FLAD rads!

JVIM 2023

January 10, 2025

Hannah Gareis, Lina Hörner-Schmid, Yury Zablotski, Jelena Palić, Silke Hecht, Bianka Schulz

Background
Feline lower airway disease (FLAD), which includes feline asthma and chronic bronchitis, causes inflammation, bronchial obstruction, and clinical symptoms such as coughing and respiratory distress. Radiographic abnormalities are frequently observed in FLAD, yet the relationship between radiographic changes and clinical symptoms remains unclear. This study aimed to evaluate whether radiographic abnormalities improve with treatment and if they correlate with clinical signs.

Methods
This was a prospective observational study involving 24 client-owned cats diagnosed with FLAD between 2018 and 2021. Diagnostic criteria included clinical history, radiographic findings, and bronchoalveolar lavage fluid (BALF) cytology. Each cat underwent a clinical examination, a 12-point clinical scoring system, and a 10-point radiographic score assessment at baseline (day 0) and after 60 days of individualized treatment with anti-inflammatory therapies, including glucocorticoids. The data were statistically analyzed to identify changes and correlations between clinical and radiographic scores.

Results

Radiographic Findings: All cats exhibited bronchial or bronchointerstitial patterns on initial radiographs. Significant improvements in total radiographic scores (median 3 to 2, p=0.01) were observed after treatment, primarily in bronchial (p=0.01) and interstitial patterns (p=0.04).
Clinical Improvements: Total clinical scores improved significantly from baseline (median 5.5 to 1.5, p<0.001), particularly for coughing frequency and respiratory distress.
Correlations: No significant correlation was found between improvements in clinical and radiographic scores. The percentage of neutrophils in BALF moderately correlated with the initial clinical score but not with radiographic findings.

Limitations
The study lacked a standardized treatment protocol, leading to variability in therapeutic approaches. Radiographic evaluation was performed without sedation, potentially compromising imaging quality. Small sample size and absence of repeated BALF analysis at follow-up limited conclusions about inflammatory changes over time.

Conclusions
Significant improvements in clinical and radiographic scores were achieved with individualized treatment, though the improvements in these parameters were not correlated. Repeated radiographic examinations are recommended for monitoring therapeutic response in cats with FLAD, particularly in cases where clinical monitoring is challenging. Further research is needed to explore long-term outcomes and standardize diagnostic and therapeutic protocols.

Lateral (A, C) and ventrodorsal (B, D) thoracic radiographs of a cat, demonstrating improvement in radiographic abnormalities. (A, B)Radiographs at presentation (day0) show a marked generalized bronchial and unstructured interstitial pattern with a focal caudal dorsal alveolar infiltrate(circle) and pulmonary hyperinflation. The total radiographic score was 8. (C, D)On recheck radiographs (day 60),the bronchial and unstructured interstitial pattern are decreased in severity and is now considered moderate. The focal alveolar pattern is no longer visible. Pulmonary hyperinflation persists. The total radiographic score was5. During the radiographic examination, the cat was unsedated, which did not always allow for optimal positioning.

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