Dynamic upper airway obstruction secondary to severe feline asthma

A 2 yr old castrated male cat presented to an emergency referral facility for several episodes of gagging, nonproductive coughing, and increased respiratory effort. He was diagnosed with inspiratory stridor and referred to another emergency referral practice for further diagnostics. Three separate, sedated oral examinations, nasal computed tomography (CT), rhinoscopic biopsies, and tracheoscopy showed no structural causes for the cat's stridor. An endotracheal wash was consistent with feline asthma. Blood work showed a peripheral eosinophilia and exposure to Dirofilaria immitis (D. immitis). The feline asthma was treated with albuterol, fluticasone, dexamethasone sodium phosphate, and terbutaline. Despite aggressive therapy for feline asthma, the cat had several episodes of severe inspiratory respiratory distress and stridor secondary to an upper airway obstruction. After 3 days of hospitalization, a temporary tracheostomy was performed and no further episodes of respiratory distress were noted. The tracheostomy tube was removed 3 days later, and the cat was discharged on the fourth day. At a 14 mo follow-up examination, the client reported no further episodes of respiratory distress, coughing, or gagging. To the authors' knowledge, this is the first report of dynamic upper airway obstruction secondary to feline asthma.