Most people have heard the term pneumonia and know it is a serious lung infection. In fact, pneumonia is not a specific term and essentially means inflammation in the deep lung tissues where oxygen is absorbed into the body and waste gases are removed. Pneumonia has the potential to be life-threatening regardless of its cause, and there can be many possible causes. Usually there is an infectious disease at the root (virus, bacteria, fungus, even a worm) but not necessarily. Pneumonia can be caused by inhaling vomited or regurgitated food, inhaling smoke or chemicals, or it could be immune-mediated with no infection at all (eosinophilic infiltration). Bronchitis is a separate condition from pneumonia, and involves inflamed airways of the lung rather than inflammation in the deep lung tissue itself, but pneumonia and bronchitis commonly go together to created what is called bronchopneumonia.
Pneumonia is commonly classified by its original cause:
- Fungal pneumonia
- Viral pneumonia
- Parasitic pneumonia – such as from lungworms or from migration of other worms through the lung.
- Bacterial pneumonia
- Allergic pneumonia – the result of extreme infiltration of the lung by inflammatory cells in the absence of infection.
In most cases of pneumonia there is a bacterial component. Even if not the major cause, it can happen as an opportunistic secondary infection. This means that no matter what started the pneumonia, bacteria have likely joined in. In most cases, managing the bacteria is vital. This article centers on managing bacterial pneumonia, although much applies to pneumonia in general.
When To Suspect Pneumonia
Coughing puppies from the pet store or shelter may have a simple kennel cough (a minor bronchitis) but they are high risk for distemper infection.The diagnosis of pneumonia hinges on the chest radiograph (x-ray) but knowing when to take chest radiographs can be tricky. The veterinarian must put together findings from the history, physical examination, and possibly response to initial therapies to decide if radiographs should be checked.
- Coughing dogs or cats with a fever, listlessness, or appetite loss should definitely be radiographed for pneumonia; though many patients with pneumonia will not have fevers and some will still be deceptively active.
- Coughing dogs with a history of megaesophagus or with a history of symptoms typical of megaesophagus should be radiographed for pneumonia.
- Kittens with severe upper respiratory infections who do not respond to the usual management should be radiographed for pneumonia.
Coughing is the hallmark symptom, though certainly not all coughing pets or even most of them have pneumonia, and many pets with pneumonia – especially cats – hardly cough at all. Bacterial pneumonia does not just happen; it is virtually always caused by something else, so some kind of diagnostics will likely be needed to determine what led to the bacterial pneumonia if it is not readily apparent.
The pneumonia patient may be in one of three states:
- Stable: in other words, eating well and active despite a nasty cough and/or abnormal chest radiographs. These patients can often be treated at home.
- Unstable: poor appetite, inactive, in need of hospitalization.
- Critical: unable to get enough oxygen into their systems. These patients require oxygen therapy and possibly 24-hour care.
The goal is to get the patient stable enough for home treatment as several weeks are needed to fully clear pneumonia. When the patient is eating well, he may be discharged with antibiotic pills, a regimen of physical therapy, and a schedule for re-check radiographs (usually weekly).
The hospitalized patient has the following needs.
Intravenous Fluid Therapy
Coughing may be annoying but it is therapeutic and, when it comes to pneumonia, we want to encourage it, not suppress it. Coughing brings up the pus, mucus, and inflammatory cell products that make our patient sick. If the secretions of the lung are allowed to dry up, the patient will never be able to cough them up. For this reason, IV fluids must be maintained to keep our patient hydrated and keep the respiratory secretions wet.
Antibiotics are given to kill the bacteria, but which antibiotics should be chosen? We need something that will penetrate into the pus and mucus, which many antibiotics cannot do. Often a four-quadrant approach is used that covers bacteria classified as Gram negative and Gram positive as well as those classified as aerobic and anaerobic. This typically involves two antibiotics used in combination to synergize one another and covers almost every possible bacterial organism.
Alternatively, the lungs may be cultured through a procedure called a tracheal wash. This process involves light sedation, which the patient must be stable enough to withstand. Sample fluid from deep in the lung is retrieved for culture. A culture identifies the organism and provides a list of antibiotics that can kill it. If possible, it is best to obtain a culture as a surprising number of resistant bacteria are in the environment and we not only want to confirm our antibiotic choice is appropriate but we do not want to needlessly develop resistant bacteria.
If the patient is sick enough for hospitalization, antibiotics are typically given as injections so as to maximize absorption into the body.
Nebulization is similar to vaporization and involves equipment called a nebulizer. The nebulizer creates a mist of fine fluid droplets that can be combined with antibiotics or airway dilators. Unlike vaporized droplets, though, these droplets are small enough to penetrate down into the lung. (Vaporizers make larger droplets, which mostly penetrate to the sinuses only. They are used to moisten upper airway secretions while nebulizers moisten lower airway secretions.) Nebulized saline or water may carry antibiotics with it, providing an additional source of moisture and antibiotic for the sick lung thus deeply treating the infection.
Light exercise is also helpful in mobilizing the respiratory secretions. The patient should not be over-exerted as lung capacity is not normal but use your judgment as to what level of exercise is tolerated.
In most cases, oxygen therapy is not necessary but when a pneumonia patient simply cannot move enough air, there is no substitute for oxygen. Room air is 20% oxygen. An oxygen cage typically is set to deliver 40% oxygen (higher percentages over the long term are actually toxic to lung cells), and oxygen-delivery hoods are also popular. A patient who requires this level of support is extremely sick.
Once a good appetite is evident, the patient may be discharged for home care. The following tips are recommended as long as the patient is coughing:
- Do not allow prolonged exposure to extreme cold or wet weather. Keep your pet primarily indoors.
- Consider using a vaporizer (or better yet, buy your own nebulizer) for 10 to 15 minute intervals a couple of times daily. If you do not have a vaporizer, leave the pet in the bathroom with the shower on to create a misty vapor. If the bathroom does not get sufficiently misty, a small pet can be confined to a carrier and the vaporizer can be directed into this smaller space.
- Perform coupage at least four times daily and allow light exercise to promote the cough.
- Do not try to suppress the cough with over-the-counter cough suppressants. We want the infected material in the chest to be coughed up.
- Use the antibiotics as directed. Expect several weeks to be required.
- Talk to your veterinarian about when you should return for re-check radiographs.
Pneumonia is a serious infection and several weeks are needed to clear it. Prognosis ultimately depends on what the underlying cause was but, if oxygen therapy isn’t needed, and the cat or dog will eat and drink and take oral medications, many of these infections can be treated long-term at home under your veterinarian’s supervision.