VETT 212 Respiratory System Notes

Key Terms

Atelectasis: Complete or partial collapse of a lung or a section (lobe) of a

lung.
Asthmas/Small Airway Disease: A condition in which the airways become
inflamed, narrow and swell, and produce extra mucus, which makes it
difficult to breathe.
Cor pulmonale: pulmonary disease that in turn causes cardiac disease
Emphysema: chronic obstructive pulmonary disease (COPD); coalescence of
alveoli, In emphysema, the inner walls of the air sacs weaken and eventually
rupture creating one larger air space instead of many small ones. This
reduces the surface area of the lungs and, in turn, the amount of oxygen that
reaches your bloodstream.
Pneumonia: Inflammation of air sacs in one or both lungs, which may fill
with fluid.
Bronchitis: Inflammation of the lining of bronchial tubes
Pulmonary edema: A condition caused by excess fluid in the lungs.
Dyspnea: difficulty breathing
Tachypnea: abnormally rapid breathing
Bradypnea: abnormally slow breathing rate
Cyanosis: a bluish discoloration of the MM (mucous membranes)/skin
resulting from poor circulation or inadequate oxygenation of the blood.
Hypoxemia: an abnormally low concentration of oxygen in the blood
Hypoxia: deficiency in the amount of oxygen reaching the tissues
Bronchoconstriction: the contraction of smooth muscles surrounding the
small terminal bronchioles deep within the respiratory tree; can be caused by
many different mechanisms.
Nebulization (aerosol therapy): administration of a drug by mist that is
inhaled.
Metered-dose inhaler: MDI aerosolized delivery systems (inhalers) that
have been used in human medicine for decades and starting to be used in
veterinary medicine.
Mucociliary apparatus: mechanism that traps inhaled particles in a mucus
layer and moves it up and out of the respiratory tree.
Antitussive: type of drug that suppresses cough
Inspissated mucus: mucus is dried out.
Downregulation: phenomenon by which the cell begins to remove receptors
from its surface as a means of compensating for the increased stimulation
from the drug. Overtime, the loss of receptors means the cell becomes less
responsive to the drug.
Acetylcholine: neurotransmitter that is normally associated with the
parasympathetic nervous system

Inflammation and migration of inflammatory cells (e.g., neutrophils) cause

mucus to become more sticky or viscous

Stimulation of the larynx produces a more forceful and gagging cough than a
bronchiolar irritation.
Receptors lower in the trachea and in the bronchi respond to chemical and
mechanical irritation or the release of histamine by producing a deep cough
mediated by the cough center

Antitussive

Block cough reflex

Centrally acting: reduces coughing by suppressing the cough center neurons
in the brainstem.
o Example hydrocodone or codeine found in cough syrups
Locally acting: reduces coughing by directly soothing the respiratory mucosal
irritation that is initiating the cough.
o Not used in veterinary medicine
o Example: cough lozenges
Productive cough brings up mucus
o Antitussive should not be used when productive cough is present
Antitussives suppress the coughing mechanism that the body
uses to remove mucus, cellular debris, exudates, etc.
Non-productive cough dry, hacking; w/no significant mucus brought up
o May occur in early stages of infection or inflammation when the
mucous glands lining the respiratory tree have not yet increased
production of mucus
May become productive as disease progresses
o In dehydrated animals the cough is usually nonproductive.

Butorphanol

Opioid - suppress the respiratory center as a side effect/means of

suppressing the cough reflex
Schedule C-IV (lower amounts of narcotic)
Only FDA approved veterinary product for cough.
Analgesic
Depression/sedation
o Fewer respiratory/cardiovascular depression effects compared to
hydrocodone/codeine
Some anorexia/nausea
May have constipation - opioids slow GI motility and decrease intestinal
secretions

Hydrocodone

Potent opioids

o More potent as an antitussive than codeine

o Overdose of the opioid narcotic antitussives can cause respiratory
depression.
Schedule C-III potential for human abuse
Sedation/analgesia
Constipation
May mask pain/clinical signs of other diseases

All products containing codeine are C-II (pure), C-III (acetaminophen+codeine), C-V
(cough/cold preparations)

Dextromethorphan

OTC

o Commonly used w/ acetaminophen = harmful to cats

Weaker antitussive
Abuse METH
Not very effective in veterinary patients.

