My 8 year old is really struggling. We've tried the inhaler, did not work, and he now on 5mg of Prednisolone daily, no longer working. It did at first, but no longer. We've also use an air filter in the main room where he usually stays. This has been going on for a couple of years now and it has become worse over time. He is becoming more lethargic and he does not want to be petted because when he purrs, it sets off the attacks. He seems to have them daily, sometimes multiple times. Regarding our prevention tips, he is at a healthy weight, no stress and the rest, with the exception of the HEPA filter is in place.. no smoke, diffusers, etc.. I could really use some advice. We are not real happy with our vet as the service just seems to be like an assembly line. I'm concerned he's going to die on me at a young age. Thanks for your advice.
Hi Dhannegan, this does sound like a tough situation, because I've encountered few cases where an inhaler was not helping to control asthmatic signs. And usually, when asthma is first diagnosed, it's best to see how well it improves with oral prednisolone first, so you would expect oral pred to still make a difference if switching back to it.
One thing that may help the symptoms is a bronchodilator, like theophylline. This can help open up the airways and provide some relief. This is one that we usually don't start in asthmatic cats early on because you can definitely see tolerance to it over time. But in your cat's case, it may be a good thing to ask your vet about. I wouldn't say we use cough suppressants often in asthmatic cats but in this case, it may also be a consideration to at least help with the symptoms.
Beyond that, it's hard to speculate. Pulmonary fibrosis is rare, but could be occurring. This is where scar tissue forms, replacing normal lung tissue. Chronic inflammation can sometimes lead to fibrotic changes, but fibrotic changes themselves do not respond to steroids, which is why I mention it.
There could also possibly be another process occurring secondary to the inflammation, like a bacterial infection that has developed. Possibly less likely if this poor response to medication has occurred over a longer more progressive timeframe.
Having some x-rays performed, if this hasn't been done recently, and having them sent out to a radiologist (which should be an option your vet could provide) may help provide some information, especially if there are any earlier x-rays to compare them to.
If you're having trouble with your own vet and there is not another primary care vet you feel comfortable seeking out for a second opinion, an internal medicine specialist would be the best resource to seek out. They are usually to be found at larger referral/emergency centers but do see scheduled appointments every day. There is some additional testing that they could help with to look for new or additional causes as well. Your vet may at least be able to provide a name or location locally for an internal medicine specialist if you ask. Otherwise, you may be able to find one locally through an online search in your area.