Gazette Vet: Cough, Puke, or Heart?

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By John Andersen, DVM

Asthmatic cat.
Asthmatic cat.

Much like taking your car to a mechanic, trying to explain your pets’ noises and symptoms to your veterinarian can be a challenge.

“Rosie has been doing this cough/hack/gag thing lately.”

“I think Snowball is vomiting, but she never brings anything up.”

“Puffy gags when she eats. I think she’s coughing, but maybe she’s about to puke?”

An important part of my job is to constructively steer the questioning to get to the bottom of a problem. I have yet to have a dog or cat explain to me how they’re feeling, so it often takes a bit of detective work. This is definitely the case when trying to differentiate between coughing, vomiting, or difficulty breathing in a cat.

First of all, cats do not “cough up” hairballs; they puke them up. Hairballs are accumulations of hair in the stomach and, if they get large enough, they will block the outflow of the stomach and trigger a vomit reflex. So when your cat “coughs up a hairball,” he is very much retching, and then vomiting and will produce a disgusting hairball along with some stomach fluid. There is typically no coughing involved here.

Coughing is actually a very specific sign that a cat has allergic inflammation in their airways, such as allergic bronchitis or feline asthma. When a cat coughs, it will typically crouch down, stick its neck out, and cough. This is often a dramatic and focused coughing effort, lasting 10 to 20 seconds, vs. a quick, casual cough such as you or I might have.

If you see your cat only occasionally coughing—let’s say once a month–don’t worry, it’s obviously a minor problem. However, if your cat is having several of these coughing spells per week or per day, or if they seem to go on for a long time, you should contact your vet.

Allergic bronchitis can progress to very severe respiratory distress. The problem is that cats don’t tell us when they’re having some of the early signs of difficulty breathing.  Since they don’t go jogging or exert themselves regularly, their cardiopulmonary system rarely gets tested and we have a hard time knowing something is wrong until it’s really wrong. Cats that have allergic bronchitis/asthma typically have a lot of inflammation in their airways and lungs. Eventually they can become clogged with mucus and fluid, leading to a big decrease in their ability to take in oxygen. Typically, these cats need to get started on steroids to reduce the inflammation. Then we can decide on long-term management. Believe it or not, some cats do very well with inhalers! We have to use the masks and chambers like those used for small children, but this can be an effective way of managing this disease process for some cats.

Of course, the cats that come in with asthma and smell like cigarette smoke are probably not going to get better until their owners quit smoking. Things like smoke, perfume, and fragrance in the house are definitely triggers, but for many cats it’s just an allergy to Virginia.

Heart failure is the other tricky diagnosis when cats are having a hard time breathing.  Typically, cats with heart failure don’t cough at all. They simply start having a harder time breathing. These cats typically have an elevated respiratory rate and their breathing is labored. With dogs and cats, we really don’t see heart attacks as in people, but rather congestive heart failure. This is where their heart has become weaker over time until it’s no longer able to pump out the blood it is receiving. This causes a fluid backup, typically in the lungs. Amazingly, cats can lose about 50 percent of their lung function before they really start to show you they are having a hard time breathing. So, just as if your cat coughs a lot, if your cat seems to breathe fast and heavy and is not feeling well, you should have it checked out, especially if it has been previously diagnosed with a heart murmur.

“Midnight” was a cat that was added on as an emergency one evening. Her owners called in a panic saying Midnight was really having a hard time breathing and that she was “open-mouth” breathing (cats always prefer to breath through their nose – breathing with their mouths open is typically bad).

We told them to bring her right in. Unfortunately, the stress of the car ride must have been too much for her. As soon as she got into the exam room, she took her last gasping breath and died. I would love to imagine that this cat was probably showing some signs of difficulty breathing that could have been detected prior to that day, but some cats really don’t.

“Jasper” was a cat who came in for an annual exam. I noted that she was clearly having a hard time breathing. The owner was convinced that it was simply the cat purring–she would typically take deeper breaths when she was purring. However Jasper was clearly not purring and I was able to convince her to take some x-rays.  We were both surprised to see about 70 percent of her lungs filled with fluid! I wasn’t sure if I was dealing with cancer, heart failure, or severe allergic/inflammatory disease and Jasper’s mom was not interested in taking her to a cardiologist for an echocardiogram (ultrasound of the heart – the only true way to assess heart disease). This was very reasonable, as Jasper is 15 years of age. So, I shot from the hip, did my detective work, and treated for everything.  Incredibly, Jasper is alive two years after this event and we still don’t have a specific diagnosis.  I think it’s a combination of heart disease AND allergic disease, but my therapy has worked and mom is happy!

The take-home message is that cats will hide significant illness from you, so if you suspect something is wrong, have her checked out.