Mucolytics

Break up, or lyse, mucus and reduce its viscosity so the cilia can more
easily move it out of the respiratory tract
Acetylcysteine: mucolytic; breaks apart sulfhydryl (S-S) bonds
o Can be admin. By nebulization, can cause irritation to respiratory
tree - may require a bronchodilator before use to prevent reflex
bronchoconstriction.
o Also used as IV antidote for acetaminophen toxicosis in cats

Expectorants

Increase the fluidity of mucus by generating liquid secrets by respiratory

tract cells.
Expectorate = to spit
o Increases the amount of fluid moved up from the lower respiratory
tract to a point where it can be spit out
Antitussives should not be used w/ expectorants
Guaifenesin: expectorant; works by stimulating the parasympathetic nervous
system and irritating the gastric lining
o Can cause vomiting
o Can be used as an IV admin. Muscle relaxant for equine

Decongestants

Reduce congestion
Primarily works by causing a vasoconstriction in the nasal mucosa
Alpha 1 receptor that when stimulated causes vasoconstriction and is the
receptor involved with the mechanism of action of decongestants.
Side effect: Increased HR (precaution w/cardiovascular diseases)decongestants are not specific for alpha-1: most have some beta-1 activity

Bronchodilators

Sympathetic nervous system stimulation produces bronchodilation

o Stimulation of the parasympathetic nervous system in the bronchioles
causes bronchoconstriction.
Beta 2: specific receptor that (when stimulated) causes bronchodilation.
Drugs that prolong effects of acetylcholine by inhibiting acteylcholinesterase,
will increase parasympathetic nervous system activity and result in
bronchoconstriction.
Histamine: released by mast cells and causes inflammation and
bronchoconstriction
o Causes bronchoconstriction by stimulating histamine type1 (H1)
receptors on bronchiolar smooth muscle cells.
o Antihistamines only work before the histamine is released.
Antihistamines are competitive antagonists for histamine at the H1
receptors. If bronchoconstriction has occurred, the H1 receptor has
most likely already been stimulated by histamine and other chemical
mediators that stimulate bronchoconstriction. A direct bronchodilator
such as a beta2 agonist drug is needed.
Cats: serotonin causes bronchoconstriction (similar to histamines in
humans); cyproheptadine = serotonin blocker used in feline asthma
Albuterol, terbutaline: use to dilate bronchioles by directly stimulating beta2
receptors.

B-Adrenergic Agonists

These are drugs that stimulate (agonist) B receptors in general

o Because many beta 2 agonist bronchodilators also have some beta1stimulating capacity, an increase HR is common with most Badrenergic agonist bronchodilators.
Can be risky if the heart is already hypoxic due to compromised
respiratory airways and stimulated by beta1 receptor to increase
its contractility
Epinephrine, isoproterenol, and ephedrine = old beta1 and 2 stimulators
Terbutaline and albuterol = newer drugs
o Primarily selective beta2 stimulators
o Produce some stimulation of the heart (especially at first few doses);
degree of tachycardia decreases w/ repeated exposure to the drugs.
Terbutaline also reduces mucus viscosity; allowing the
mucociliary apparatus to work more effectively

o Both are available in oral form and inhalers

Terbutaline is also available in SubQ inject.
B2 agonist drugs can lose their effectiveness as a result of downregulation

Methylxanthines

Stimulate central nervous system

Same drug group as caffeine and theobromine in chocolate
Bronchodilators such as: theophylline and aminophylline
o Aminophylline = 80% theophylline + 20% ethylenediamine salt
The salt facilitates absorption of aminophylline and allows the
drug to be better tolerated by the GI tract
Methylxanthines cause bronchodilation by affecting some of the smooth
muscles cells biochemical factors
o Theophylline: acts on cAMP and directly interferes with calcium
mobilization required for the contractile elements of muscle to connect
and contract; blocking forces muscles to remain in relaxed state.
Toxicity: Tachycardia, nausea, anorexia, vomiting
Aminophylline (and theo-) can interact with a wide variety of other drugs

Corticosteroid

Controversial
Not to be used with respiratory fungal disease
Used in situations w/ acute inflammation (potentially life-threatening)
Stabilizes mast cells (inflammatory cells)
o Decreases the release of potent inflammatory mediators that cause
swelling/edema of the bronchiolar tissues
o Helps stabilize the integrity of capillaries reduces fluid loss in the
tissues
o Stabilizes cellular membranes more than antihistamines.
Cats w/ feline asthma syndrome appear to respond well to corticosteroid
treatment
Horses w/COPD heaves may be treated w/ aerosolized form as part of
treatment.
NSAIDS are not used in respiratory therapy because they block the formation
of prostaglandins to relieve inflammation
o In the lungs prostaglandins play an important role in maintaining
bronchodilation

Diuretics

Remove accumulated fluid from the lungs

Therapeutic dehydration
The fluid of ascites/pulmonary edema is slowly moved into the blood and
then out the body through the kidneys.

Disadvantage: animals tend to dry out the respiratory secretions rendering

the mucociliary apparatus less effective
o Drying out the mucus makes it more sticky and harder for the cilia to
move

Oxygen

Used in animals that are transiently hypoxic

Can be very stressful to some animals, making condition use and can
sometimes precipitate collapse
Oxygen is very dry
o Humidify air to prevent severe drying of the mucous membranes and
mucociliary apparatus.