levels in severely affected pup- pies; however, there is no evidence of benefit in patients with uncomplicat- ed CIRDC. 17 If considering use of a bronchodi- lator in a patient with CIRDC, I pre- fer methlyxanthines due to their other potentially beneficial effects, includ- ing anti-inf lammator y properties, improved mucociliary clearance, and improved diaphragmatic contractili- ty. 17 Unlike cats and humans, dogs do not develop true smooth muscle bron- choconstriction, and therefore, beta- 2-agonists are not useful in the man- agement of canine respiratory disease. In my opinion, bronchodilator ther- apy, while extremely important in management of feline lower airway disease, has limited value in canine respiratory disease and may have undesirable adverse effects (cardiac, gastrointestinal). Therefore, I do not recommend bronchodilators for treat- ment of infectious tracheobronchitis or pneumonia caused by B bronchi- septica or CIV. Expectorants Aerosolized or oral expectorant or mucolytic therapy is often instituted in cases of canine respiratory diseases that result in excessive tracheal and/or bronchial secretions. However, I do not recommend ther- apy with expectorants because: • Nebulized N-acetylcysteine can be irritating and result in broncho- spasm, further worsening tracheo- bronchitis and coughing. • Guaifenesin, an expectorant often paired with a cough suppressant, has no scientific or anecdotal (that I have observed) evidence support- ing its use in patients with B bron- chiseptica or CIV. Antiviral Agents The safety and efficacy of specific anti- viral agents, such as neuroaminidase inhibitors (eg, oseltamivir phosphate, zanaminir) has not been evaluated in dogs. 1 Therefore, these agents cannot be recommended for dogs with CIV or other respiratory viral diseases. Intranasal Vaccines There are anecdotal reports promot- ing administration of the intranasal B bronchiseptica vaccine in dogs with CIRDC. However, to date, there are no controlled studies that support its use as a "therapeutic" intervention in dogs with B bronchiseptica infection or CIV and, in critical patients with this infec- tion or virus, intranasal vaccine admin- istration may worsen the course of dis- ease because the immune system is already compromised, and an immune response places additional stress on the system. n (Continued on page 78) VETORYL ® Capsules (trilostane) 10 mg, 30 mg, 60 mg and 120 mg strengths Adrenocortical suppressant for oral use in dogs only BRiEf SummaRY (For Full Prescribing Information, see package insert.) CauTiOn: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. DESCRipTiOn: VETORYL is an orally active synthetic steroid analogue that blocks production of hormones produced in the adrenal cortex of dogs. inDiCaTiOnS: VETORYL Capsules are indicated for the treatment of pituitary-dependent hyperadrenocorticism in dogs. VETORYL Capsules are indicated for the treatment of hyperadrenocorticism due to adrenocortical tumor in dogs. COnTRainDiCaTiOnS: The use of VETORYL Capsules is contraindicated in dogs that have demonstrated hypersensitivity to trilostane. Do not use VETORYL Capsules in animals with primary hepatic disease or renal insuffciency. Do not use in pregnant dogs. Studies conducted with trilostane in laboratory animals have shown teratogenic effects and early pregnancy loss. WaRningS: In case of overdosage, symptomatic treatment of hypoadrenocorticism with corticosteroids, mineralocorticoids and intravenous fuids may be required. Angiotensin-converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient's ability to maintain normal electrolytes, blood volume and renal perfusion. Potassium-sparing diuretics (e.g., spironolactone) should not be used with VETORYL Capsules as both drugs have the potential to inhibit aldosterone, increasing the likelihood of hyperkalemia. Human WaRningS: Keep out of reach of children. Not for human use. Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you. pRECauTiOnS: Hypoadrenocorticism can develop at any dose of VETORYL Capsules. A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. Mitotane (o,p'-DDD) treatment will reduce adrenal function. Experience in foreign markets suggests that when mitotane therapy is stopped, an interval of at least one month should elapse before the introduction of VETORYL Capsules. The use of VETORYL Capsules will not affect the adrenal tumor itself. Adrenalectomy should be considered as an option for cases that are good surgical candidates. aDVERSE REaCTiOnS: The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness. Occasionally, more serious reactions including severe depression, hemorrha gic diarrhea, collapse, hypoadrenocortical crisis, or adrenal necrosis/rupture may occur, and may result in death. Distributed by: Dechra Veterinary products 7015 College Boulevard, Suite 525 Overland Park, KS 66211 www.VETORYL.com 866-933-2472 VETORYL is a trademark of Dechra Ltd. © 2009, Dechra Ltd. NADA 141-291, Approved by FDA (trilostane) Laura A. Nafe, DVM, MS, Dip- lomate ACVIM (Small Animal Internal Medi- cine), is a clinical instructor in small animal internal medicine at Univer- sity of Wisconsin SVM–Madison. She received her DVM from Uni- versity of Missouri then completed an internship in small animal medi- cine and surgery at North Carolina State University, before completing a residency in small animal internal medicine at University of Missouri.